# Blood Products (Overview)

Note: Providers will be able to order blood products in CPRS after sites install and implement OR*3.0*243 (CPRS GUI v.27), OR*3.0*212, and the VistA Blood Establishment Computer System (VBECS) software.

With the release of CPRS GUI v.27 and patch OR*3.0*212, CPRS will have a new dialog that providers can use to order blood products. The Blood Components and Diagnostic Test Orders dialog has three tabs: Patien t Infor mation, Orders, and Lab Results. Because this dialog is modal, meaning that it stays on top of CPRS, these tabs enable the provider to have the necessary information at the time of ordering.

If the user selects an item under the Order tab's Write Orders pane or from an order menu, the Blood Components and Diagnostic Test Order Form dialog opens to the Patient Information tab. But, if the user selects a quick order that is not an auto-accept quick order or elects to edit or copy an existing order, the dialog will open to the Blood Bank Orders tab.

You can either read this entire section or go to the specific area of interest using the links below:

· VBECS Patient Information tab

· VBECS Blood Bank Orders tab

· VBE CS Lab Test Results tab

The Patient Information Tab

The Patient Information tab displays identifying information for the selected patient (name, social security number, and blood type), along with the following information:

· Lab Specimen - The Lab Specimen ID number and the expiration date for the specimen taken from the patient for diagnostic tests, such as type and screen. The expiration is 3 days from the time the specimen was accessioned. 3 days is a default that sites can change using a CPRS parameter.

· Antibodies Identified - Any antibodies identified in the type and screen are displayed here.

· Transfusion Requirements - VBECS provides any necessary instructions or needs for transfusion display here.

· Transfusion Reactions - Any reactions the patient had during a transfusion are shown here.

· Available Units

o Unit ID - The blood bank number assigned to the unit.

o Component - This shows the type of component.

o Status - There are 4 statuses:

· Assigned - A unit identified for a patient, but has not been crossmatched.

· Crossmatched - The unit has been designated as typed and crossed.

· Autologous - The unit is the patient blood that was previously donated for the patient’s use.

· Directed - This unit was donated with the intention that it would be given to this patient.

o Expiration Date - This date represents when the unit is no longer good.

o Division - The name of the division where the blood component is located.

Links to items in this topic:

· VBECS Patient Information tab

· VBECS Blood Bank Orders tab

· VBECS Lab Test Results tab

· Back to the top

The Blood Bank Orders Tab

On the Blood Bank Orders tab, providers can place orders for blood components and diagnostic tests that need to be done before the components can be given to the patient. As with many types of orders, the user can create personal quick orders for blood com ponents and tests the user frequently orders.

On this dialog, the user specifies:

· Blood Components – The list of items comes from CPRS from a parameter and shows what blood products can be offered. Items might include:

o Red blood cells

o Fresh frozen plasma

o Platelets

o Cryoprecipitate

o Whole blood

o Other

· Modifiers - The modifiers are controlled by a parameter that is set at each site. It might include things such as washed, irradiated, etc.

· For All Components--Date/Time Wanted* - The date and time when ALL blood components for this order should be ready that enables the user to order the blood for a future date, such as for a surgery.

· Urgency* - This list comes from CPRS and might include items such as Routine, Pre-Op, ASAP, or STAT. The urgency applies to all components and diagnostic tests listed under the Selected Components and Tests area.

· Surgery (conditional) - If the user selects Pre-Op for the urgency, the Surgery field becomes active and the provider can select the surgery to be performed from the drop-down list or enter it manually. If the surgery is not listed, the provider may enter a surgery (the field accepts free-text) because this is not a comprehensive list of surgeries.

· Reason for Request* - The user can choose a reason from the drop-down list (sites define items in the list using a parameter) or type a free-text entry. This reason for request applies to the entire order.

· Comment* - If the provider has information that should be passed on with the order, the comments can be added in this field. The comments apply to the entire order. (This is a required field if the user selects the Blood Component "Other".)

· Diagnostic Tests - The items on this list comes from CPRS and enable the provider to request specific tests associated with blood component ordering. When the user selects this item, the fields under blood components are then cleared. The user can see those items again by highlighting the blood component under Selected Blood Components and Tests.

· Collection Type* - The collection type determines how the specimen should be collected: Lab collect, Ward collect, Send patient to Lab, or Immediate collect, for example.

· Collection Date/Time * - The date and time enable the user to specify when the sample should be collected.

Items required to order each blood component or diagnostic test are marked with an asterisk (*) after the name of the field, such as Reason for Request*.

How the Blood Orders Tab Works

Ordering blood components and diagnostic tests is different than ordering other items in CPRS because users can place orders for several different blood components and tests in one dialog at the same time. For example, if a user wanted to order platelets, whole blood, and a type and screen, the user could do all of that in the dialog at the same time. To accommodate ordering of multiple items, the Blood Bank Orders tab creates a list of items ordered under the Selected Components and Test area.

When the user selects a blood component from the Blood Component drop-down list, the item is immediately added to the Selected Components and Tests area (think of this as a shopping cart like some web sites use). The user can then detail the necessary information for that component, such as quantity, modifiers, the urgency and reason for request, etc.

Note: As the name implies the For All Components--Date/Time Wanted applies to all blood components. It is NOT possible to set a different time for individual blood components in the order.

When the user puts in data for these fields, these values will stay in when the user switches between components or tests. Because the values that apply to the entire order continue to display, the user can select it ems and enter the other values for each component and diagnostic test.

Alternatively, the user could select all of the components and tests first, then select each item under the Selected Components and Tests list and fill in each individually. To edit any item, the user must either fill in the fields as soon as the item is selected from the drop-down list, or highlight the item in the Selected Components and Tests list and then edit the fields.

Under the Selected Components and Test area, the user can also remove a single item by selecting the item and selecting the Remove button, or if the user wants to remove all the items, the user can select the Remove All button.

Based on the set up, CPRS may prompt the user that the selected blood component requires a specific diagnostic test. For example, if the user selects whole blood and the patient does not have a Type and Screen within the last 3 days (3 days is a default, clinical coordinators at the sites can set the number of days based on local policy), the user will see a message under the diagnostic test drop-down box stating that a Type and Screen is required.

As the user enters orders, the order text is built in the field at the bottom of the dialog. Thus, the user should review this area to ensure that all necessary information is included with each item.

To help the user edit the values that go along with each component and test, several values that apply to the entire order now remain visible:

· For all components--Date/Time Wanted

· diagnostic test Collection Type

· diagnostic test Collection Date/Time

· Comments

· Reason for Request

· Urgency

The date wanted can be set for all blood components and also defaults for the diagnostic tests. Modifiers apply only to blood components.

Also, when the user moves the f ocus to either the Blood Components or the Diagnostic Tests area, values for the last item entered in that area display so that user can edit the values. If the user wants to edit another item, the user must select it from the Selected Components and Test area first.

Configuring the VBECS Dialog

Each site can configure some areas of the Blood Component and Diagnostic Test Order Form dialog. A CPRS parameter lets sites decide if the Blood Component area or the Diagnostic Test area is shown on the left of the dialog. The other area then displays next to the first area on the right of the dialog.

Sites can also customize the order of the following lists:

· The Blood Components

· The Diagnostic Tests

· The Reason for Request

The order of items in these lists is controlled by parameters set by Clinical Application Coordinators (CACs). CACs can therefore put the most used items earlier in the list.

Links to items in this topic:

· VBECS Patient Information tab

· VBECS Blood Bank Orders tab

· VBECS Lab Test Results tab

· Back to the top

The Lab Results Tab

The Lab Results tab enables clinicians to view the lab results associated with the selected blood compon ent. If there are lab results in the system when the user selects a blood component, the tab name changes to Lab Results Available. This tab then shows the results from the lab tests designated in VBECS by the administrator at each site. So, for example, t he user might see different lab test results based on whether the user selected whole blood or platelets.

Note: The most recent results are displayed, but these results may be from test done some time in the past. Users should use good judgment as to whether they should order a new test.

Links to items in this topic:

· VBECS Patient Information tab

· VBECS Blood Bank Orders tab

· VBECS Lab Test Results tab

· Back to the top

Related Topics

How to Write Orders

Ordering Blood Components and Diagnostic Tests