IMMERSED IN ANY TYPE OF PHYSIOLOGICAL SOLUTION DURING TRANSPORT
7. The Replant Surgeon will order lab, medications, etc., upon evaluation or upon
discussion with a referring physician. Tetanus prophylaxis and antibiotics are commonly ordered on partial and total amputations.
TRAUMA GUIDELINE
TRAUMA SERVICE X-ray – Trauma Room Profile St. Joseph’s Hospital &
Medical Center PAGE 1 of 1
June 1992 April 2010
ORIGINAL DATE REVISED
PURPOSE: To define basic and extended set of x-rays studies for Level I trauma patients.
GUIDELINES:
1. There will be standard initial trauma x-ray panel for Level I trauma patients. Trauma Profile – Basic (Adult and Pediatric)
CXR (1 view) AP Pelvis (1 view) AP
C-Spine Radiographs (4 views) - AP, lateral, odontoid, swimmers OR
C-spine CT Scan
2. Upon arrival and assessment of the Level I Trauma Patient, the Trauma Surgeon or Trauma Resident will order a Trauma Profile – Basic.
3. The Trauma Surgeon or Trauma Resident will order additional imaging as indicated. 4. The radiology technician on duty and assigned to the trauma team will clarify the x-
TRAUMA GUIDELINE
TRAUMA SERVICE Lab – Trauma Room Profile St. Joseph’s Hospital &
Medical Center PAGE 1 of 2
June 1997 April 2010
ORIGINAL DATE REVISED
PURPOSE: To define basic and expanded trauma room lab profiles for Level I trauma patients.
GUIDELINES:
1. The Trauma Surgeon will order a Basic Trauma Lab Profile on all Level I Trauma Patients. The Expanded Trauma Lab Profile and/or the Obstetric Trauma lab Profile are optional and may be added by the Trauma Surgeon based on the acuity of the patient.
Basic Trauma Lab Expanded Trauma Lab Obstetric Trauma Lab
Hemogram BMP D-Dimer
Type and Screen Amylase Fibrinogen
Blood Alcohol Protime Fibrin Split Products
UA (dip in ED) PTT K-B Stain
Urine Toxicology Urinalysis -Drug Screen (ages 12 and older) Serum HCG (females 10-50 yrs)
*Urine Pregnancy test may be ordered by the physician
2. The Phlebotomist will ask the Trauma Physician if either or both of the optional profiles or any additional single tests are to be ordered.
3. When the Expanded Trauma Lab Profile is ordered, the Phlebotomist will ask the Trauma Physician if a Blood Type and Crossmatch should also be ordered and the number of units requested.
4. After drawing the Level I trauma patient’s blood, Lab Phlebotomist assigned to the Trauma Team will enter the initial trauma profile orders including any initial blood orders, into the computer ordering system.
5. A full set of blood tubes will be drawn on all Level I patients for additional testing as needed. The patient will be blood banded by the Phlebotomist when blood samples are drawn.
6. The Trauma Room RN assigned to the trauma patient will dip urine specimens collected in the trauma room and send the urine for toxicology (drug) screen and complete UA when ordered. If no urine is collected in the trauma room, the admitting floor will be notified, by the Trauma Room RN transporting the patient, to send the first urine collected for urine toxicology – drug screen.
7. Lab technicians will call the Trauma Resident pager with the results of each Level I Trauma patient’s CBC and for critical values immediately after test results are available.
TRAUMA GUIDELINE
TRAUMA SERVICE Emergency Issue of Blood Components St. Joseph’s Hospital & SJHMC Laboratory Guideline Medical Center
PAGE 1 of 4 April 2009
Original Date Policy:
The Blood Bank Department at St. Joseph’s Hospital & Medical Center will issue
appropriate blood components in an emergent situation where the patient’s blood type is not known or compatibility testing has not bee completed.
Purpose:
To assure that the Blood Bank will provide appropriate components in a timely manner when an emergent need for blood exists. This will include using the Laboratory Information
System (Cerner) and manual methods to provide as safe a product as possible for transfusion. Procedure:
1. When there is an urgent need for blood and no time for compatibility testing to be completed, the physician (or his/her designee) must sign the Blood Bank
Downtime/Emergency Release form (XBUS-40A) in order to receive
uncrossmatched blood. The name of the physician requesting uncrossmatched blood must be documented. If the requesting location does not have a form available, offer to tube one up STAT or explain that the nurse can take the responsibility to sign for the physician and this can be done at the issue window. There are two classifications of “uncrossmatched blood”.
a. Uncrossmatched – This will always be blood group “O” and Rh “Neg”, when the blood type of the patient is in doubt. If Rh “Neg” is in short supply or if the request is for a large quantity of units, Rh “Pos” may be supplied. If at all possible, Rh “Neg” will be reserved for females of child bearing age (less than 50 years old) and pediatric patients. Once the specimen from the intended recipient is received and blood typing has been performed, Rh specific blood components will be selected for transfusion. The decision to give Rh incompatible blood components will be up to the discretion of the technologist. Group “O” red blood cells will always be given if the immediate spin crossmatch has not been performed. b. Crossmatch Incomplete – This product is available after blood typing and an immediate–spin crossmatch has been performed. ABO and Rh specific blood products are supplied but testing for unexpected antibodies has not yet been completed. An immediate-spin crossmatch will physically be performed and these units issued.
2. The emergency issue process is initiated after a phone call is received requesting emergency issue of blood or if nursing personnel arrives at the issuance window with
the Emergency release for requesting emergency issue of blood. The requesting location will provide the Blood Bank with the following information:
a) Patient name (Doe name/number, if a trauma situation) b) Medical Record Number (MR#)
c) Gender (assume female if unknown) d) Total number of units needed
e) Requesting physician
f) Requesting location blood is to be delivered to
Blood Bank personnel will record this information on a trauma call sheet and use it to issue the blood components in Cerner. (For blood requests from the trauma room, refer to POL I:4.6 Emergency Issue Units Stored in Trauma Refrigerator).
3. Laboratory Support Services is notified (ext. 64686 of the need for a “trauma runner” to transport the cooler with blood to the requesting location or an overhead page (ext. 1964 is made for a “trauma runner”. Blood is delivered by laboratory personnel only for trauma patients. All other locations must present to the Blood Bank for pick up of the emergency issue blood.
4. Hemo components are issued using the emergency issue procedure. Refer to CERN:5.1 DIS – Emergency Issue in the Cerner Computer Manual.
5. Affix a RED “UNCROSSMATCHED BLOOD” label to each component of group O Rbcs issued prior to completion of an immediate spin crossmatch.
6. Affix a RED “CROSSMATCH COMPLETE” label to each component if the immediate spin crossmatch has been performed by the antibody screen is not yet complete.
7. Affix a YELLOW “ALERT Type specific blood, Non group O patient” label to each component if the unit is a type other than group O and an immediate spin crossmatch has been completed by the antibody screen is still in progress. 8. Obtain a cooler and pack the “blue ice” per the procedure. Refer to POL I: 4.4 Cooler Transport and Storage of Blood Components.
9. Issue the blood components with the trauma runner or with another technologist following the normal issuance policy. Emergency issue will be performed with a maximum of TWO technologists, or one technologist and the person who is
obtaining the blood at the window.
a. The trauma runner will not have the usual “sticker” with patient information for issuance. The information obtained from the phone call, or from the individual at the issuance window requesting uncrossmatched blood, will be substituted.
b. Read the following information out loud to the trauma runner or technologist: • Patient name/DOE name
• MR#
• Patient’s ABO/Rh and Blood Bank ID number (this will be omitted if unit is uncrossmatched and no sample has been received)
• Blood unit identification (BUI) number from the blood product • ABO/Rh from the blood product label
• The unit donor ID number is re-verified. The 2nd person must read back the donor ID number from the compatibility tag to the issuing
technologist.
c. If all the information agrees with the compatibility tag, the person reading the information will affix the compatibility label to the blood component.
10. Place the units into the cooler, according to procedure, complete the cooler tracking log sheet, activate the timer and give the cooler to the trauma runner to transport to the requesting location. In the case of a trauma request, the “trauma runner” is assigned the responsibility of obtaining the signed Emergency Release form from Trauma Room personnel. The Emergency Release form will be required to be presented to Blood Bank staff before the units are released, if the requesting location is other than the trauma room.
11. Red Blood cells that are issued uncrossmatched must be crossmatched with the patient’s sample upon receipt in the Blood Bank. If the immediate spin crossmatch is
incompatible, immediately notify the requesting physician of the incompatibility. Additionally, notify the Laboratory Medical Director (or the Pathologist-on-call). Document notification on the RCO requisition and also include an above-the-line chartable comment in CERNER when answering the XM IS test.
12. After the emergency has stabilized, complete the following items in a timely manner: a. All uncrossmatched or crossmatch incomplete rbcs issued and left the
Blood Bank must be “Crossmatched” in Cerner. It is not necessary to print a compatibility tag when the crossmatch test is verified: enter LPME. b. Before entering the interpretation of the crossmatch for each unit, press the
F11 key (footnote key). Enter the results of the crossmatch and ente the appropriate comment with an above-the-line, chartable comment: UNXM, for blood that was issued uncrossmatched, (include the date and time testing was completed) or XMINC, for blood that was issued after an immediate spin crossmatch was performed but before the antibody screen was completed (also include the date and time testing was completed). c. If units are returned to the Blood Bank, return the units in the computer
and print a new bag tag if they are to remain in the XMATCH status. If not, use the function RDP to release the units back to AVAIL. Remove the patient sticker from the unit. Refer to the RBB procedure in the BB Cerner Manual.
d. File the yellow, NCR copy of the Emergency Release Form in the appropriate binder. Place the white chart copy in the appropriate fo0lder (depending on patient location), in the front office for routing to the appropriate floor. If the patient is deceased, place the chart copy into the Health Records Loose Copies bin, also located in the front office. To the white chart copy add the “Permanent Chart Copy” stamp in RED to the upper left corner.
References:
Technical Manual, American Association of Blood Banks, Bethesda, MD, current edition. Cerner Blood Bank Transfusion User Reference Guide current edition.
TRAUMA GUIDELINE
TRAUMA SERVICE Emergency Issue Units Stored in the Trauma St. Joseph’s Hospital &
Refrigerator Medical Center
SJHMC Laboratory Guideline
PAGE 1 of 3 May 2010
ORIGINAL DATE Policy:
The Blood Bank department at St. Joseph’s Hospital and Medical Center will provide
appropriate blood components to be stored in the Trauma Room Remote Refrigerator for use in an emergent situation where the patient’s blood type is not known or compatibility testing has not been completed.
Purpose:
To assure that the Blood Bank will provide appropriate components in a timely manner when an emergent need for blood exists. This will include using the Laboratory Information
System (Cerner), Trauma room remote refrigerator and manual methods to provide as safe a product as possible for transfusion.
Procedure:
(Procedures in this category are applicable only to blood bank personnel have been deleted – please refer to policy in Blood Bank for complete details).
Notification of intended use:
Trauma room staff will place a call to the Blood Bank when they are going to use the blood in the refrigerator.
Blood bank will obtain the Trauma Refrigerator Log and give the current lock combination to the Trauma Room after verifying the name and badge number of the caller is on the list of trained staff. If the caller is not on the list, ask to speak with the Trauma Clinician on duty. If the Trauma Clinician is not available, issue blood in a cooler. Do not give the lock
Trauma Room staff will provide the following information to the Blood Bank: • Patient name (use DOE # or patient’s actual name if available) • Patient’s medical record number
• Number of units requested • Physician
• Delivery location (if sending blood in a cooler)
• Badge number of person requesting blood (used to issue in computer) • Unit numbers being used from refrigerator
• The doe sticker utilized to get blood out of the refrigerator must be the same sticker used on the blood bank paperwork.
• The nurse who removes the blood from the blood refrigerator must be one of the two licensed staff who check/sign the transfusion paperwork.
Trauma Room staff will remove the required number of units from the refrigerator. They will re-lock the refrigerator. The lock combination must have one number moved in order for it to lock.
Trauma staff will place a patient information label on both sheets of the Emergency Request for Blood Form. They will print the physician’s name on the form and obtain a signature. Trauma staff will place a patient information label on both of the uncrossmatched blood identification bag tags. One tag will be removed. One tag will remain attached to the unit until the transfusion is complete. The completed uncrossmatched blood identification bag tag will be placed in the patient’s chart.
Trauma staff will give the emergency request for blood form, signed by the trauma physician or designee, one copy of each bag tag(s), and the RED “deliver to BB” sheet to the
phlebotomist drawing blood. This will be sent to the Blood Bank along with the patient samples. If the phlebotomist has left the trauma room, all the paperwork will be sent to the laboratory via the tube system from the trauma room tube station.
PROCEDURE NOTES:
Once blood is removed from the trauma refrigerator, it can not be returned to the refrigerator, unless the following occurs:
• Bag tags have not been labeled with a patient generated identification sticker • Greater than 30 minutes have not passed since removal from refrigerator Trauma room staff will place a call to the Blood Bank and inform them the units have not been used. Blood Bank staff will determine if the units can be placed back into the
refrigerator, and if they can, the lock combination will be given to the trauma staff so they can access the refrigerator again. Blood Bank staff will change the lock combination as quickly as possible when blood is returned to the trauma refrigerator.
If the units have been stickered and not used, the blood must be returned to the Blood Bank to have new tags generated. Blood will be returned to the trauma refrigerator as soon as possible.
If the units have been out of the refrigerator for more than 30 minutes, the units will be returned to the Blood Bank and properly disposed of in Cerner and placed into the Biohazard Trash.
Blood will be sent to the trauma room in a cooler when the refrigerator blood has been used. Blood issued in a cooler will remain in the cooler until the units are transfused or returned to the Blood Bank. These units will not be placed into the trauma refrigerator.
Blood in the trauma refrigerator is for patient use in the trauma room or ER CT scan (which is physically located in the trauma room). If the trauma patient is in any other location outside the trauma room, blood will be sent in a transport cooler. The only exception will be emergency room OB patients needing an emergency c-section. These patients will be
transferred to the trauma room for the section but will be indicated in the computer as an ER patient. These patients are allowed use of the blood in the trauma refrigerator.
If the patient is not registered in Cerner when trauma staff calls to inform us of blood usage, the units will be issued in Cerner as soon as the patient is registered. Be sure to use the time the trauma room called (as documented on the trauma orders pad) when issuing.
If the trauma patient requires use of the blood in the refrigerator after the phlebotomist has left, the uncrossmatched request for blood form will be sent to Blood Bank by way of the tube system from the trauma room.
If the trauma patient is being urgently transferred to another location and the blood from the refrigerator has not been given yet, trauma staff will request a cooler to be sent to down. The blood will be placed into the cooler and transported with the patient or if transferred to an ICU, the blood needs to be returned to the Blood Bank to be packed into a cooler.
Once the blood in the trauma refrigerator is used, Blood Bank staff will process two new units of blood to restock the refrigerator, as soon as possible.
During critical shortages of O NEGATIVE red blood cells, the trauma refrigerator will be stocked with O POSITIVE red blood cells. A note will be placed onto the trauma refrigerator stating it is stocked with O POS. When trauma staff calls for the lock combination, Blood Bank staff will request an approximate age of the patient. If the patient is a child or female less than 50 years old, attempts will be made to provide O NEGATIVE blood to the trauma room in a cooler. Blood Bank staff will make the final decision on whether the O POS should be used for the trauma.
REFERENCES:
Technical Manual, American Association of Blood Banks, Bethesda, MD, current edition. Cerner Blood Bank Transfusion User Reference Guide, current edition.
TRAUMA GUIDELINE
TRAUMA SERVICE Blood Component Return to the Blood Bank St. Joseph’s Hospital &