BankerGirl

We have Meditech instead of Epic, but we also do all of our MTP documentation on paper. We have a designated recorder that is responsible for documenting transfusions, vitals and lab results. We have a few more MTPs than you from what you said, but there is no way they could do this in the computer. We never know where the MTP will occur and getting the recorder access to a mobile PC that she can move along with the patient (they almost always end up in OR at some point) would be a nightmare. The documentation is usually not ideal, but the situations themselves rarely go as they are "supposed to go" so we analyze every MTP after the fact and try to do better the next time.

This is how we have it set up. Works just fine.

It was documented as a safety event, and no, I didn't get the unit back so I can't say how bloody. The nurse called me after she transfused the unit and had discarded the bag. I didn't think about her spiking the unit prior to laying it down. I have had leaking segments before, but I pulled the segs just prior to issue and would think that I would have noticed blood on my hands or the checkout counter if that had been the case. I do handle and mix them while inspecting them at issue. She put in the incident that the labels were bloody when she got the unit from the courier, but that it looked dried and she just thought it was odd. Later when she picked it up to transfuse it she had blood on her gloves. If it leaked in transit, I would think the courier would have had blood on her hands, and she did not.

We recently had a nurse call to say that the unit of blood she received was visibly bloody on both sides of the unit. Blood was smeared on both the unit label and the crossmatch compatibility label. The courier brought it to her and she laid it down in the patient's room while she went to attend to another patient, and when she returned and picked up the unit, it was bloody. She checked it for leaks and, finding none, started the transfusion "because the patient needed the blood." (She is Type A Neg with an anti-Fya and a 6 gram hgb.) She then called the courier who brought her the blood and the courier said she didn't have any blood on her and didn't see any blood on the unit when she picked it up. The nurse then contacted our Employee Health nurse who told her to call the blood bank. I was the individual who checked out the blood and told the nurse that it did not leave the blood bank in that condition. Any thoughts on this situation? I want to scream NO! NO! NO! but need some ammo for our risk manager. By the way, each manager concluded that their employee did nothing wrong and "Standard of Care" was met.

Malcolm, I'm shocked!

We do the same as above.

We also use their Medical Record number for our patient wristband, and we manually result the second Type and Screen. I don't know of a way to copy the results, although that would be really nice. Most of the time the blood bank orders are on their own requisition, so we can use the Move To Another Account without any issues.

We move the account number if there are no other tests on the requisition. If there are, we simply copy the results into the Inpatient order and credit the charges on the outpatient one. This assumes that the outpatient was armbanded when the type and screen was done and meets our requirements for pre-transfusion testing.

We have an NPR writer on contract with the hospital. I hope we never lose her!

I have found most of the standard blood bank reports useless for transfusion review. I don't specifically remember data mashed up and becoming unreadable, but it is difficult to do a proper review with the multi-line reports that they give you. I had my NPR writer develop a transfusion review report for me which pulls all of the data I need in a semi-colon delimited format. I download this report, export it into Excel, and then each transfusion is on its own line with headings that I can sort any way I need. This has been a lifesaver!

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We keep our cord blood samples until we run out of storage space. This usually works out to between 20-30 days. We have done testing on them up to a week after delivery if the baby is jaundiced at their 1 week doctor's appointment, but that is exceedingly rare. They almost always get ordered the day after delivery.

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No, it is all or nothing. You are required to retype all units, not just Type O.

This was addressed in a previous thread. I can't remember exactly what it was called but it is fairly recent.

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Beer is what the going currency is around here. Seriously, though, you are welcome.

The way to handle this is to create a separate product for the pheresis units in the product dictionary. We have them set as RCLK (whole blood derived), and RCLKP (Pheresis derived) and RCLK2 (pheresis second container). This way they do not appear as duplicate units in Meditech and scan correctly in both LAB and TAR.

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Well, I just finished reviewing transfusions for last month and there are 7 transfusions with no end time.

A name is satisfactory to get the ball rolling, but they are required to sign all orders eventually or our hospital suspends their privileges. Once they are signed, their privileges are reinstated.

Agreed Malcolm. With Meditech, there is a BIG red warning when the transfusion time parameters are exceeded, and some of the nurses following the offender will end the transfusion, while some won't. Some enter a nursing note, and some ignore it. Most of these happen in our outpatient infusion area where the patient is dismissed before those transfusion time parameters are exceeded and they don't have the chart open anymore, but some still occur on the other nursing units. Our outpatient nurse manager will always take care of it when I notify her, but the other units do not.

If you use Batch Enter or even Quick Enter Units, the source of all of the blood units must be the same. We don't use these functions because we get units from many different ARC Regions in one shipment. We were burned by someone not noticing the different region on some units and just scanning them all without paying attention. Then none of the DINs are correct and it was a hassle for me to fix them individually as they were discovered. If your antigen typing is barcoded, then I am jealous because ours is not. The Quick Enter Units routine does have an Antigens field, but I don't know if the barcoding would work. It would be worth testing, however.

This is the answer to your question: a current specimen. A historical blood type is not a current specimen!