Purpose Statement

The Whole Blood Usage workflow allows authorized users to document the administration of Whole Blood or other configured blood products from a Med Kit.

The workflow documents patient, incident, provider, authorization, product, and administration information while maintaining an accurate inventory record. Once the transaction is completed, the administered inventory is deducted from the selected Med Kit.

Background Information

A Whole Blood Usage may also be referred to as a Whole Blood administration or medication administration.

The Usage workflow should be started from the Med Kit that contained the administered blood product. Users can document a Usage as a standalone transaction or add related actions, such as receiving replacement inventory or performing a count.

Patient and incident information must currently be entered manually. Planned ePCR integration may allow agencies to link Whole Blood Usage records to patient care records in a future release, but this functionality is not part of the current workflow.

Before beginning, confirm that:

• Whole Blood has been enabled for the agency.
• The blood product has been received into the appropriate Med Kit.
• The user has permission to document Whole Blood Usage.
• Temperature and signature requirements have been configured.
• The patient, incident, provider, and usage information is available.

Required Permissions

Users documenting a Whole Blood administration must have the following permission:

• Whole Blood - Usage

Additional access to the Medications module and the selected Med Kit may also be required based on the agency’s role configuration.

Users who add another action during the same workflow may need the permission associated with that action. For example, receiving replacement inventory requires Whole Blood - Receive/Return, while performing a count requires Whole Blood - Count.

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Step-by-Step Guide

Before You Begin

Use this workflow when:

• Documenting the administration of Whole Blood or Packed Red Blood Cells from a Whole Blood Med Kit.
• Recording patient, provider, and administration details for a completed transfusion.
• Removing administered blood products from Med Kit inventory after a usage.

If replacement inventory is received during the same operational sequence, use Add Action to continue with a Receive Event.

If a sealed Med Kit is opened during the workflow, a Count may be required before the Med Kit can be returned to service.

Initiate Whole Blood Usage

1. Open the Whole Blood Med Kit

• Select the First Due logo.
• Navigate to Medications.
• Select Med Kits.
• Open the appropriate Whole Blood Med Kit.

Whole Blood Med Kits display Blood next to the Med Kit name.

2. Filter the Med Kit to Locate Blood Product (Optional)

When a Med Kit contains multiple blood products, use the available filters to locate the correct inventory. Depending on the available records, users may be able to filter by:

• Medication name
• Lot number
• Serial number
• Blood unit
• Expiration date

3. Start the Usage Workflow

• Select the blood product being administered, if desired.
• Select Usage.

Users may also select Usage first and choose the product later in the workflow.

Enter Patient and Incident Information

1. Enter the Patient Name and Incident Number

Patient and incident records are not currently linked automatically to ePCR records. Enter the information exactly as documented in the agency’s patient care records.

2. Enter the Medical Record Number (MRN) (Optional)

Enter the patient's Medical Record Number (MRN), if available.

The MRN may help agencies associate the Whole Blood Usage Event with the patient's medical record or hospital documentation.

Follow your agency's documentation policies when recording the MRN.

3. Select the Nature

Document the reason for administering whole blood products.

Users can select one of two reasons:

• Medical
• Trauma

This list is not available for customization.

4. Document Blood Products Administered Prior to Arrival

The Prior to Arrival field may be used when blood administration began before the transporting crew assumed care, such as during an inter-facility transfer.

5. Enter a Usage Reason

Document the reason or medical indications for administering whole blood products. 

This can be tied to the Nature or determined by agency protocol. 

This list is not available for customization.

Document Administration Details & Patient Response

1. Enter the Usage Date and Time

Document when the blood was administered.

The current date is highlighted in the calendar.

You can:

• Type the date and time directly into the field.
• Select the date from the calendar.
• Choose the time from the available drop-down menus.

Select the month or year in the calendar to quickly navigate to a different date.

2. Enter the Administering Provider

Select the agency member who administered the blood product.

Only personnel included in the agency roster are available for selection.

If blood administration began prior to EMS arrival, select the Primary Patient Care Provider responsible for the documented Usage Event.

3. Enter the Administering Providers Role or Qualification 

The provider's Role or Qualification does not automatically populate from their personnel record.

Verify appropriate Role or Qualification is entered before continuing to prevent data errors.

This list is not available for customization.

4. Select the Authorization method

Authorization options may include:

• Protocol
• Written order
• Online order
• Physician on scene

This list is not available for customization.

5. Enter the Authorized By Information

Document the individual who authorized the Whole Blood administration, when required.

This field accepts letters, numbers, and special characters and may include information such as:

• Physician name
• Identification number
• Hospital affiliation
• Phone number

Agencies should establish policies defining when this field should be completed and what information should be recorded.

6. Document the Patient Response 

Select the patient’s Response:

• Improved
• Unchanged
• Worse

7. Document any Patient Complications

Available complication options may include no complications or a transfusion reaction such as hypotension or a hemolytic reaction.

This list is not available for customization.

8. Enter the Blood Med Kit Temperature

Record the temperature of the blood product or storage kit at the time of administration, according to your agency's procedures.

The temperature unit and acceptable minimum and maximum values are determined by the agency’s Whole Blood setup. If the entered temperature falls outside the configured range, the system displays a validation warning.

9. Add Notes (Optional)

Enter any additional notes relevant to the Usage Event.

Document Administered Blood Product

1. Add the Administered Blood Product

• Select Add Product.
• Choose the blood product administered from the available inventory in the Med Kit.

2. Review Blood Product Details

Review the displayed product details, including:

• Blood type
• Lot number
• Blood Unit ID
• Expiration date

3. Enter Number of Units Administered

The system will give an error message if attempting to input a Usage Dosage larger than the quantity on hand for that specific Blood Unit ID.

4. Document the Blood Product Temperature

The product temperature may match the administration temperature entered earlier, or a different value may be recorded when the agency tracks the storage-kit temperature and the individual blood-bag temperature separately.

This temperature field will not populate from the temperature input under Administration Information. The same warning validation message may appear for temperature values entered below or above set thresholds.

5. Save Administered Product Information

• Select Save.
• Verify that the correct blood product appears in the Usage list.
• Use the Edit or Delete options to correct a product entry before completing the transaction.
• When multiple products are administered, select Add Product again and repeat the process.

Add Additional Whole Blood Actions (Optional)

1. Select Add Action

After documenting the Usage, select Add Action to continue with another Whole Blood workflow.

• Receive — Document new or replacement Whole Blood inventory being added to the Med Kit.
• Return — Document replacement inventory that must be removed after it is received, such as a unit that fails inspection or is otherwise determined to be unacceptable.
• Count – Verify the Med Kit inventory after the exchange. 
  • For sealed Med Kits, a Count is required to document the new seal number after the kit has been reopened. 
  • For locked Med Kits, complete a Count only if required by your agency's policy.

Multiple actions can be combined into a single Multi-Action Workflow to accurately document the sequence of events.

Refer to the Whole Blood Multi-Action Workflows article for additional information about combining actions.

2. Verify Multi-Action Workflow Prompt

• Review the Multi-Action Workflow confirmation message.
• Select Continue.

The selected action appears with the previous action in the workflow header.

Sign & Finalize Blood Product Usage

1. Select Sign & Finish

When all Usage information has been entered:

• Select Sign & Finish.
• Select the required signer or signers.
• Complete the configured signature validation.
• Select Save.

2. Complete Department Signature Requirements

Signature requirements vary by agency configuration and may include:

• One or more internal users
• Up to four signers
• Signature only
• Signature and PIN
• Profile-prefilled signature
• Outside-organization signer

3. Capture Outside-Organization Signatures (Optional)

If an Outside-Organization Signer is required, enter the requested identifying information before collecting the signature.

4. Verify Blood Products in Med Kits

After the Usage Event is complete, the administered blood products are removed from the selected Med Kit inventory.

The Kit Temperature and 1st Expiring Medication fields are updated based on the most recent Whole Blood Med Kit event.

Complete a Required Count for Sealed Med Kits

If a sealed Whole Blood Med Kit is opened during a Usage Event, the system requires a Count before the Med Kit can be returned to service.

After completing the required signatures for the Usage Event, the system displays a message indicating that a Count is required.

Select OK to acknowledge the message.

If no additional workflow actions are being completed, the application returns to the Med Kits page.

From the Med Kits page:

• Open the applicable Whole Blood Med Kit.
• Select Count.
• Complete the required Count and enter the replacement seal number.

Refer to Performing Whole Blood Med Kit Counts for detailed instructions.

Best Practices

• Start the Usage workflow from the Med Kit that physically contained the administered product.
• Verify the Blood Unit ID, lot number, blood type, and expiration date before selecting the product.
• Enter the patient name and incident number exactly as they appear in the patient care record.
• Record the actual administration date and time, not the time the documentation is completed.
• Confirm the provider, authorization method, and authorizing physician information before finishing the transaction.
• Document the blood temperature at the time of administration.
• Review any out-of-range temperature warning and follow agency policy before completing the record.
• Record the patient response and any complications accurately.
• Add each administered product separately when more than one blood product is used.
• Review all information before selecting Sign & Finish, because the completed Usage removes the product from available inventory.
• Perform a count after the Usage when required by the Med Kit configuration or agency policy.
• Review all Usage information before selecting Add Action. Once another action has been added to the Multi-Action Workflow, previous actions become read-only and cannot be edited.

Troubleshooting & FAQs

Why is the blood product not available in the Usage workflow?

Confirm that the product was received into the selected Med Kit and has not already been used, returned, or otherwise removed from inventory. Also verify that the correct Med Kit was selected.

Why can’t I locate the correct blood unit?

Use the available filters to search by medication name, lot number, serial number, Blood Unit ID, or expiration date. Confirm that the unit was received into the selected Med Kit.

Why do I have to enter the patient and incident information manually?

Whole Blood Usage records are not currently linked automatically to ePCR records. Planned ePCR integration is future functionality.

What should I enter for Prior to Arrival?

Use this field to indicate whether the blood administration began before the documenting crew assumed care, such as during an inter-facility transfer.

Why is a temperature warning displayed?

The entered temperature falls outside the minimum or maximum range configured by the agency. Verify the value and follow agency procedures before completing the transaction.

Can I document more than one blood product in the same Usage?

Yes. Select Add Product for each Whole Blood or Packed Red Blood Cell product administered.

Can I document a Usage and a replacement Receive together?

Yes. Use Add Action to add a Receive event after the Usage. The user must also have the required Receive/Return permission.

Why are multiple signatures required?

The number of signers and validation requirements are controlled by the agency’s Medications signature configuration.

Why do I receive a message that a Count is required after completing a Usage?

If the Med Kit is configured with security seals, opening the kit during a Usage Event requires a Count before the Med Kit can be returned to service. Follow your agency's procedures for completing the required Count.

What happens to inventory after the Usage is completed?

The administered blood product is automatically deducted from the selected Med Kit’s available inventory.