bmarotto

CMS approved P9072 effective January 1, 2017.

We do use Rover to collect samples. Orders and results for Blood Bank tests flow through Beaker. Blood Product "Prepare" orders come directly from Epic and the results go back to Epic. Epic told us with BPAM it had to be this way. Be aware that for tests, the trigger that sends the Order Message to Soft is not order placement or specimen collection but receiving the specimen into Beaker Lab. For this reason, is it very common for the "Prepare RBC" order to arrive in Soft before the Type & Screen. We had to tweak some interface settings to make sure the T&S and "Prepare RBC" order ended up on the same order in Soft. This may not be a problem with the new Order Linking functionality in the newest version of Soft.

We have had SCC Softbank as our Blood Bank system since 2008. Our lab was on Sunquest lab until March 2015 when our facility implemented Epic and the Lab went on Epic's Beaker. I was very heavily involved with the Epic/Beaker/Soft implementation. We brought up new inbound (ADT/Orders) and outbound (Results and Billing) interfaces. We were also one of the first sites to go live with Epic's BPAM (Blood Product Administration Module). Soft was able to send the required result components necessary for BPAM to work. The only thing missing is the product expiration, which has to be scanned at the time of transfusion. We have always been very happy with Softbank and the features it offers. It is very user friendly. I have staff who have formerly worked with Sunquest, HCLL, and Meditech and they have all said that Softbank is by far the easiest to learn. Implementation support has been great. I found that Epic was not very flexible in their interfacing and expected Soft to make changes to accommodate Epic workflow. Soft always managed to come up with a solution that worked for us. Blood Bank tests are processed through Beaker. We were able to have the Beaker labels for Blood Bank specimens configured so that the specimen ID number can be used on our Blood Bank instruments. Soft files this number as an "Auxiliary Order Number" so there is no need for relabeling. The billing has been flawless from the start. We do have SoftLab which sort of runs in the background and there is setup that has to be done in SoftLab as well as SoftBank. Most of the reporting as well as billing are done by Softlab and it is Softlab that interfaces directly with Epic. We have found ongoing technical support to be very good. In August 2015, we brought two affiliate hospitals (formerly Meditech sites) up on Epic/Beaker/Soft. Soft was very supportive in assisting us with the multisite build since this was our first experience with a multisite environment. The next hospital should be easier! I would not hesitate to recommend Soft. No matter what Blood Bank system you select I strongly suggest you have a Blood Bank person involved in the Beaker build, or at least present during discussions. I did not have Beaker training but I have been told that during the training out at Epic there was little to no mention of Blood Bank. If you have non Blood Bankers building Beaker, they may make decisions that will cause you problems down the road...like being able to add lab tests on to a Blood Bank sample. Another suggestion is to be sure to be involved in the build decisions and test blood product orders with every Beaker module. My experience was each group tended to do their build in a vacuum, despite trying to get them to attend unified blood workgroup meetings.

We don't have Meditech, but I would suggest finding out if they can define a billing rule to remove all but one 36430 a day. Then have the nurses charge one with every unit; no need to keep track. That is what we do with Epic.

E5821 Thawed POOLED CRYOPRECIPITATE|NS/XX/rt

We do not QC panels. Like John, I do not see the value of arbitrarily picking an antigen to QC. "Smoke and Mirrors" is not a game I like to play. I will hold out until told otherwise (hopefully I will be retired before then).

Thank you. That is what I thought.

I am assisting a hostpial that occasionally reconstitutes RBC with plasma for Neonatal exchange transfusion. Does this alone require FDA registration?

You will love Softbank, David! We have had it for Blood Bank since 2008. We are going live with Epic and Beaker Lab the end of this month.

Our current EMR is an old homegrown system. We will be implementing Epic. Our lab is going from Sunquest to Beaker.

We are not live with Epic yet but are implementing the BPAM (we have SoftBank). From a BB perspective, Soft Tx would be better but we were not allowed the option. As for interfacing with your BB system, you have to find out if your system can send in discreet OBX segments for the Unit number, Unit Status, ISBT-128 product code and ISBT-128 blood type barcode. Product expiration date is optional (Soft can not send the expiration). One thing I learned is that Epic does not want the ISBT-128 data identifiers. For example, if for product code E0382V00 youjr system sends =<E0382V00 you will need your interface engine strip off the =<. Same for the =% for the blood type and = for the DIN.

I think that is one of the gray areas. To thaw plasma and use the FDA recognized post thaw dating you do not have to register. Changing to "Thawed Plasma" is relabeling as a different product....but one that I do not believe is FDA licensed so you have to make sure the FDA license # is crossed off. I would tend to agree with Eagle Eye and say you do not have to register. We do use "Thawed Plasma" and are FDA registered. We were visited by the FDA a few weeks ago and when she heard we were discontinuing our Autologous Donor program due to low volume, she said we could discontinue our registration if it wasn't that we irradiated blood. She knew we use Thawed Plasma and did not mention that would require that we remain registered.

We also have Softbank and do the same as Terri.

Does anyone have a washed platelet procedure using the 2991 that they would be willing to share?

Here is a short video about the 30 minute rule. http://transfusionnews.com/2013/06/30/video-30-minute-rule-for-rbc-temperature-control-may-be-too-restrictive/

Just tell them to keep those units moving at all times until they hang them. We issue our units in insulated lunch bags with small cold packs. Grab that bag by the handle and constantly swing it back and forth. Yup, that is just as ridiculous as the dual temperature requiement. Can anyone honestly say when they are receiving blood that the temperature does not exceed 6C? Unless you are in a cold room when you unpack, pull segments, and log the units in....

I also went through this with Soft. Each blood type of Octaplas has a different product code. Group AB is X0004000 for the frozen product and X0008000 for the thawed product. The product is not labeled with an Rh Soft says they are waiting for ICCBBA to provide them with specs for the Octaplas labels. I was able to print the thawed product labels manually using Shift-F9 but there is only the barcode and eye readable number. The product name does not print. I was not able to scan in the DIN because it begins with the country code X. Soft currently only recognizes W for USA and C for Canada. You can manually type the DIN in and it does not ask for a check digit..

We use the same criteria (Hgb <7.0 gm) but are more lenient with outpatients who are transfusion dependent. For example, a patient who receives blood on average every theee weeks comes in and the hemoglobin is 7.4 gm. We know he/she is not going to make it three weeks and will end up coming in emergently needing a transfusion so we allow them to transfuse. The studies were done on hospital inpatients, who are having labs monitored daily and many are expected to have their Hgb recover without transfusion. We know the transfusion dependent outpatient or chemo patient is only going to continue to have a fall in Hgb. Just my two cents.

I agree with Terri. SoftLab pretty much runs inthe background as far as the BB techs are concerned. SoftBank is a great system. I highly recommend it.

We use E2701 since it specifies the parent product was frozen < 24 hours. E2684 does not specify this.

Interesting thought. Everyone seems to have their own opinion on how the Transfusion Order set is built. Nurses say there are some physicians who wouldn't have a clue what to put for a rate if you left it open for them to decide. With the EHR build, they are trying to minimize the number of "clicks" the physician has to make. One clinician wants to be able to do everything in "three clicks or less". I suspect we will go around and around for a while and finally make a decision. Some will be happy, and others.....

We are revisting all of our Order Sets as part of our EMR implementation. A question came up regarding if a transfuse order must specify the infusion rate/time. Alternately, can the Order Set state the infuse time to be "per policy" with the option for the physician to specify a faster or slower time? For example, the policy may say to transfuse a unit of red cells over "1.5-2.5 hours as tolerated". The physican would only specify if the desired infusion time is faster or slower (not to exceed four hours).

We went from Sunquest to Softbank six years ago. We love Softbank. I did not like Sunquest BB back then but their current version may be better. We are going on EPIC/Beaker next year and keeping Soft for Blood Bank.

So all of us in the U.S. received "the letter" from our blood centers about the expected shortage of AB plasma due to the new AABB standard to mitigate TRALI. We have a fairly active apheresis service and expect Murphy's law to go into play and give us one or more Group AB TTP patients. We also have a liver transplant program. Either of these can push into looking for an alternative to AB plasma. In reviewing the Octaplas information, I noticed the post thaw storage to be 12 hours at 2-40 C or 3 hours at 20-250 C. I am trying to set this product up in my computer system and trying to determine what dating to use. The 2-40 C seems pretty narrow. What happens if the product is issued at 40 C with 12 hour dating and is returned unused at 70 C an hour later? Does anyone have any information on how the storage requirements were determined? Are these the storage temperatures used in Europe?

No low temp alarm for our freezers.