BankerGirl

We went live with TAR several years ago and it has made my life much easier. I think there is a way to document the vitals through TAR, but even if they don't do it that way, all of the vitals entered into Meditech end up in the same "bucket" eventually, so I had our NPR writer design a report for me that pulls all vitals entered on the patient from 1 hour prior to 15 minutes after the end of the transfusion. This can pull a lot of vitals if the patient is being monitored very closely, but I would rather have too many than not enough.

We have Client Server v. 5.66 and I believe that was the version we had when we instituted this, but it might have been 5.65. I don't know anything about character limits, we just told IT what we wanted it to say and they figured out how to word it so it fit.

We ordered our product labels from Shamrock. The problem we ran into was the occasional "oddball" product that our supplier (ARC) would get from a different region which would have a different preservative formulation and we wouldn't have those labels. We have such a large number of different labels that it is very difficult to find the correct label, and that's assuming the techs noticed the difference in the original label to begin with. That is why we decided to switch to Hematrax. Quite expensive, but much easier and accurate.

Also, if you are handwriting the expiration date and time, you might consider converting directly from frozen FFP to Thawed Plasma. You will confuse the nurses greatly if you change the expiration date twice, with the last one being LATER than the previous one. Experience speaking here. It also save you from having to process the unit twice.

I managed to get the education handout uploaded to the library section under SOPs. Not quite sure this is the perfect place to put it, but that's where it is. Since we made the type and screen order the same as a RC product order due to physician request, we decided to not reflex any products since it is an all or nothing reflex situation. Otherwise we would have to cancel the RC order on all type and screen specimens. If anyone has any other questions, I would be happy to address those.

Same thing here.

We are on version 5.66 right now.

Well I can't seem to get the attachment to show the CPOE screens, so I will email them to Susan, and anyone else who wishes to see them.

I have attempted to attach a copy of our current protocol. The physicians were confused about the actual product orders and when to order a type and screen versus a crossmatch, and they also didn't want to have to place a nursing order AND a blood bank order. We chose to hide the blood bank orders by placing a "z" as the first character in the orderable and reflexing appropriate blood bank testing to the nursing orders. Based on the answer to the questions, blood bank places any additional orders necessary to fulfill the request. This may be confusing, but I will try to clarify anything if necessary.

Susan, We set this up a couple of years ago. We added several drop down boxes to our transfusion orders and made them mandatory so they have to put something there. If they wish to transfuse outside of the accepted criteria, there is an "Other" option which mandates a free text field for them to list the justification. Of course, they can always put in a space or some nonsense reason in there, but if they do that, then our Medical Staff Performance Improvement Committee reviews it and determines if the physician needs to further justify it. If you would like to see our screen, I can email you a copy.

pbaker: We have a small hospital in our area that decided it was more cost effective to just give all RH negative mothers RhIG rather than worry about performing a weak D on the baby. They don't deliver many babies, and if they were to buy anti-D reagent it would expire long before they could make use of it. I believe that they perform a fetal screen to catch large fetal bleeds, but they do not perform KB testing.

tricore: Your reference is outdated. I quoted the 2015 version which says each antigen for each unit. Karrieb61: It seems to me that you are doing this correctly.

Our LIS coordinator has the current CPT (2015) code book so I decided to look it up. Code 86903 no longer exists, and 86902 says "If multiple blood units are tested for the same antigen, 86902 should be reported once for each antigen for each unit tested." My interpretation is that you can bill for all units tested AND for all antigens tested on each unit. It doesn't say anything about what to do if the unit is already tested from another patient. Maybe we will change back to the way we were charging.

I did know that Malcolm. And we appreciate that luxury of using our reference lab for our difficult to find units. That being said, I did recently resort to transfusing an A Neg unit to an A Pos patient with an anti-C when, after screening 13 units, I only found one C negative A Pos unit. Cheating, I know, but much faster and cheaper!

Actually, that was just a couple of months ago. Not saying that she was correct, but we did change our billing practices as a result. That's why I was hoping for an "expert" opinion. As for Malcolm's comment about Jk(a-b-), we would request those units from our blood supplier and let them decide what to charge.

I was told by our billing compliance folks that we can only charge for the number of units ordered regardless of how many we screen to find the required units. I would also like a definitive answer, because we end up doing a lot of these for free.

We are also Meditech, Tar and Mobilab users and you will absolutely LOVE Mobilab! We have not used blood bank bands since I started here 25 years ago, so we have had much experience with nursing cutting off the band. If we discover this, the patients BB specimen must be redrawn. Nursing doesn't notify us, but the phlebotomists do because without the patient armband, Mobilab doesn't work. We also require the phlebotomists to ask the patients their name and date of birth prior to drawing ANY specimens, so we know if the armband it incorrect. If the patient is unable to respond, then they must get the patient's nurse to identify the patient. We have a set of prenumbered Trauma packets with armbands and stickers all ready to go for anyone who comes in without identification. We require the trauma information to remain until any immediate bleeding emergency is passed, and then we redraw samples after they update or merge the admission record. We do have a stock of blood bank bands for use in emergencies when the armband gets removed or if a large number of emergency patients come in at once. As far as surgeries, we require the patient to leave the armband in place if they are drawn prior to admission and the preadmission nurses punch a hole in the visit number barcode so that visit ID is not used for nursing, but we can still use it for our purposes. We use the MR number as our armband rather than the visit number.

Terri, We use the Hettich which we bought through Helmer. It is fast (we have ours set at 80,000 RPM for 2 minutes) and works well. The only drawback I see is that occasionally you press start and it doesn't start. It seems to have a short time delay (where it is assessing the lid lock?) and won't start if pressed too soon.

This thread is concerning me greatly. We have been seriously considering switching from manual gel to the Echo, but if this is a recurring problem, I don't know that I want to do that. I understand that no method is perfect, but the fact that there seems to be no explanation from Immucor is very disconcerting. I am especially curious about those folks who are switching from the Echo to the Provue. Why did you make that decision? Also, the Ortho rep was here yesterday and says that their long awaited updated analyzer will be released shortly in the US. Anyone in Europe already using it? How different can it be? Thanks for your input.

We have had this set up for several years now and it works just fine, but in the beginning the product barcodes would not scan. We worked on it for nearly a year and Meditech said there were no settings that could affect this, but still no luck. It mysteriously started working without any intervention from us or Meditech. No one has any idea what happened. We are now on version 5.6.6.

I agree with Goodchild and SMW. We had an AB Pos patient who developed a new antibody every time we transfused her until she ran out of ones to develop. There was no way our blood suplier could find AB units for her, so she always got type O and never again typed as AB. Additionally, many of her antibodies ceased to be detectable, and when she moved, we stressed to her the importance of giving her new transfusion facility her blood type card with all her antibodies listed. Surprise, surprise, the new facility typed her as O Pos, even though she had no reverse reactions.

Agreed, Kimster, but our ED medical director thinks he is God (who would have guessed?) and I think the docs often don't even bother to read the chart or they wouldn't keep ordering Rh types either. We do have one physician who actually called the patient's OB and determined she had RhIG in the office the week before and so she didn't need any more. Small steps, very small steps...

Au contraire, mon ami. (Don't know where the French came from! Must be the international flavor of this site.) We have had 4+ reactions from RhIG when the injection was very recent, ie. in the last few weeks. We have some ED physicians who think that when a patient comes in three times in a week with vaginal bleeding, they need a shot each time. This will pop the titer high enough that the screen will be 4+, but what doesn't add up for me is the part about the patient having an amnio, but neither the Dr's office nor the patient knows for sure. Who said she had an amnio? Does the patient remember an amnio but not if she got a shot? And why doesn't the Dr's office have any records? Very interesting!

What a coincidence! We ordered ours in January and got it in October also! My boss told me that she wouldn't believe it was really here until she actually saw it on the bench! Well, seeing is believing.