shelleyk482

We record directly into MediTech. When I first got here (4.5 yrs ago), they were recording on manual logs and then at the end of their shift entering the results into the computer and they had always done that so about half of the staff was very resistant to changing. In order to get buy-in, I formed a team to look at the pro's & con's of changes, identify potential issues & develop plans to resolve the potential issues and to develop an implementation plan. The team was very deliberately put together: 2 techs who were admantly opposed, 2 that were totally convinced and 2 that different have much opinion one way or another. To make a long story shorter, we drastically increased productivity, decreased transcription errors, decreased record storage fees and increased staff satisfaction. None of the staff would even consider going back now.

I have attached a copy of the form that we implemented a couple of years ago. In Nov, nursing administration began requiring that a copy of the physician's order also be brought down. We continue to use both forms since there is a nursing checklist of items on the top of the form (for some reason you can't see this part unless you do a "print preview" or a hardcopy). This form "B-25" (as we call it) is a 2 part form; the top copy goes on the patient's chart and the blood bank retains the bottom copy. We have virtually eliminated wastage due to blood being issued w/o a consent on the chart or the patient not having a patent IV access. Our nursing administration is very supportive (the form was developed using an interdepartmental team) with this process but it took the blood bank filing "Risk Management" reports for all wasted blood products and copying nursing and operations VP's on each report. Once Nursing Administration got tired of having to respond to all of the reports, they decided that the process needed to be "cleaned up" and that it would take both the BB and nursing to be involved to make it succeed. Our facility now requires that any & all transfusion related errors, omissions, deviations, etc. result in automatic disiplinary action and we have actually had 1 nursing director fired for repeated problems in her area (no single nurse was involved in more than 1 incident). B-25 rev 08-31-07.doc

Our blood bank supports a children's hospital with a large NICU (> 70 beds). For maintenancy transfusions, our policy is to assign a unit < 7days old to a neonate for the first transfusion and then use aliquots from that unit until the unit expires or is used up ("limited donor" units). For large volume transfusions such as for OR, we routinely use RBC's < 7 days old (if "fresh" units are not available, the physician is contacted and given the option to use washed units). If the neonatologist is concerned about restricting the potassium for the maintenance transfusions, they always have the option to ask us to discontinue using the "limited donor" protocol but this rarely happens. Our neonatologists are routinely more concerned with limiting donor exposures than the age of the unit.

The only involvement we have with the TP's is that the Transfusion Committee reviews the SOP on a biannual basis; nursing reviews it annually. We do not received the product, it is not entered into the LIS; we basically handed the entire process to the nursing department since we view it as a medical procedure and not a blood product.

The Dialysis nurses do the TP's at our facility. We do just inpatients and they have to be worked in since dialysis patients have priority; all outpatients are referred to the blood center.

We have required a 2nd sample for many years. We have a comment that we append to a crossmatch order that tells the nurse whether or not a 2nd sample is needed, if one is needed, the nurse knows to collect a few drops of blood in a bullet and bring it down to be tested at the same time that the product is being issued. We are a fairly large transfusion service (we issue an average of 110 products/day) so we always have 2-7 dedicated blood bank techs on duty; one is issuing while the other does a "quick type check" therefore our process doesn't delay the issue process. This requirement is applicable to both our adult and our children's hospital. I don't intend to change back once we go to barcoding system; pharmacy implemented a barcode system a couple of years ago and we've had a continuing problem with nurses printing extra barcode identification labels and putting them on the patient's chart, carrying them in their pockets, etc rather than barcoding the band that is actually on the patient. For whatever reason, for each fix you put into place, someone will spend the time and energy to find a way to get around it I have never quite understood the concept of typing the same sample twice. More errors occur at the patient identification level (either at specimen collection or at the time of transfusion) than at the testing level.

Are there any new thoughts on this from those of you who are using automation?

We are currently validating 5.6.1 and I saw where it can be set up in the test dictionary. Once we get through with going live on the update, we will probably start "playing" with the electronic crossmatch. Our workload has increased so drastically in the more time consumining areas- aliquoting, antibody Id, etc. and our work area is too small to allow for any additional personnel (if I could even find any), that I have to come up with some way to improve the work situation for my staff so this may be the best way, if it works.

I haven't looked at electronic crossmatching for years- is the Meditech computer system now cleared for electronic crossmatching?

How often do you need to replace the "bulb" on the x-ray type irradiator? We irradiate approx 1,000 products per month and when we replaced our irradiator a few years ago, our biomed department calculated out the cost & frequency of replacing the "bulb" and determined that it would be cost prohibitive for us to be able to keep an X-ray based machine running with our volume. Are any other large volume facilities using this type of irradiator?

We used to use historical data for all plasma based products but after a couple of incorrect admissions we have changed to requiring a blood type on the current admission. For outpatient transfusions, we require a blood type each time the patient presents to the hospital. If we have a historical blood type, we just do the front type as a "blood type verification". We do not require require an antibody screen unless the patient is also receiving RBC's.