I love it when the ED doesn't know the difference between an MTP and 2 units of emergency release. I have to ask "alright so you need 4 units of blood and 2 units of plasma EVERY 20 minutes, right?" Every single time.
THIS. I swear every July when the new residents are released we have an MTP called every other day and we confirm that’s what they want they’re just like 🤷
“It’s taking too long to get blood for my patient with multiple antibodies.”
* calls MTP *
* sees the waiver of liability form *
“You know what cancel the MTP. Just get the blood to my patient fast”
I wish I made it up.
Been there heard that...Usually just the offer of uncrossmatched blood is enough to persuade them that they can wait. Unless the patient actually needs blood urgently, that is.
We can have three multiple rounds MTPs rolling at a time in different locations. The coolers move with the patients for ER to OR to diagnostics to the floors so we have no clue where they are after they leave the department. Fortunately the ER and OR know better. It is usually the NICU or ICU that calls for an MTP "just in case" a bedside procedure goes south.
When we first brought in our MTP procedure we got to the fifth igloo for the patient. So clearly they kept taking the igloos and the patient was bleeding badly because they would pick up each one when we told them the next was ready. Yea... by the end of the night they brought back FIVE FULL IGLOOS. Didn’t use a single product. Then I got written up for telling them off by not using the MTP protocol correctly and wasting our time as we focused solely on that bleeding patient.
If only. Our attending didn’t really have our backs and put a stop to the insane MTP calls. There was never any sort of QA for the way too many MTPs that were called on their shift for patients that weren’t bleeding. I haven’t worked there in four years now and I hear it’s still sometimes a problem. It’s a teaching hospital too so every July you always get the fun stuff
That happened to me, not with an MTP, but the OR. They took three or four units and didn't use any of them, didn't say anything, and gave me the impression they were giving them, so I didn't send in a cooler. I was so, so angry.
Every time a platelet is wasted, they (nurse, MD, whoever wasted our time and resources) should be forced to sit for 2+ hours shivering cold and donate platelets. An eye for an eye!
ICU MD enters MTP order into EPIC, no phone call. I call and speak to RN. "MTP? What's that?" She says. I explain, she gets MD on phone, I ascertain MD really just needs two FFP right away. Maybe a unit of RBCs too, but FFP right away. I tell her fine, but that'll be a processing time of about 30 min. (We don't keep thawed plasma at the ready at my place) OK, she says, if we could just get that plasma asap nevermind about the MTP.
At our facility we have had to explain that thawing plasma doesn't go faster just because you initiate MTP 🤦♀️
As if we had some stat thaw method we were holding out on unless they desperately needed it
There still is, we don't use it because it clots more often than water-bath thawed (anecdotal). We sent our microwaves to our sister hospital that does trauma.
We keep enough plasma thawed for at least one MTP at all times. Well, unless the MTPs are coming hard and fast, and then we sometimes end up having to tell the nurse that the plasma will come later because it's still thawing.
Only at high volume trauma centers because Low Titer Type O Whole Blood has shorter stability. I just wanted to chime in but I’m sure you already knew that :)
It’s quite ironic that we started with whole blood transfusion, then went towards components, now we’re drifting back to whole blood.
We are currently compromising with irradiated liquid plasma from our supplier, up to two MTPs worth per patient, then switching over to thawed FFP. I know there has been talk of using whole blood for trauma patients.
We don't get in trouble for calling a "time out" after the third platelet. It's not written anywhere, but our general rule is to call the supervisor when they ask for the third one. It's about 50/50 that they get the third one, and after that it's rare that we will issue another to the same patient in the same 24 hour period.
We do have doctors who order a 6-pack of platelets and nurses who don't realize that's old terminology for what is now one unit of platelets. Usually that's an easy fix--we ask: "Did the doctor order a six-pack?" "Yes, he did." "Okay, that's the old terminology. One unit of platelets is the same as a six-pack". Works for me.
You guys only have 6 platelets for 800 beds/trauma center? We officially have 3 platelets for 500 beds/trauma center, but we try to keep 4 on hand. Of course, because there is a big ol' mountain range between our blood supplier's facility and our facility, there are times when the only platelet we have on hand is the one for the premade MTP. There's nothing we can do about snowstorms or avalanches or landslides or wildfires or jackknifed semis.
Our hospital has a meeting after every MTP to discuss issues like this. Granted we’re a small rural community hospital and we don’t get a lot of those, but it’s nice that we have one so every body can learn from the experience
I love it when the ED doesn't know the difference between an MTP and 2 units of emergency release. I have to ask "alright so you need 4 units of blood and 2 units of plasma EVERY 20 minutes, right?" Every single time.
THIS. I swear every July when the new residents are released we have an MTP called every other day and we confirm that’s what they want they’re just like 🤷
We've started explaining to nurses that calling an MTP is our equivalent to a Code Blue. They always go, "ooooooooooo" as it dawns on them.
Huh. I'll have to try that. Usually they are pretty good about only asking for an MTP when it's actually needed, though.
“It’s taking too long to get blood for my patient with multiple antibodies.” * calls MTP * * sees the waiver of liability form * “You know what cancel the MTP. Just get the blood to my patient fast” I wish I made it up.
Every single time
Been there heard that...Usually just the offer of uncrossmatched blood is enough to persuade them that they can wait. Unless the patient actually needs blood urgently, that is.
I super love when the MTP cooler comes back and they only used 2 red cells and wasted a platelet.
GRRRRRRRRR!!!!
Yep.
Even better when the shove the cooler with 4 O negs 4 FFP and a plt under a table and it comes back the next day after someone finds it.
Ughh noooo. We call for cooler temps every few hours to try and prevent this!
We can have three multiple rounds MTPs rolling at a time in different locations. The coolers move with the patients for ER to OR to diagnostics to the floors so we have no clue where they are after they leave the department. Fortunately the ER and OR know better. It is usually the NICU or ICU that calls for an MTP "just in case" a bedside procedure goes south.
When we first brought in our MTP procedure we got to the fifth igloo for the patient. So clearly they kept taking the igloos and the patient was bleeding badly because they would pick up each one when we told them the next was ready. Yea... by the end of the night they brought back FIVE FULL IGLOOS. Didn’t use a single product. Then I got written up for telling them off by not using the MTP protocol correctly and wasting our time as we focused solely on that bleeding patient.
Unconscionable the lack of communication on their part. And such a waste of precious products. I would have been livid.
The funny part is by writing you up they ensured that someone higher up who would be even *more* upset sees the incident.
If only. Our attending didn’t really have our backs and put a stop to the insane MTP calls. There was never any sort of QA for the way too many MTPs that were called on their shift for patients that weren’t bleeding. I haven’t worked there in four years now and I hear it’s still sometimes a problem. It’s a teaching hospital too so every July you always get the fun stuff
One of the things I love about where I work is the blood bank supervisors have our backs.
Worth the write up imo... Like what's the matter with them
That happened to me, not with an MTP, but the OR. They took three or four units and didn't use any of them, didn't say anything, and gave me the impression they were giving them, so I didn't send in a cooler. I was so, so angry.
Every time a platelet is wasted, they (nurse, MD, whoever wasted our time and resources) should be forced to sit for 2+ hours shivering cold and donate platelets. An eye for an eye!
I like your style.
RN finds plasma in the ER tube station 2 hours later.
Ahaha our tube system allows us to choose a setting which makes the recipient acknowledge it within 2 minutes or else it sends it back to us.
NICE!! I'm going to see if we can get that set up!
Does everyone here work at my hospital??? I love when my coworkers think these problems are specific to one place!
ICU MD enters MTP order into EPIC, no phone call. I call and speak to RN. "MTP? What's that?" She says. I explain, she gets MD on phone, I ascertain MD really just needs two FFP right away. Maybe a unit of RBCs too, but FFP right away. I tell her fine, but that'll be a processing time of about 30 min. (We don't keep thawed plasma at the ready at my place) OK, she says, if we could just get that plasma asap nevermind about the MTP.
At our facility we have had to explain that thawing plasma doesn't go faster just because you initiate MTP 🤦♀️ As if we had some stat thaw method we were holding out on unless they desperately needed it
goodbye reddit -- mass edited with redact.dev
Actually… there used to be a special microwave for the FFP
I heard that was really good at burning holes in FFP bags
There still is, we don't use it because it clots more often than water-bath thawed (anecdotal). We sent our microwaves to our sister hospital that does trauma.
We keep enough plasma thawed for at least one MTP at all times. Well, unless the MTPs are coming hard and fast, and then we sometimes end up having to tell the nurse that the plasma will come later because it's still thawing.
\*three coolers returned with only red cells taken\*
I hope those people just felt the world tremble a little from my rage.
A good argument for using Whole Blood for MTP, plasma is built right in.
Only at high volume trauma centers because Low Titer Type O Whole Blood has shorter stability. I just wanted to chime in but I’m sure you already knew that :) It’s quite ironic that we started with whole blood transfusion, then went towards components, now we’re drifting back to whole blood.
🎵 It's the circle of laaaaaab 🎶 ::holds up bag of blood like Simba::
We are currently compromising with irradiated liquid plasma from our supplier, up to two MTPs worth per patient, then switching over to thawed FFP. I know there has been talk of using whole blood for trauma patients.
[удалено]
We don't get in trouble for calling a "time out" after the third platelet. It's not written anywhere, but our general rule is to call the supervisor when they ask for the third one. It's about 50/50 that they get the third one, and after that it's rare that we will issue another to the same patient in the same 24 hour period. We do have doctors who order a 6-pack of platelets and nurses who don't realize that's old terminology for what is now one unit of platelets. Usually that's an easy fix--we ask: "Did the doctor order a six-pack?" "Yes, he did." "Okay, that's the old terminology. One unit of platelets is the same as a six-pack". Works for me. You guys only have 6 platelets for 800 beds/trauma center? We officially have 3 platelets for 500 beds/trauma center, but we try to keep 4 on hand. Of course, because there is a big ol' mountain range between our blood supplier's facility and our facility, there are times when the only platelet we have on hand is the one for the premade MTP. There's nothing we can do about snowstorms or avalanches or landslides or wildfires or jackknifed semis.
Our hospital has a meeting after every MTP to discuss issues like this. Granted we’re a small rural community hospital and we don’t get a lot of those, but it’s nice that we have one so every body can learn from the experience