PATIENT CARE POLICY. B. Type & Screen: C. Type & Crossmatch: D. Override Orders:
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1 PATIENT CARE POLICY Subject: PATIENT CARE ADMINISTRATION Title: MINIMUM SURGICAL BLOOD ORDER SCHEDULE 1 of 9 Revision of: 07/10/2007 Policy # NMH PC Version: 1.0 Effective Date: 04/29/2010 Removal Date: I. PURPOSE: II. III. The purpose of this policy is to establish a Minimum Surgical Blood Order Schedule (MSBOS) to assure that blood products will be available for patients undergoing the common surgical procedures that may require such products. MSBOS is a list of selected surgical procedures and the number of units of red cells that will be crossmatched for the surgery. This list is the basis of a system which sets minimum ordering levels for surgical procedures that almost always require blood, and provides an emergency reserve for those procedures that rarely require blood. POLICY: A. Northwestern Memorial Hospital (NMH) has implemented a system to identify surgical procedures that either may or do use blood products. These surgical procedures have been audited for blood use, and recommended orders have been developed for these procedures. These recommended orders make up the MSBOS. Following is a description of the categories that make up the MSBOS. B. Type & Screen: 1. Patient s blood sample is typed for ABO and Rh and an antibody screen is performed on the patient s plasma to determine if there are any irregular red cell antibodies. If the antibody screen is positive the Blood Bank will perform testing to identify the antibody and automatically crossmatch two units of antigen negative blood. 2. Procedures recommended for a Type & Screen are those that have historically used an average of below one unit of red cells per case. C. Type & Crossmatch: 1. Patient s blood sample is typed for ABO and Rh and an antibody screen is performed on the patient s plasma to determine if there are any irregular red cell antibodies. The patient s plasma is then used to crossmatch the appropriate number of units of red cells. 2. Procedures recommended for a Type and Crossmatch are those that have historically used more than 0.5 units of red cells per case. D. Override Orders: The MSBOS system is meant to be guideline, not a rule. There must be an override mechanism for patients who are expected to experience greater than normal blood loss. This override mechanism will allow the physician to order crossmatched blood for a patient who would normally have only a Type & Screen done, or to increase the number of red cell units ordered beyond the recommended number. PERSONS AFFECTED: Surgeons, Anesthesiologists, Surgical Services personnel, Nursing personnel, Blood Bank personnel
2 MINIMUM SURGICAL BLOOD ORDER SCHEDULE 2 of 9 Version: 1.0 IV. PROCEDURE: A. In the event that a patient is scheduled for a surgical procedure that is listed on the MSBOS and does not have current orders for Blood Bank testing, the Pre-admission Nursing Office (PNO), Surgical Services personnel, inpatient unit nursing personnel and Blood Bank personnel are authorized to place the necessary orders for Blood Bank testing. B. The PNO will review the surgical cases scheduled, and if a patient requires Blood Bank testing according to the MSBOS they will place a future order in the Electronic Medical Record (EMR) for the required testing to be activated upon admission. C. Surgical Services personnel in Same Day Surgery will review the patient s surgical procedure for any required Blood Bank testing upon admission. 1. The EMR chart will be reviewed for future orders placed by the PNO. If such orders exist they will be activated and a sample will be collected from the patient and sent to the Blood Bank. 2. If the patient requires Blood Bank testing according to the MSBOS and no orders exist, the Same Day Surgery personnel will place the appropriate order in the HIS, collect a sample from the patient and send the sample to the Blood Bank. D. Inpatient Nursing personnel will review the patient s orders as part of the pre-operative assessment. 1. If the patient is scheduled for a surgical procedure that is listed on the MSBOS, and there are no orders for Blood Bank testing, nursing personnel will place an order for the required Blood Bank testing in the EMR. 2. Nursing personnel will collect a sample from the patient and send it to the Blood Bank. E. Blood Bank personnel review the surgery schedule the day prior to scheduled surgeries. 1. The surgery schedule is annotated with required testing and blood availability for patients on the schedule. 2. In the event that an inpatient is scheduled for a procedure on the MSBOS and there are no current Blood Bank orders, Blood Bank personnel will place the appropriate order and request the unit personnel to draw a sample and send to the Blood Bank. V. RELEVANT REGULATORY REFERENCE: Roback, JD, Technical Manual, 16 th edition, AABB Advancing Transfusion and Cellular Therapies Worldwide, Bethesda, Maryland, VI. POLICY UPDATE SCHEDULE: Every two (2) years VII. CROSS REFERENCES: Patient Care Policy: Blood Administration VIII. APPENDIX:A: Minimum Surgical Blood Order Schedule
3 3 of 9 Division of Cardiac Surgery Adult Congenital Defects (ASD, VSC, Coarctation, PDA, TOF, AV canal, TGV)... 2 CABG... 4 CABG w/ Valve... 4 Cardiac Tumor... 2 Debridement, Sternal Wound... 6 Insertion, Pacemaker... Pericardiectomy... 3 Placement, VAD Repair, Aneurysm... 6 Repair, Ascending/Descending Aortic Arch... 4 Repair, Endovascular AAA/TAA... 2 Repair/Replacement, Valve... 4 Transplant, Heart Division of General Surgery Hemicolectomy, Left, Open... Hemicolectomy, Right, Open... Laparotomy, Exploratory... 2 Laparotomy, Exploratory w/abdominal Wash... 1 Division of GI Endocrine Surgery Cholecystectomy, Open/IOC/CBDE... 2 Heller Myotomy, Laparoscopic... Hemicolectomy, Laparoscopic... Division of GI Endocrine Surgery (cont.) Hemicolectomy, Open (left and right)... Insertion, Tube, Gastrostomy... Laparotomy, Exploratory... Splenectomy, Laparoscopic... 1 Department of Neurological Surgery Ablation, Neuralgia, Trigeminal, w/radiofrequency... 1 Burr Holes, for Drainage, Hematoma, Subdural... Carotid Endarterectomy... Chiari decompression... Clipping, Repair, Aneurysm, Suboccipital... 1 Closure, Wound... Craniotomy, for Aneurysm... 2 Craniotomy, Decompressive... Craniotomy, Fossa, Posterior, Prone Position... Craniotomy, Head Trauma... 2 Craniotomy, Resection of Tumor, Cranial Base... 4 Craniotomy, Resection, Malformation, Arterial Venous... 2 Craniotomy, Resection, Tumor... Craniotomy, w/drainage, Hematoma, Subdural... 3 Cranioplasty... Excision, Mass, Scalp... 1
4 4 of 9 Department of Neurological Surgery (cont.) Fusion, Anterior, Cervical... Fusion, Anterior, Lumbar... 2 Fusion, Anterior, Minimal Access... 1 Fusion, Anterior, Thoracic... 2 Fusion, Anterior/Posterior, Cervical... 2 Fusion, Anterior/Posterior, Minimal Access... 2 Fusion, Anterior/Posterior, Thoracic, Lumbar, Sacral, Multip... 1 Fusion, Anterior/Posterior, Thoracic-Lumbar... 4 Fusion, Posterior, Cervical... 1 Fusion, Posterior, Lumbar... 2 Fusion, Anterior, Minimal Access... 1 Fusion, Anterior/Posterior, Minimal Access... 1 Fusion, Posterior, Minimal Access... Fusion, Posterior, Thoracic-Lumbar... 6 Fusion, Posterior/Anterior, Posterior Thoracic- Lumbar... 3 Fusion, Spine, Laparoscopic... 2 Incision and Drainage, Wound, Spine... Laminectomy, Posterior, Cervical... Laminectomy, w/discectomy... Microvascular decompression... ORIF, Fracture, Odontoid, Posterior... 1 Department of Neurological Surgery (cont.) ORIF, Fracture, Odontoid, Anterior, Open... Placement, Drain, Ventricular, External... 1 Pituitary (transphenoidals)... Pituitary (transphenoidals), skull base... 2 Reconstruction, Flap... 5 Removal, Implant, Spine... Replacement, Cervical Disc... Resection, Tumor, Cord, Spinal... Resection, Tumor, Minimal Access... Revision, Shunt, Ventricular Peritoneal... 2 Stereotactic brain biopsy... Sympathectomy... Department of Obstetrics & Gynecology Caesarean Section, High Risk**... Caesarean Section, Low Risk**... DHOLD Debulking... 4 Ectopic Pregnancy, Ruptured... 2 Ectopic Pregnancy, Unruptured... Exenteration, Total or Partial... 6 Hysterectomy, Abdominal... Hysterectomy, Abdominal w Urethropexy, Retropubic... Hysterectomy, Radical, Abdominal (GyneOnc)... 2
5 5 of 9 Department of Obstetrics & Gynecology (cont.) Hysterectomy, Vaginal... Hysterectomy, w/dissection, Node, Lymph, Pelvic (GyneOnc)... Hysterectomy, w/omentectomy, w/biopsy, Node, Lymph (GyneOnc)... Hysterectomy, Total, Laparoscopic DaVinci... Laparoscopy, Diagnostic (Gyne)... Laparotomy, Exploratory for Reduction, Tumor (GyneOnc)... Laparotomy, Exploratory, TAH and/or BSO w/staging (GyneOnc)... Laparotomy, Exploratory, w/bso (Gyne) Myomectomy... 1 Pelvic Exenteration... 6 Reconstruction, Vaginal... Vulvectomy, Simple... 2 Vulvectomy, w/ Dissection, Groin... 2 Vulvectomy, w/ Reconstruction, Flap... 2 Vulvectomy/Flap Reconstruction... 2 Vulvectomy/Groin Reconstruction... 2 Department of Orthopedics Amputation, AK/BK, Unilateral... 1 Amputation, Arm... 1 Amputation, B/K, Bilateral... 1 Department of Orthopedics (cont.) Amputation, Below, Knee, Unilateral... 1 Application, External Fixator, Pelvis... 2 Arthroplasty, Total, Hip... 2 Arthroplasty, Total, Hip, Bilateral... 2 Arthroplasty, Total, Knee... Arthroplasty, Total, Knee, Bilateral... 1 Arthroplasty, Total, Knee, Unicompartmental... 1 Arthroplasty, Total, Shoulder... Excision, Bone, Heterotrophic, Hip... 2 Fusion, A/P, Lumbar... 2 Fusion, Anterior or Posterior, Cervical... Fusion, Anterior/Posterior, Thoracic-Lumbar... 6 Girdlestone, Hip... 2 Hemiarthroplasty, Hip... 2 Incision and Drainage, Femur, Proximal... 1 Incision and Drainage, Hip... 1 Incision and Drainage/Removal of Implants, Hip... 2 Laminectomy, Posterior, Cervical... 1 Laminoplasty... (ORIF) Open Reduction, Internal Fixation, Fracture, Pelvis... 2 ORIF, Fracture, Femur, Distal or Proximal... 1
6 6 of 9 Department of Orthopedics (cont.) ORIF, Fracture, Pelvis... AO Replacement, Total, Hip, Uncemented... 2 Replacement, Total Hip... 2 Revision, Acetabulum... 2 Revision, Arthroplasty, Total, Hip... 2 Revision, Arthroplasty, Total, Knee... 1 Rodding, Intramedullary, Femur... Sacrectomy... 1 AO Division of Plastic Surgery Abdominoplasty w/ separation of parts... Bypass Graft, Femoral Distal Leg... 2 Dissection, Neck... 4 Flap, Free... 2 Flap, Latissimus Dorsi, Advance... Girdlestone... 2 Mastectomy, Radical, Modified... Mastectomy, w/flap, Pedicle, Tram... Reconstruction, Flap... Separation of parts/hernia repair... Division of Surgical Oncology Cholecystectomy, Open/IOC/CBDE... 2 Esophago-Gastrectomy, w/pullup... 2 Division of Surgical Oncology (cont.) Gastrectomy, Total... 2 Gastrectomy, Partial... Hemicolectomy, Laparoscopic... Hemicolectomy, Open (left and right)... Laparoscopy, w/whipple... 2 Laparotomy, Exploratory... 1 Mastectomy, w/flap, Pedicle, Tram... Procedure, Whipple... 2 Proctocolectomy, w/anastomosis, Ileo-Anal... Proctocolectomy, w/creation, Pouch, Ileo-Anal... 2 Reconstruction, Flap... 1 Resection, Abdominal-Perineal... 2 Resection, Anterior, Low... 2 Resection, Gastric, Oncology... 2 Splenectomy, Laparoscopic... 2 Division of Thoracic Surgery Bronchopleural Fistula Repair... Bronchoscopy, General Anesthesia... Bronchoscopy/Thoracoscopy... Bronchoscopy/Thoracotomy... Decortication... 1 Embolectomy... 2
7 7 of 9 Division of Thoracic Surgery (cont.) Esophagoscopy, General Anesthesia... Esophagectomy... 2 Lobectomy... 2 Lung Biopsy... Lung Volume Reduction... Mediastinal Tumor Resection... 3 Parathyroidectomy... Pleurectomy... 1 Pneumonectomy... 2 Segmental Resection... 1 Thoracoplasty... 2 Thoracotomy... 4 Thymectomy/Sternotomy... 2 Tracheostomy... Division of Transplantation Surgery AV Fistula Lower Extremity... Laparoscopic Assisted Donor Hepatic... 2 Laparotomy, Exploratory... 2 Nephrectomy, Transplant... 2 Resection, Hepatic... Resection, Liver, Laparoscopic... 2 Resection, Right Lobe... 2 Division of Transplantation Surgery (cont.) Donor Nephrectomy... 2 Transplant, Kidney and Pancreas... 2 Transplant, Kidney, Cadaver... 2 Transplant, Kidney, Living... Transplant, Liver and Kidney Transplant, Liver and Small Bowel Transplant, Liver, Cadaver Transplant, Liver, Living Transplant, Pancreas... 2 Department of Urology Cystectomy, Laparoscopic, Davinci Robot... Cystectomy, w/conduit, Ileal... 2 Cystoplasty, Augmentation, Bladder... Cystoscopy, w/resection, Prostate, Transurethral... Dissection, Node, Lymph, Pelvic... Nephrectomy, Partial... 2 Nephrectomy, Partial, Laparoscopic... Nephrectomy, Radical... 2 Nephrectomy, Simple... 2 Nephroureterectomy... 2 Nephroureterectomy, Laparoscopic Davinci Robot.. Prostatectomy, Laparoscopic, Davinci Robot...
8 8 of 9 Department of Urology (cont.) Prostatectomy, Open... Pyeloplasty, Laparoscopic, Davinci Robot... Resection, Prostate, Transurethral... Revision, Conduit, Ileal... Ureteroscopy, w/ Ureteroplasty... Division of Vascular Surgery Amputation, Leg... 1 Bypass Graft, Aorto Femoral... 1 Bypass Graft, Aorto Iliac... 2 Bypass Graft, Artery, Mesenteric... 2 Bypass Graft, Artery, Renal... 2 Bypass Graft, Femoral Distal Leg... 2 Bypass Graft, Femoral-Femoral... 2 Insertion, Filter, Greenfield/Tulip/Optease Femoral-Jugular... Laparotomy, Exploratory... 2 Repair Aneurysm, Thoraco-Abdominal w/pump, Biomedicus... 6 Repair, Aneurysm, Abdominal, Aortic... 3 Repair, Aneurysm, Femoral... 2 Repair, Aneurysm, Thoraco-Abdominal... 6 Repair, Endovascular AAA or AAA/TAA... 2 Thrombectomy... 2 AO KEY 0 No RBC Orders # Type & Cross, # units Type & Screen AO As Ordered DHOLD Draw and Hold
9 MINIMUM SURGICAL BLOOD ORDER SCHEDULE 9 of 9 Version: 1.0 IX. APPROVAL: Responsible Parties: Susan R. Masarik, MBA, MT(ASCP) Manager, NMH Blood Bank Glenn E. Ramsey, MD Medical Director, NMH Blood Bank Reviewers: Surgical Services Committees: Blood Transfusion Committee Approved: February 17, 2010 Patient Care Committee Approved: March 18, 2010 Medical Executive Committee Approved: April 12, 2010 Approval Party: Gary Fennessy Vice President, Northwestern Memorial Hospital Electronic Approval: April 13, 2010 X. REVIEW HISTORY: Revised: 02/01/2010 Revised: 07/17/2007
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