maristgo

Is there a computer work around to create an aliquot in Meditech without the aliquot (i.e A, B) adding to the DIN number? The IT card prints the DIN number with this aliquot "A".
and it does not match the ISBT label. My protocol references  the  ISBT product code designates the aliquot (i.e AO) but an inspector indicated that this does not represent a closed system and the DIN number can not change.  Looking for a protocol to address this issue?
 
 

Per the CAP requirement, highlighted items are added. We are using very small label with SOFTBANK which has minimum requirement. (first four items)
How is everyone complying with below requirement.
1) Are you changing your label size?   Thanks

This is the way Meditech documents the splitting of products. Now with ISBT, the product code does not change when you split, so this is how the computer differentiates one split from another made from the same product.  The split number (A, B, Ba, whatever) needs to print on the tag so you can tag the product properly and the blood bank and bedside staff know which split is being issued and transfused.  I've had Meditech 27 years, we're a pediatric hospital so we make tons of aliquots, and no inspector (CAP, AABB, FDA, JC) has ever had a problem with this.  Your CAP inspector should not cite you for something they don't understand. The previous post is correct - adding an A or B to the DIN when splitting has nothing to do with a closed or open system.  I would challenge that citation.  

It is built in Issue Component.  I initially built it in Component Processing but wasn't happy with it for some reason that I can't remember at the moment.

MEDITECH is currently adding a Blood Bank Bar Code Label Verification routine. If you would like to be involved in the Design Discussions for this new enhancement please reach out to Damerault@meditech.com. Thank you.

We just added a required customer defined screen that asks if we verified all labeling.  Being able to scan it as a double check would be WONDERFUL!

View Printer Configuration   ZT410 - I like the "refrigerator light" in this printer!
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Is anyone performing label verification with Meditech 5.67? Does Meditech have a labeling verification program

We use 4x4 inch adhesive labels printed out of Meditech.  We purchase them from PDC Healthcare, I believe, and they are FDA approved for use on blood bags.  Removing them is usually not an issue if the label hasn't been on for more than a few hours but if they are returned and placed back in the refrigerator overnight, then they can be nearly impossible to remove intact.  The adhesive seems to really like the cold, as well as certain platelet pheresis bags.

This flowchart represents our requirements for handling blood components returned unused by Nursing. 
There are three (3) basic elements: 1) Appearance, 2)Temperature, and 3) Time out of storage.  If the visual inspection of the component does not reveal any unusual observation(s) and the component is within acceptable temperature limits and the component has not be out of storage for more than 30 minutes then the blood component may be reissued for transfusion.
1.  Blood component is discarded if the container is spiked or outlet port(s) opened (regardless of temperature or time out of storage).
2.  Blood component is discarded if the container contents are abnormal in color or appearance (regardless of temperature or time out of storage).
3.  Blood component is discarded if the temperature of the blood component has exceed acceptable limits (regardless of appearance or time out of storage).
4.  Blood component is discarded if more than 30 minutes has elapsed since removal from storage (regardless of appearance, temperature or time out of storage). We do not issue in coolers.
If any of the four (4) numbered statements above is/are true, component may not be reissued for transfusion and is immediately discarded into the biohazard trash. No exceptions.
The BBK CLS who receives a returned unit is required to complete this form and use a colored highlighter to trace his/her pathway from the starting point to a termination point.  The completed form is reviewed by the supervisor and filed.
My understanding of the "30-minute" rule is that the temperature of component is ignored if the component has been out of storage for less than 30 minutes.  We do not ignore temperature.  There was an article in the AABB News several years ago that debunked the "30-minute" rule.
We borrowed our 30 minute time limit out of storage from the old rule, but did not validate.  We assume that a blood component returned unused with a normal appearance, within temperature and within 30 minutes of issue may be reasonably returned to storage for reissue.
This process is intended to limit the number of decisions required to be made by a generalist.
 

I'm GLAD I haven't!

You could always irradiate the blood bag (as well as the blood), while the stupid nurse is holding it!!!

Growing up, I was fascinated by one tarnished old blue ornament that was always placed with due ceremony deep in the center of the tree, where it was as safe as could be from accident. It was from my grandparents’ first Christmas, which dates it back to 1912 or so. My dad gave it to me years later with the understanding that it would eventually be passed down to my oldest daughter. When we took out the Christmas paraphernalia last year, though, I was horrified to find the carefully packed ornament shattered! It was no doubt the work of malicious Christmas elves who, bored with their year-long internment in the ornament box, broke it during a night of drunken revelry. I was crestfallen, until a work friend suggested I go to a craft store and get an empty plastic ornament and put the pieces inside. Which I did, and retrieved the broken pieces from the trash, and the ornament, over a century old, hangs today in our tree and will end up with my daughter one of these days.
 
Every culture, religion, nation and ethnicity has its holidays, whether spiritual or secular, seasons of joy, thankfulness and redemption, when we gather together to celebrate and enjoy the fellowship of our families and friends. So I’m happy to be able to share a bit of mine, and I wish for good health, peace, prosperity and happiness for all in our BBT family.

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.

Psyche's system used to be web-based rather than on your own server.  When I looked at them 10 years ago they had not heard of electronic crossmatch.  
 
Meditech support is poor or was 5 + years ago when I last used it.  The guy who trained me on the Blood Bank module back at their office in MA told me that you couldn't use a barcode scanner on the BB module!  When I used Meditech I found fellow users on Bloodbanktalk and we formed an email group as we all converted to ISBT.  They were much more helpful than Meditech Support.  Meditech is a pretty well integrated system.  It is extremely customizable so that various users seem to have almost different systems.  It has some quirks--like you couldn't deal with an autologous unit that was labeled as Rh pos because the patient/donor was weak D positive and the patient sample was tested only at IS and thus was Rh negative.  I would link the unit to the patient and the patient's blood type would change in Meditech to Rh positive!  I hope they have fixed that by now.  Definitely not built by blood bankers.
 
Now we are on Horizon Blood Bank marketed by McKesson for Haemonetics (previously Wyndgate).  Avoid McKesson products, especially for the HIS.  We have used 2 different McKesson EMRs and the nurses and doctors are quite dissatisfied.  HBB is fine because it is just the rebranded Haemonetics product.  All McKesson modules are interfaced; it is not an integrated system so some parts don't play so well together.

I manage a small 21 bed hospitals blood bank. There has recently been talk about letting us purchase a computer system for our blood bank. Currently we are using a logbook to record all reaction, and then inputting the results (not reactions) into our LIS.
 
Does anyone know of an afordable software available for such a small hospital?
Heres some numbers that may be helpful in determening what might suit us best:
Our monthly averages
T&S 300
antibody pannels 2
crossmatches 80
transfussions 7
 
We've gotten one quote for 12,000 instal, 1,500 per month, and that is not including the cost to intergrade with out LIS system for the lab. 
 
Thanks