Jessica A
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Posts posted by Jessica A
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2 hours ago, Likewine99 said:
If you have the IT department do the validation make sure they are blood bankers, or at least understand exactly what you are validating. I've done this twice in my career. I took several of my frequent flyers that had multiple antibodies, some of our patients that had previous antibodies but currently showed negative screens and those patients with "odd special needs" i.e. things outside the usual antibody problems.
Like Banker Girl I did 10% of the total converted records, yes that is a lot of pts in a big data base, but as you do your validation you will get comfortable with the converted data in the new system.
We also did more than one pass of converted data. Checked the first vendor extract, found some "misses", they re-coded the extract, checked the second pass, etc. By the time we made it to go live the data was clean. We did have to have some "comments" in the new system as it's hard to map like for like especially with special instruction.
Key point is to make sure you have good documentation for when your assessors and inspectors show up. I've been asked on more than one occasion to provide the data conversion validation documentation.
Good luck and have fun
The IT department is only responsible for creating the exports (50+ different export files), it is 100% my job as the supervisor to make sure the format is working in our archive. When it didn't work I reported the issue then the IT folks worked with the vendor to figure out how to format the files to get them to display correctly. I'm extremely particular and wouldn't have trusted any one else to understand or get it right anyway. It sounds like a small part but we have decided we are doing about 1% of our 52000+ patients. Plus a percent of unit and RhoGAM histories as well. But we are hand picking to make sure all patients with special requirements are checked and at least 1 example of every possible antigen and antibody is checked to make sure the translation is correct, plus a large portion of patient with comments.
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41 minutes ago, PBM RN said:
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.
I have not heard of importing into EPIC. What sorts of data would get imported into EPIC? We have an archive patient chart that everything from the Cerner chart went in to so I can see the old transfusion records and any test results on the patients but that is it. Our reporting team dropped the ball on getting the files tested to see if the format was correct for SoftBSA in a timely manner so we have been working on getting the file formats correct since July. They are finally correct after about a thousand iterations. I've been checking pieces and examples the entire time but we are starting the official validation of BSA this week. This includes all BB tests, specimen IDs, patient demographics, blood types, antigens, antibodies, special requirements, comments, plus all RhoGAM and unit histories. If that goes well we copy our patient database from SoftBank and will overlay BSA with the copy, revalidate the patients or a portion of the patients. Then when we are satisfied this is correct we will take SoftBank LIVE down to import the BSA data and spot check a portion of the patients to make sure there wasn't a snafu in the import process, not so much the data itself.
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14 hours ago, Ensis01 said:
The IT department and software company should be jointly setting up and validating. You explain in excruciating detail to your IT people what you need and they make sure it can / will be done. Find out how imported history will be displayed and will there be a difference between imported and entered data. For example will special needs be imported as a comment or as a hard stop. Will comments have a maximum number of characters per comment or in total. ABO subgroups etc.
What I am saying is; more important than percentages (as most are straight forward) find a variety of unusual patient histories and check with IT and the software rep to ensure their history will be imported to your satisfaction. Once imported you are stuck.
There is a strong argument not to import. This will allow a clean database that you know is consistent and accurate. When you do a history search you search the old system and put a comment in the new system saying search done, information transcribed, date and initials of who did the search. If you are cautious you cold set up a policy of two history searches and the old system then need not be searched.
I should have specified that the historical data was entered into our archive to my exacting specifics and I have been mini-validating all along because it was an extremely complicated import that took our reporting team months to iron out all the information. All of the historical data will live in SoftBSA with the patient data eventually importing in to SoftBank. Unfortunately, my generalist staff only works in BB a couple of days per month and we have already had a near miss due to the history not being in our live system so import of patient data is crucial. They had trouble transcribing a complicated patient from our old Cerner system into SoftBank while the historical data was getting sorted out. Right now I'm about to officially validate BSA prior to them copying our live database and loading the patient information in the copy of the SoftBank database which will also have to be validated. Right now I'm inclined to check the ABO/Rh history on 500 patients which is about 1%, check 100 patients with antibody or antigen histories and all patients with special instructions such as irradiation or comments.
We are importing unit and rhogam data as well and I think it would be a good idea to check at least a few of every product type we have ever used in the past decade with a heavy emphasis on our common products. All of this is necessary because we don't have a contract to maintain access to our old system and the files that IT will have as raw data from our old system will be inaccessible and not interpret-able by lab staff. Tests will also be available in my archive but we can also get those on the archived patient chart in an easier format so I don't see the point in spending a ton of time validating this other than making sure a handful match for each test.
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We are importing all of our historical blood bank data from Cerner into SCC SoftBSA/SoftBank, most importantly our patient blood types, antibodies, antigens, comments and special requirements. We are trying to figure out what number or percentage of patient histories to validate. Any input? I can't find a CAP reg related to this.
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joining, went live with EPIC/SCC in July 2019
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4 minutes ago, David Saikin said:
Depending on how many MTPs you deal w it may be prudent to have a FP thawed at all times. I worked in a very busy trauma center. We always had a Jumbo fp (AB or A) thawed and ready to go out. Since it was kept in the refrig it was already at temp. I just validated some MaxQ boxes. But I did not get the MTP box as I do not store plts in house.
I wish we were at least big enough to keep platelets all the time but we also don't keep platelets in house unless we have a scheduled open heart or an actual transfusion order. We do maybe 1 MTP every other month so we can't keep thawed FFP for that reason. Did you get the regular maxQ coolers that are designed to hold I think 2 or 4 units? I'm really concerned about how easy it is to accidentally freeze the red cells in our current coolers.
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22 minutes ago, AMcCord said:
We are using the Credo ProMed line rather than the ones that look like the Igloo cooler. The ProMed inserts for the smaller coolers are cubes w/ a lid (TIC). The outer nylon shell has a vacuum sealed dense foam insert w/ lid that the TIC fits into. The entire TIC goes in the refrig for the red cell transporter. The entire cube for the Plt transporter sits on a shelf at room temp (monitored). We also have large coolers in the ProMed line that have individual liquid filled 'slabs' that build the TIC cube in the cooler (separate pieces for 4 sides, top and bottom).
We chose the ProMed line because the nylon shells have shoulder straps plus a short strap over the lid to make carrying them easier. We send quite a lot of blood product across our campus to a cancer center and wanted to find something that would work well for them. They are also OK for the ED and MTPs on the floors. That nylon outer shell would not work well for surgery - can't be cleaned as well/easily as a hard shell on the Igloo type. (We don't send blood products to the OR in coolers.) I suspect the Credo igloo type cooler would hold temp well. It looks like they have an insert similar to the ProMed line, but we haven't tried one of theirs. Our Igloo types were not Credos.
Replacement inserts are available. The vacuum sealed inserts have an expiration date, so they must be replaced every 4 (?) years. We ordered ours from Pelican BioThermal. I clicked on the 'contact us' button on their website and someone in sales got back to me with the information I needed. Credo coolers are expensive. I believe that the small one (holds 2 RC) cost us over $400 in 2017. We ordered an extra TIC for each cooler, so once we get a cooler back from the cancer center we can sanitize the cooler, swap TICs and send out blood for another patient. The nylon shells are still holding up very well and I haven't yet needed to replace a TIC or insert because of damage or temp failures.
If/when I add more coolers, I am going to look at MaxQ. They prices have been lower than Credo in the past. I've been in contact with their sales people directly. They are coming out with some combo coolers that look great for MTPs - wheels and a separate platelet pouch. They have a very basic cooler that we might use when we transfer red cells with patients that was less than $200 when I priced it last. If one of those didn't make its way home we wouldn't be out as much money as if we lost a Credo cooler. MaxQ coolers also have an exterior that would be easy to clean.
Thank you for the info. I think I'll contact the company to get a quote on their hard side coolers or see if they will sell me the inserts separately. I tried the MaxQ MTP cooler and couldn't get it to validate. The FFP went in fairly warm and that side never came down to 1-6C. The red cells quickly went up above 1-6C. We don't keep thawed FFP on the shelf so anything for our massives is thawed at time of order and doesn't get a chance to get refrigerated before it goes out. I would think it would work great if the FFP starts at closer to 10C. I was super bummed that I couldn't get it to work. The only option would be to try to convince my techs to pull the FFP from the bath sooner and I don't think I would get great compliance.
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9 minutes ago, AMcCord said:
We didn't have very good luck with our Igloo coolers holding temp. so we always used plenty of wet ice. Could have been the specific cooler type that was the problem, however.
Our current coolers are Credo and they use cooler inserts (with different liquids inside) that are specific for the temp maintained. The inserts for red cells are conditioned in the refrigerator. The inserts for platelets are conditioned at 22C. As long as someone doesn't leave the lids of the coolers open and remove the tops of the inserts, they will hold temp for 8 hours easily. (When I validate them I let the data logger run for 24 hours and they are all still holding temps at the end of that time.)
Are you using the ones that look just like an igloo cooler? I'm wondering if the cooler is basically the same but the little containment unit being the difference maker. Do they sell replacement inserts? Can you give me the specific product you are using and if you don't mind, how much each one cost for you? Did you by them from the company directly or was there a third party medical vendor you used?
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Are you using freezer gel packs, freezer blocks, bags of melting ice or something else in your igloo plymate coolers?
I'm having issues with 2 gel packs dropping the units below freezing and 1 not getting the bags below 6C. I really don't want to switch to actual ice for many reasons.
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QuoteOn 11/5/2018 at 9:20 AM, R1R2 said:
I would think that the freshest irradiated or unirradiated unit you have on hand would be suitable for a baby in a true emergency. A full unit could be issued and tranfusionist would use what they needed and discard. This plan should be discussed with all involved before it happens to make sure everyone is OK with this. Perhaps a procedure should be written as well.
This is what I would tell them to do if it came to it. I think I'll update our procedure and start by saying "in a true emergency" we'll use our freshest O Neg and give it as uncrossmatched. We already have the procedure written that they will take the whole unit and give what they need, discarding the rest. We of course had a situation recently where a large maternal fetal hemorrhage nearly killed the baby and someone said "we don't do that here" (the RN I believe) when the MD asked about transfusing before lifelining. So as part of the CAPA I'm having to look at our policies which admittedly need updating.
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So my hospital hasn't transfused a pediatric patient, let alone neonate, in at least a decade. We don't stock splitting or syringe supplies and we don't keep an irradiated fresh pedi unit either. The rational is that the nursing staff and lab staff lack the experience to do such transfusions and by the time everyone read their procedures the baby could be lifelined to a facility with a NICU (we have a helicopter available 24/7). Even by road during traffic the drive would only be about an hour. Our blood supplier is about an hour away (2 if they take their time getting it ready during rush hour) so again, it is faster to transfer the baby than wait for the blood to arrive and prepare it.
We have a special care nursery but it's really not that "special", I've never actually seen a baby with worse than some mild breathing or blood sugar issues stay here. What does everyone else without a proper NICU do for the extremely rare pediatric patient?
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On 7/7/2018 at 1:38 PM, Malcolm Needs said:
You are by no means alone John, but (I THINK) most of these acronyms are to do with Information Technology (IT) than actual blood confusion!
blood confusion! Ha ha, that's probably a typo but it is definitely how I feel about our LIS/BBIS conversion! The number of acronyms used by EPIC are in the hundreds, it is overwhelming. And every employee in the company appears to be under the age of 28 so they have plenty of mental resources available to remember them all whereas all of us in the hospital are staring in wide eyed fear.
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1 hour ago, applejw said:
We are using both Epic and Softbank which, for the purpose of MTP , do not play well together. OR uses the MTP workflow which does allow realtime documentation for units that are selected to the actual patient -where we run into trouble is the units that are emergency released or in the first MTP cooler. These units are pre-selected to a 'dummy' patient and Epic will not allow unit scanning for the particular patient and gives the user a scanning error of something along the lines of "this unit is not intended for the patient" - always great to see on the transfusion end during a high-stress chaotic event where there is massive blood loss.
We send paper transfusion records with all MTP units so that they can be scanned into Epic later. The OR flowsheet for MTP is fairly good for units after the first cooler once you have an experienced user doing the transfusion documentation. We have developed a similar flowsheet for emergency released red cells and plasma for use in the ER - could be expanded to other locations but it works differently than BPAM and requires user education.
We are going to Softbank and I used Soft over a decade ago at another facility. We never used a dummy patient for our emergency release. I can't remember the exact process now, but we always released the units to the real patient. Maybe you can tweak your emergency release process to make things easier for the first MTP cooler?
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On 7/5/2018 at 9:01 AM, AMcCord said:
There is an emergency transfusion option in Epic. We are not using it yet, but I've seen a demo - our mother ship for Epic is still playing with that. It is pretty slick. It allows the patient and the unit to be scanned, then quick notes for the infusion. These entries can be added to very easily as the transfusion is continued and finished. Info can be added later if something is missed or there isn't time when it's happening. It looked like it would be just as fast or faster than hand written notes when the trauma coordinator was showing it to me. The sticking point right now is that we don't have a blood bank information system, so chances are good that some or all of the units that are emergency released are not going to be in Epic. When we get caught up, if we get caught up, the units will be there. That takes time as everything is a manual entry at this point. Nursing staff just doesn't get that. Once we bring up SafeTrace Tx, hopefully by the end of the year, we'll have emergency release through the system and everything will be in Epic. I hope we can implement that piece in Epic.
It was my understanding that the emergency transfusion option was really just an Is/Os flow sheet that doesn't perform the patient/unit safety check that BPAM performs. How in the world are you surviving without a BBIS? Can you even use BPAM without any information crossing back to EPIC?
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We are going to Softbank and I really wish hospital administration would seriously consider purchasing the SoftIDTX module which works similar to BPAM but WAY better. For example, it looks a lot more like the anesthesia BPAM module than the nursing BPAM module. You can see every unit available for the patient on one screen and simply click "start" or "stop" when you begin and end the transfusion. It does a better job of prompting for vitals as well. It would work fabulously well in an MTP situation.
For those of you who don't use BBID armbands, how do you meet the CAP requirement for a secondary method of patient identification? I get that rover does the ID at the time of draw and BPAM does it at the time of transfusion but do we just get a pass for MTP situations? As I brought up with EPIC and nursing, it is not out of the realm of possibility to have 2 MTPs going at the same time who are different blood types. This terrifies me.
For those that DO use BBID armbands, how do you get EPIC to acknowledge the armband as a patient identifier? Can they add a field in BPAM to scan or type the armband number and bounce it back to something? I feel like we need to keep the BBID armband for MTP situations since I will have literally nothing else to make sure the correct patient gets the blood.
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Does anyone have experience with MTP documentation in EPIC with or without concurrently documenting in BPAM? My facility is going to EPIC and we'd like to get rid of the BB armbands since Rover and BPAM will allow us the necessary patient identification steps but I am told that MTP is not usually documented in real time which means there would be no scanning of the patient armband prior to transfusion. I would be fine with this if we were not issuing type specific blood and sticking with group O RBCs/AB or A FFP but we routinely give type specific in our MTP protocol. It makes me very nervous to think about crossmatched blood not being appropriately checked against the patient.
We have been told to document MTP on paper which to me seems like it would be more labor intensive than scanning the units. We are also eliminated paper transfusion records with the exception of computer downtimes and MTP. To me it seems like the RNs would be less competent using a form that they rarely see (we do MTP once a quarter or less) than using the computer which they will become accustomed to quickly. Plus we are going to a new BBIS so our paper transfusion records will look completely different than they do today.
Is it weird to any other EPIC users that EPIC suggests going back to the middle ages for the most critical transfusions? In general I am completely unhappy with BPAM and how immature and unfinished it feels despite being released several years ago. I'm very tempted to continue to use paper transfusion records until they can figure out how to make it better.
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I want to implement Verax but I'm waiting until we change computer systems in 2019 because our current system does not work for us at all. That will help a lot. I've only been at my hospital for about 6 months and we are not currently inspected by the FDA but I'm still trying to get us cleaned up to my standards before I invite them in. The closest hospitals don't have any sort of critical care or cancer center so they will rarely need a platelet. I have requested that they call us before the blood supplier since the are even farther from the blood center than we are. The one hospital that we could pawn them off on wasn't interested when I suggested it. We discard an average of 50-60 per year. As a former platelet donor, I would be devastated to know that the units I spent hours donating every few weeks were thrown out.
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We do not routinely stock apheresis platelets because we only give 10-15 per month. We perform a variable number of CABG procedures in our cardiovascular OR. Our current physicians require 2 platelets on hold in case they are needed but they rarely get used by the patient. If we are lucky we can use the same 2 platelets for multiple CABG procedures in a week or use them on our other inpatients but mostly they get discarded. We are at least an hour from our blood supplier so by the time we place a STAT order it usually takes 2-3 to get the product.
My question is for other facilities that don't stock platelets but do perform CABGs. How many units of apheresis platelets do your surgeons want on hold? Do you end up discarding them? I'm wondering if I can convince my surgeons to only request 1 and if they need to use it, we can order another on a STAT run.
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We do our screens in gel but all of our ABO/Rh and rare antisera testing is in tube. So we wouldn't be changing methodology, just clones. I know each clone has it's own quirks. I'm hoping with our patient population that we wouldn't see a lot of discrepancies by switching clones. When we move to automation in a few years, I'm a little more concerned about discrepancies.
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Currently, my 200 bed regional hospital 45 minutes outside a metropolitan city uses Immucor Series 4 which contains MS201 and MS26 clones. I'd like to change vendors due to pricing. We only do weak D testing on cord samples or the rare investigation into a strong positive Fetalscreen sample or prior type discrepancy. I want to make sure we choose the most appropriate cost effective reagent for our hospital population. Does anyone have any suggestions on what to choose in the hospital setting? Maybe some pro's and con's for the different clones? Feedback on reactivity strength, etc? I'm considering the Bio-Rad blend.
validating patient histories in new LIS
in Computer Systems / Software / ISBT128
Posted
EPIC should not have any impact on needing a 2nd specimen. That's actually a setting in the hosparams of Softbank as well as a crucial piece of information in 1 of the data files. If SoftBank is set to allow for a blood type from an outside import as an initial type AND the correct file has the DATE of last ABO/Rh test included, the system will recognize the old blood type AND that the old type counts toward electronic crossmatch (and type specific RBCs if your hosparam is set that way). Initially, the data files were missing the date for the last blood type and I made them import that as well. Now, assuming the validation goes well, we won't need to do retypes for patients with imported histories.