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What I suspect might be going on is that your ABORH test for "check type" is allowed to be used to add additional orders on. Check your Customer Defined Parameters. We created a separate test from the ABORH called "check". This blood type test had no charges attached to it. You will not be able to bill for the 2nd blood type test. We added a test to our TS order only called "is check type needed". The is a Y/N response. If answered "Y", a new requisition will print. We added a query for the Techs to "check mark" a box if phleb. needed to go and collect the specimen. All check type requisitions are brought to BB 1st. If we can locate a different specimen to use, then the Tech goes and gets it. If no specimen, we mark the box and bring it back to phleb. to draw. We also allowed "check" to be ordered from Lab if the Tech felt it was warrented. We also have a test called RETYPE, which is using the SAME specimen as the ABORH, and repeating the test at no charge.

In your statement "Meditech allows user w/o any warning", this depends on how the facility set up the calculation to work, not Meditech. The facility must add the warning to the calculation. You most likely need to evaluate how the calculation is set up, and possibly the ACCESS Dictionary. Here is how we set up the Calculation in Meditech: Triger Tests: ORD=Y, Res=Y, NP=N, ND=Y, QNS=N. If you answer "Y" for NP (No Print) or QNS, these results of "Y" are used as part of the calculation. In the Truth Table, this is the logic we used: IF{'X [bbk err msg]("Invalid blood type calculation.")}, X; Also be sure that your truth table is set up correctly. I made a spreadsheet of every possible result, and then created a Blood type outcome for each type. That is ~30 different combinations to create all of the blood types for an adult (w/o DU testing). For example, you may allow users to use A,B, but it is not required. To report an adult OPOS blood type, the truth table would be set up like this: Anti-A NEG Anti B NEG Anti-A,B NOT POS (user can answer NEG or NOT Done, but not POS) ANTI-D POS RHCONT NOT POS A CELL POS B CELL POS There are four(4) possible combination of results that are allowed to create a blood type of O POS. In the Access Dictionary, OVERRIDE BLOOD TYPE CALC MISMATCH? is answered "Y". If your forward type did not match your back type (eg. pt has anti-M causing A or B cell to be positive, but is neg when antigen neg A or B cell is used for typing), user would enter actual results, and at our facility we add comment as to what was performed to verify result. The user can then manually enter the blood type that should be reported and blood type is accepted. This will appear on the "Override Warning Report". You also have the choice of entering the "corrected" value for the A or B cell as a result and entering a comment as to what the original result was and why it is different (Antigen neg cell used). This way, the calculation will not have a mismatched outcome. I wouldm't recommend this, but it could be used. This action would not appear on the override warning report. If this is answered "N", the user will not be able to define a blood type when there is a mismatch. Our facility is comfortable with BBKers performing this function because of their excellent training. Some facilities may feel that only the supervisor should enter these "mismatched" results. In that case, I would resort to downtime and issue "O" until the blood type can be entered by supervisor. I would never have an invalid blood type be an acceptable blood type used in the system.

Yes, the markers need to be the same for the unit marker and the patient marker. They need to be on both so that the warning does not appear. Sorry about "Atlas", I did not realize that it is an "intranet" connection, so it is probably only available to our network of facilities. I would think however that Meditech should be able to direct you to online information.

I am on the Magic version5.6.6, but the Nomenclature Map was used to enter an IMO (Intelligent Medical Objects) mapping. This will be used for EHR (Electronic Health Record). In the Magic Version, this is on page 1 of the Product Dictionary

We use a rule that gives the user just a warning. In the event that the BB needed to provide a product w/o the marker, we wanted to have the option to override. This can also be set up as a "hard stop" if you want. How we applied this was to enter this as an assignment/issue rule for PC on page 4 of the Product dictionary. You need to create the rule in LIS Shared Dictionaries, Rule Dictionary and create a BB assignmnet rule type. Go to Atlas and enter "Lab Rules" and you should be directed to the Rules Catalog that provides examples of how to create different types of rules in Meditech for Lab. ;Marker Rule is used to flag patients that require specific blood ;requirements ie, HLA matched platelets, CMV negative blood. ;Marker Rule resides in the Product Dictionary. ;Marker applied to PATIENT must be the same marker applied to PRODUCT. ; [f bpt unit mkrs comp]^X, IF{X "Pt marker not on unit: "_X_" OK? "^X, [f basn yes/no](X); [f basn ok]};

rcollins, If you chose to have every ISBT128 product defined like I did, then for those products from apheresis, I left the volume undefined and when the unit is put into inventory, The Tech has to enter the volume on the bag. For those products with an undefined volume, we took the average weight of about 30 units and default that volume in. We use 350ml. We tell the RNs that they are to use the volume that appears on the I/T card as the volume of the product.

Red Cross is introducing the use of a plasma product that is labeled as "Plasma stored in the freezer within 24 hours of phlebotomy". (PF24RT24) E7644 Apheresis plasma Frozen within 24 hours after phlebotomy Held up to 24 hours at room temperature after phlebotomy Does anyone know the corresponding THAWED product code?

We use Meditech with BCTA (bar coding at the bedside). We use the hospital id band (has a barcode). When the user scans the barcode, if it is not for that patient, it will not allow scanning, and the RN should return the product to the blood bank. We require a second separate draw on any non-type O patient prior to a red cell transfusion to confirm the blood type if we do not have a previous type type history. We have been using this for more than 2 years, and it has been working great without a separate blood band.

Dr. Pepper's response reminded me of what our BB Supervisor does. He tracks the common "errors" in the department, and ceates a "quiz" for the Techs to answer quarterly usually reffering to the errors that he tracked. If one can make ther error, then someone else might make the same one. He calls it "Questions of the Quarter". It basically requires the Techs to answer 4-6 questions. Sometimes they are asked to write down the page number and the section number of a particular SOP. Of course they are to READ the section so they can refer to it. Another example would be "What information MUST be on a BB specimen in order for it to be accptable for use". Another might be to calculate the volume of RBCs needed for an exchange transfusion. Or, what is the expiration date/time of the syringe of RBCs prepared for neonate transfusion? Calculate the number of vials of Rhogam needed based on the KB result. He uses this as a "teachable" moment. He speaks to anyone who did not answer the question correctly. These questions are also included with the Tech's annual review. Keep it simple.

I am actually scheduled to work exclusively in BB. It is very important to have one or more regular employees dedicated in the department because of the complexity of the work. It also gives the generalist who may rotate through BB another contact in case they need advice or help. The one thing that I can point to that other generalists working in the Lab do not have is the sense of "ownership" that I have working in BB. I have been given my own list of duties that I am responsible for to help maintain the department. There is no "wait for the next guy to do it" because it is MY responsibility. I have other supervisors tell me that my supervisor is lucky to have me because he doesn't have the lack of commitment from the generalists that they do. Why not give generalists responsibilities? If every Tech had "ownership" of certain tasks, perhaps there would be an opportunity for more committment from the employees. How about assigning one generalist to maintain one instrument? Just a thought...

If you are using Meditech, on page 3 of the Product dictionary, you are going to have to create an ORDER GROUP for the RETYPE test and enter the name of that order group under "Non-Affiliated Source". Also on page 3, for products requiring a confirmation to be performed, the "Default Blood Type" needs to be answered as "U" unknown. On page 1 of the Product dictionary, "Typing Required?" should be answered as "Y". Now when this product is entered into inventory, users will need to perform the retype test on the unit that is defined in your Order Group prior to use. You need to set these up "backwards" in order to create the Order Group. 1) create the component T-Tests for your Group Type test for your retype "RETYPE". Ex: anti-A unit, anti-B unit, anti-D unit (anti-A,B unit). 2) create your B-Type Calculation for your RETYPE Blood Type (RTYPE) 3) create the G-Type Test using your component tests and blood type tests (RETYPE) 4) create the Order Group (BBRTYPE) ***Order Type: ADD ***Spec Type: NEW ***Coll Date: T ***Time: N ***Priority: R ***Received?: Y ***Recv Date: T ***Time: N ***BBK Test: RETYPE 5) Enter the retype order group on page 3 of product dictionary non-affiliated source: BBRETYPE Every defined product that requires a retype will need to have "BBRETYPE" added on page 3 of Product Dictionary. To perform the retype test, find the specimen associated with the retype order for that product, users can enter "BU#" (blood unit number) and then scan the unit number and the retype order for that product will be there for resulting. Once the product has been retyped, the blood type when turn from "unknown" to the confirmed blood type performed.

We have several practicies that we do to make sure we have information available during a downtime (we actually just had a 2 hour unscheduled downtime today, and our measures we have in place worked great). 1) We download the MEDICAL RECORD CARDS for the previous 365 days to one dedicated PC. We override the report every day to include the last 365 days. Be sure that you call CSS to have your LIS Parameter changed to 365 days for the BBK HIST AUDIT LOG. You are only required to verify the history (blood type) within the previous year. 2) If we have any patient with a significant history (antibody, CMV Neg units required), we print one Medical Record Card for that patient, and keep it in a BBK History File notebook. We keep these history notebooks indefinitely. This way, we will still have the history available longer than 365 days. 3) We also have scheduled to print daily, the Final disposition list of all products from the previous day. We keep them by the month so if we needed to find a unit, we could. This is a fairly close record of unit disposition. If you have not transfused a patient, and you are looking at their history, you will only see the blood type reported. You will not see any other "activity" from this record other than a transfusion or transfusion reaction workup result. You will not see the results of the specimens performed on this patient here. What do you mean by "recent" history?

Jennifer, We use Meditech, but I can't think of a rule. There are a few options you can consider however. If you control "where" the pre-op work is performed (at our facility, they come directly to Lab), you can add queries and if they meet the criteria for extended TS, then here are some possibilities: 1) Have a different TS on pre-op orders that includes the extended TS timeframe (eg; TSPREOP) 2) In the Access Dictionary, you can allow the user to extend the expiration date/time of a specimen. User can change the expiration date/time on all pre-op orders that qualify. You could probably create an NPR report that could pull all PRE IN patient types to a list to review for qualification.

I did something like this a few years back. I approached it as an opportunity to get kids interested in the health care profession. Here are a few things I did (based on me being a blood banker): 1) I got into my PPE, lab coat, gloves, face shield (goggles) so they could see how I work all day 2) I asked them if any of them knew their own blood type, and what was the universal blood type 3) I brought in old CAP kodachromes and projected them to show blood and micro specimens 4) I talked about all of the many places where a degree in health sciences could take them a) Lab Sciences: Micro, Chem, Serology, Hem, BB, Molecular Biology Marine Micro c) Food Micro d) Public Health e) Medical school 5) I talked about many of the places where a degree in MIcro(health sciences) had a part if discovering recent health outbreaks: a) Ebola Virus Toxic Shock Syndrome c) HIV (AIDS) d) E. Coli toxicity e) H1N1 outbreak f) Mad cow disease As I asked questions, I gave out a little two-pack oreo cookie to anyone who participated. That went over really well. Good luck

I would only consider using if there is a way to scan all of that information into the computer. Way too tedious for the return.

cswickard, Are you still coping completed Issue/Transfuse cards with BCTA? We no longer have the nurses complete the cards if given through BCTA. (This is for Meditech users)

Directed Donations are donations made "directly" for that patient Designated Donations are products that are specifically put aside for a patient. Best example I can think of is HLA matched platelets which are designated, but may not be directed (with patient's knowledge and approval).

TRANSFUSION:Volume 45, May, 2005 "Use of Polyethylene Glycol for performing autologous adsorptions"

We are currently up on MEDITECH, which will have in place a means by which nurses can look for available products for their patient using the STATUS BOARD. This will be implemented to us by the end of the year. Right now, the nurses could look for available products using PCI (Patient Care Inquiry), but they don't do that. It's so much easier for them to order a duplicate knowing full well that if it is a duplicate, the Blood Bank will call to clarify the order. They also call and ask if a product is ready even though they can look themselves. I don't think there is any way to change this other than training the RNs and "rufusing" to give them information they can obtain themselves. It's not going to prevent the duplicate orders. They just won't call. When we implement BCTA (bar-coded enhanced transfusion administration) this year, this tool will be used for the nurses to enter transfusions into the computer, and require bedside scanning of the patient's armband and the product to confirm that it is the correct product for that patient. In order to start the pre-transfusion vital signs, the nurse will need pull up their patient's information which will include the products that are ready to be transfused. All I see is a nurse calling to see if a product is ready prior to them entering vital sign information instead of looking in the STATUS BOARD first. We will see how the training goes.

We are not up on eTAR yet, but the blood bank enters all transfusions right now. This also helps us with monitoring the completeness and accuracy of the transfusion record. One of our sister hospitals uses the "presumed transfused" feature. They have the system set to enter that transfusion after 24 hours. That is done in case there is a transfusion reaction that needs to be entered. Those exceptions are entered PRIOR to that 24 hour period. Does anyone still plan on entering the transfusions, or MUST this information be entered through OE? I'm a control freak, and I'm not sure I want to relinquish control over transfusion entries. Who monitors if the transfusions are completed with eTAR? How facilities are handling aliquot preparation with eTAR and ISBT 128. We did not purchace HEMATRAX labeling so our labels are all done by overlays. What is going to happen when you try to read that barcode at the bedside and it has a suffix on the DIN when you scan the product number? We chose to use the "Make component" routine even for our aliquot preps. We entered in the Product Dictionary "allow aliquots?" as NO. At the Component Product field, we entered all of the possible aliquot products that could be prepared from that parent product. Because each "aliquot" has it's own product code, currently we can issue aliquots without the suffix being added to the DIN. It is my impression that when you use eTAR, the product code is scanned, which will now be a problem with eTAR because MEDITECH will ONLY recognize the first 5 digits of the product code. E0224V00 E0224VA0 would be seen as the SAME product code in MEDITECH. What has anybody done about aliquots and eTAR?

Lara, I'm not sure I understand what number you are talking about, but I believe you are referring to the DIN. When split products are prepared either two apheresis red cells, or red cells and FFP, red cells and platelets, etc, ALL products collected from the same donation will be given the same DIN. What keeps them separate is the use of the product code. You can have several products with the same DIN as when you prepare components (FP to FP thawed). This is why the product codes need to be defined. You won't be able to call both parts of an apheresed unit "PC". What you may be talking about is the use of a "suffix" that was added to the end of a codabar unit number to keep track of the aliquots. Meditech has a way of tracking the aliquot by it's divisions. Our facility elected to not follow this convention because we felt we wanted to follow the guidelines set by ICCBBA where the DIN does not change (even when preparing an aliquot). Only the product code changes. Again, when we have to barcode read at the bedside, you can't have the aliquot label use the parent unit number, and then the issue slip include the suffix. They won't match. You can avoid this in Meditech by only using the "make component" routine for also preparing aliquots. For example, we would prepare an aliquot by making a component from the parent RBC product (E0224), and prepare the component (E0224VA0). We would call these two different products and therefore we would use the same DIN without a suffix. It can be complecated, if you give me your email address, I can contact you directly if you like.

My answer to that would be how easy do you want to be able to trace a unit? Split products that are prepared by pheresis will have two product codes with the SAME unit number. You will not be able to call both of these products "PC" because the same unit number can't be given to the same product twice. Soon, facilities will be required to scan products at the bedside. It will be similar to reading medications at the bedside. This may impact your decision. I believe that the product code will be one of the required fields to be scanned at the bedside. It must match the product that is issued. Is it easy to tell a nurse that packed cells is the same as apheresis RBC? I wouldn't think so. In spite of all of the large amount of work involved in creating new products, it made more sense to create them all. It does go quickly once you determine a system of naming all of the products. If you "modify" products at all (pool or prepare aliquots) you will need to also trace these products. All of these products must be barcode readable.

Sorry I wasn't more clear. I meant to say, you should not enter in the Product Dictionary "PC" only. If you do this like what was done with Codabar and enter all the Product codes that are PC, you will only be able to print labels for the first product listed. For ISBT 128, each product needs it's own Product Code associated with it's own Print number. Product Groups is great when validation is required because you can validate one member of the group, and you're done. Creating Product Groups was a great suggestion!

Antrita, The FDA doesn't even care if you use ISBT 128. It just needs to be an acceptable barcode system. Pay careful attention to these threads when members are suggestion to NOT use product Groups as your sole product (eg:PC,FP). If you will be printing labels, the printer will ONLY recognize the first product listed to print. You need a separate product for every ISBT 128 product you want to use.

I setup the Product dictionary for our small market (3 hospitals) in MEDITECH. There is MUCH to consider when undertaking this project. QUESTIONS: 1) will you be printing labels or buying pre-printed? 2) do you modify (aliquot or pool) products? 3) do you have a donor room? 4) do you ship products? 5) are you registered with ICCBBA? 6) have you talked to your blood supplier? when will they be converting to ISBT 128? Please let me have an email address, and I will contact you directly.