PBM RN

I am wondering if anyone has moved away from using Blood Bands in the Epic Softbank setting for Outpatients? We are currently using the Epic band as the blood band but still requiring the Epic band to be left on between the T&S draw and the return for infusion. Our population is growing and there is not time to always do transfusion the same days in OP. TIA Anne

Welcome to everyone who has joined us. Carrie - We have not figured it out in a true linking either. We do draw a pink top as part of the ED rainbow draw and send to BB for the add on T&S when needed but it is still manual in BB Blackl - The Epic Userweb forum has a pretty consistent list of issue with Epic and Soft. The majority of issues have to do with T&S and ABORH logic, linking test and orders to encounters, giving blood across encounters, documenting MTP, and ensuring every area of the organization has a build if it gives blood products. dpapp820 - I don't get involved in the billing side, but it would seem there is a logic/parameter behind the billing of the same test in X amount of time that is not allowing the repeat test to occur.

We had our historical data imported from our legacy system into Softbank, however we did not import it into Epic. When we are looking at lab results, or using the order logic, to determine if a second verification blood type is needed, it can now only look back to our Epic go live date and not through our entire history of results. It is manual work to determine if a verification specimen is needed.

Kerry BB - We are an Epic/SoftBank facility since October 2016. There is a small group of use on the Epic Userweb. We have moved away from blood bands and to Epic bands except in the areas where the patient is drawn without receiving an Epic band. This occurs in outlying satellite labs. There we use an Epic band.

If you are importing into SCC, are you also importing into your EHR? We are a Epic facility and at go live missed the opportunity before go live to import into Soft and Epic from Sunquest and Meditech. We have now imported into Soft but wish we had done it at go live into Epic. I was not involve in the validation.

We are a System in the Northwest and since going to a standing order at our largest facility, it has helped. However, we also have three small, rural CAH facilities, and the smaller facilities are waiting sometimes 4-5 days to restock O's. We have level 2, 3 and 4 trauma centers in the System and Oncology infusion at three sites. Platelets seem to be the biggest shortage lately. Our oncology population uses most of those. We have not implemented formal rationing but after a couple of very high use days recently, we are going to discuss it late this week. Right now the Providers are asked if the transfusion need is immediate or if it can wait for more product to come and hope for a "gentlemen's agreement" between the providera. If anyone has a formal process to ration that they can share I would appreciate it. We know we use more blood than anyone else in our region, but we also now have blood drives at every hospital site in our System and in the communities we serve. It is very frustrating to know the day could come soon when we don't have the products we need. Platelets are only collected in one site for our region. We have asked the ARC regional board to try to address that.

Carrie, We require two separate draws on any patient without a historical ABORH on file, and we pull a T&S on most OB patients when they are admitted per OB hemorrhage risk. However, we have recently built and add-on for a Blood Bank hold tube that is run in ED as a part of the Rainbow draw. This may be similar. Let me know and we can pass the build along.

We send out whatever is ready first and maintain a 1-1-1 ratio. For us that generally means 2 RBC and 2 FP to begin and then Platelets in the second round of 2 RBC- 2 FP, then 2 RBCs, 2 FP to finish out a 1-1- ratio and then repeat. Cryo on separate order if indicated (Fib <150 or on FibTem.) We keep 2 FP thawed at all times. We are also a Level II Trauma center but have 2-3 times more activations, depending on the month. We have a Trauma Order that includes 2 RBCs and 2 FP if indicated. I would agree that we often do not make it to the platelets either. Evidence supports 1-1-1, but not platelets earlier than that necessarily. If we could support the cost, and use before expiration, we would go to whole blood for the first two coolers of MTP. Unfortunately we cannot justify the doubled cost and wastage.

Thank you all for letting me know you are Epic/Beaker and Softbank too. We continue to have certain frustrations with Epic and SoftBank but so far they seem to be similar to everyone else. Please let me know if you have a solution for any of these that we have not found yet. MTP - still on paper but we can input total volume/product Cryo dosing - 5=1 seems to be a challenge to convey Peds Aliquots - we have figured out how to prepare 2 syringes/pedi-bags per order but not more Moving outpts to an inpat setting to complete a transfusion Documenting units between facilities in our own System when pts are transferred An inpatient report per nurse or care unit of transfusions not stopped and completed, a BPA has been advised against Thank you, Anne

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S, I am not sure I understand this. We have outpatient labs, clinics and care areas where the Epic band is placed when the patient is registered. The band is then scanned either by a handheld device if phlebotomy draws (Rover) or a handheld scanner if Nursing (Symbol is the brand) and the label is created electronically for specimen collection? We converted from Meditech in two of our facilities and we gained functions, not lost. Anne

We are also trying, again, to move our Medical Staff to CMV Safe. How do you educate your Physician/ providers to CMV safe. We have providers ordering CMV Safe when it is no longer needed. Partly because we have to have a acknowledgement by the Provider to switch, but they are worried to switch if they don't know the entire patient history. We are now considering educating the Providers and Physicians and then allowing the Blood Bank to reflex to CMV Safe unless a specific order for CMV negative is placed. How did you make the conversion? Any Provider education resource you are willing to share? Less than 4 mos of age and the amternal indications are the only we have clearly demarcated.I have found several education pieces in the UK and Canada but not the US? Thank you in advance.

WellSky is the Mediware product, right? That is the other BB software we looked at too.

Great we have a good group! I have two recent questions if you don't mind more emails. I know this question has been asked in the larger forum, but specific to Epic/Soft how are you all dealing with John Doe's and the conversion of the record once the patient has a known identity if the T&S was drawn on John Doe? Are you redrawing, running parallel charts until DC, or are you converting at a specific time like 72 hours? Second question - how are you handling gender in the Transgender population? We are considering having birth identity go to SoftBank from Epic instead of legal gender? We are still working out how to express the need for the birth gender at registration for patient safety in a sensitive manner. Thank you, Anne

This is great! There are more of us than i thought! I am a TSO/Blood Management Coordinator for a 9 facility System. We went live on Epic with SoftBank in October 2016. We are still experiencing many of the same issue with functionality that other are and we have added issues due to Softbank.