MSBOS1
MSBOS1
MSBOS1
Blood Ordering
Schedules (MSBOSs)
and their use across
the West Midlands
• Background
• Organisational aspects
• Summary MSBOS
• Other recent studies applying similar criteria have concluded that reduced
numbers of patients in their institutions warrant a pre-operative G&S or cross-
match6, 7
Aims of this project
• 67% (10/15)
MSBOSs are up to
date
Organisational aspects
• Number of procedures on each MSBOS: range 17 – 167
Organisational aspects
‘Important to ensure pre-op clinics are ‘Our hospital no longer operates with
using appropriate, consistent ordering’ a defined MBOS. This was phased out
when we moved to electronic issuing’
Blood issued for the Blood issued as per the If no Abs/low Hb then request set
patient as per the request (guided by aside, for ‘issue on demand’
request (guided by MSBOS, different (reliant on electronic issue)
MSBOS) numbers of red cell
units specified if red If Abs/low Hb then blood issued as
cell antibodies per request
• 1. identified)
• 2.
• 3. Issue on demand
40% (6/15) 33% (5/15)
West Midlands Summary MSBOS
• Anticipated challenges:
• Some sites will do more complex cases of the same procedures
• Hard to describe the average: provided min, max and mode
• Unexpected challenges:
• The number of procedures
• Variation in use of sub-categories:
‘colectomy’ or ‘total, hemi, partial, sigmoid colectomy’
• Description of the operation sometimes unclear:
‘hernia repair’, ‘nailing’
• Only a few procedures with no GS specified
West
Midlands
Summary
MSBOS
The most frequent procedures
Freq Min Max Mode
Colectomy (including any of total,
hemi, partial, sigmoid,
Hartmann’s) 14 GS 3 GS
Total hip replacement (THR) 14 0 2 GS
Abdominal perineal resection 13 GS 4 2
Total knee replacement (TKR) 13 GS 2 GS
Cholecystectomy 12 0 GS* GS
THR Revision 12 GS 4 2
Prostatectomy - open 12 GS 3 2
Transurethral resection of prostate
(TURP) 12 GS 2 GS
The procedures with the most
variation
Freq Min Max Mode
Splenectomy
7 GS 6 2
Oesophagectomy
6 GS 6 3
Elective open abdominal aortic
aneurysm repair 7 GS** 6 4
Common procedures that appear
infrequently
Inclusion Order Transfusion rate7
Appendicectomy
14% 0 or GS 0.2%
Haemorrhoidectomy
14% GS 1%
Varicose vein surgery
29% GS 0%
Other comments
• Update the regional email distribution list and have multiple contacts per hospital
• Check descriptions of the surgical procedures in local MSBOSs are clear and
sufficiently detailed
• Consider comparing local ordering requirements with the summary MSBOS and
discussing with your hospital transfusion committee if markedly different
• Future projects:
• Audit of pre-op blood ordering and the number of units actually transfused for
surgical procedures
• Audit clinician awareness of MSBOS and blood ordering pathways in each trust
• Consideration of a list of procedures that could be specified as not even
needing a G&S
Thankyou to the contributing
organisations:
• The Dudley Group NHSFT
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