INITIATING RECURRENT TRANSFUSIONS IN OUTPATIENT SETTINGS

Transcription

1 INITIATING RECURRENT TRANSFUSIONS IN OUTPATIENT SETTINGS This guide is to assist in initiating the COMMON Recurrent Packed Red Blood Cells and Platelets PowerPlan. Reviewing the Plan The COMMON Recurrent Packed Red Blood Cells and Platelets plan has 4 phases within it. The phases are: Timing and Parameters, Laboratory, Packed Red Blood Cells, and Platelets. Timing and Parameters Phase The Timing and Parameters Phase will include the ordered timing of transfusions, communication order for blood work, and Conditional If/Then orders containing transfusion parameters. Timing of Infusion The Timing of Infusion order contains the frequency (days, weeks) and duration (weeks, times) of the transfusion. To obtain additional information right-click on the order and select Order Information. P a g e 1

2 The Order Information window will display indicating the frequency, duration, estimated start and stop date of this plan. Orders contained within this recurrent transfusion plan are valid between these dates. Communication Order The Communication Order provides the order for the Laboratory phase to be initiated prior to each transfusion. The timing of the blood work will also be based off the timing of infusion order. Conditional If/Then Orders The Conditional If/Then orders provide the parameters for the blood transfusion. The Packed Red Blood Cells and Platelets phases will be initiated based on these parameters. There may be multiple parameters selected within a single plan. Laboratory Phase The Laboratory phase is defaulted to contain a Group and Screen and Complete Blood Count with Differential. The provider may also have included additional blood work which is required with each visit. All blood work required prior to transfusion will be found within this phase. P a g e 2

3 Packed Red Blood Cells Phase and Platelets Phase All orders directly associated to the patient receiving a transfusion will be found in the Packed Red Blood Cells phase and/or the Platelets phase. Any pre-transfusion medications that are required will be selected in the Medications section by the provider. Important: Transfusion parameters are not located within these phases. The ADULT: Packed Red Blood Cells (PRBC) or ADULT: Platelets (PLT) orders contains Reasons for Transfusion which is information pertinent to the Blood Transfusion Lab only. This information is not to be used as the parameters for transfusion Initiating the Plan On patient arrival check the Timing of Infusion order found in the Timing and Parameters phase to ensure the order is still active by reviewing the start/stop dates. Proceed to the Laboratory phase in the View pane to the lab tests. You must be on the Phase heading level to Initiate that phase. Phase heading levels include: Timing and Parameters (Future), Laboratory (Planned), Packed Red Blood Cells (Planned), and Platelets (Planned). P a g e 3

4 When initiating a phase the Communication type will be Initiate Orderset. Click the button and then click the button for labels to dispatched. Packed Red Blood Cells and Platelets Phases Lab results must be completed prior to initiating the transfusion phases. Check the lab results against the transfusion parameters found in the Conditional If/Then orders in the Timing and Parameters phase. Go to the appropriate BLOOD TRANSFUSION phase and review the orders Ensure that the Number of Units Required field is consistent with the Conditional If/Then transfusion parameters. Modify the number of units as required and select Electronic as the Communication type. P a g e 4

5 Initiate the Packed Red Blood Cell phase as per previous directions. Copying and Initiating on Subsequent Visits When the patient returns for subsequent transfusions the Laboratory, Packed Red Blood Cells and Platelet phases may need to be copied prior to being initiated. Required phases may be in a Completed or Discontinued status. Right-click on the appropriate phase and select Copy from the shortcut menu. Click the button. A new phase will be added to the plan in a Planned State. This phase can now be initiated as per the Initiating the Plan instructions. P a g e 5

6 Recurring visits less than 96 hours apart. If the patient was last transfused less than 96 hours ago the phase may still be in an Initiated status. To copy this phase it must first be discontinued. Right-click on the phase and select Discontinue from the shortcut menu. In the Discontinue Reason drop-down click Order Completed. Enter the ordering physician and select the Communication type of Electronic. Click the button and then click the button. The phase will now be in a Discontinued status and can be copied and reordered as per the Copying and Initiating on Subsequent Visits instructions. P a g e 6

7 Completing the Plan The patient will continue to be transfused until the Stop Date/Time has been reached according to the Timing of Infusion order Information. Once the Stop Date/Time has been reached the Timing and Parameters phase will need to be discontinued to prevent the plan from crossing future encounters. Right-click on the Timing and Parameters (Future) phase. Select Discontinue from the shortcut menu. In the Discontinue Reason drop-down click Order Completed. Important: Do not activate the Timing and Parameters phase. This will alter the ordered Start and Stop Date/Time of the phase. This phase should only be discontinued when the plan in no longer required. Ensure that all phases of the plan are either completed or discontinued. The plan will no longer be available on the patient s next visit. P a g e 7