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HIGHLAND HosPiTAaL clealeal
STRONG MEMORIAL HOSPITAL
PATIENT CARE ORDERS FOR
BLOOD TRANSFUSION
SH 598 MR
HT (em): ____W¥ (kg):
‘An Indication must be written for: + All|prn orders:
= Cytotoxic agents, when not being used for treating malignancy
DO NOT USE ABBREVIATIONS: U, 100.0, 0.00, Trallng rer (KO mg),
Lack of leading zero (XX mg), MS, MSO., MgSO., ug. TLW.. AS. AD. AU.
Acetaminophen
Allergies/Sensitivities ‘Adverse Reactions [>= pene TESTER
650 mg PO x1 premed
Diphenhydramine
Date & Time NON-DRUG ORDERS
[ADMIT TO (tending MD and Foor baal 7 ae ale
eye are ee
or
Diagnosis: SRATORETTE STR
(Standing Order [1 One Time Order
Diphenhydramine
25 mg Ww x1 prn (may repeat x 1)
Transfusion reaction/hives
Ti Type and sereen blood
Z Insert peripheral intravenous catheter for blood
transfusion
D Transtuse via central venous catheter
Cy ADMINISTER PREMEDICATIONS WITH EACH TRANSFUSION.
|. PLATELET TRANSFUSION
iTranstuse ____ units random donor platelets
over approximately 45 minutes
Meperidine
OTranstuse Units single donor platelets
over approximately 45 minutes fe Toure FRESTENCT
(DTranstuse Units human leukocyte 25 mg Vv x1 pm
{Transfusion reaction/rigors
antigen (HLA) matched platelets over
‘approximately 45 minutes
Hold for Platelets =
I, RED BLOOD CELL TRANSFUSION
(Transtuse ___ units packed red blood cells,
‘each unit over approximately 2 hours
iTranstuse ____units washed red blood cells.
‘each unit over approximately 2 hours
Discontinue intravenous infusion after transfusion
‘complete
Diitold tor Her >
[1 DISCHARGE PATIENT AFTER TRANSFUSION COMPLETE.
Signature! SRT FSET
Title
SIGN EACH SET OF ORDERS AND INDICATE DATE & TIME