RHIG Dispense from Pharmacy

[ESIZENSKY]

Hi All,

We recently moved RHIG to pharmacy? I have a few questions that will help with our work flow.

1. Does Blood Bank notify pharmacy when RHIG is needed for a patient?

2. Does the clinical staff check EMR (Meditech 5.67) for test results and call pharmacy for the RHIG?

3. Does BB notify the clinical staff RHIG is needed.

4. If using TAR do you have RHIG  orders on status board?

Our test profile indicates RHIG eligibility and number of vials needed. The results are available in Meditech EMR.  Pharmacy is demanding a notification (phone call) and clinical staff is to busy to check EMR results. 

When BB dispensed RHIG the clinical staff  TAR status board demonstrated it was ready.  I would like to have best practice for both clinical and laboratory but it seems that Pharmacy states it is a requirement for direct notification.

Thanks,

 

 

[Ensis01]

I do not know what the "best practice" is but my experience is that unless the BB makes the (documented) phone calls to both RN and pharmacy the BB will be blamed when a dose is missed, whatever the reason.  

[John C. Staley]

I'm curious, who's idea was it to move the RhIG to the pharmacy?  It never came up at any of the facilities I worked at or were familiar with.  I know it's been discussed in these forums on occasion but I don't remember what the driving force behind it has been.

[donellda]

Most of the hospitals that I worked at issued Rhogam from the Blood Bank. It is easier to track that way. The hospital that I retired from last year dispensed it from the pharmacy which made it a nightmare for tracking especially when an outpatient sample presented with an anti-D. Client services had to get involved to see if the patient was given Rhogam. 

[AMcCord]

23 hours ago, John C. Staley said:

I'm curious, who's idea was it to move the RhIG to the pharmacy?  It never came up at any of the facilities I worked at or were familiar with.  I know it's been discussed in these forums on occasion but I don't remember what the driving force behind it has been.

We still issue RhIG from Blood Bank but there was some discussion prior to a JC inspection a couple times back about pharmacy being ultimately in charge of all meds issued/administered. Nothing changed on my end and I never heard what pharmacy did to satisfy themselves that they were in compliance. Pharmacy does now order RhIG for us, though it is billed to lab and we collect the revenue, so I'm guessing that is part of what they did to make sunshine and happiness on their end. The current pharmacy director wants no part of RhIG outside of what they already do.

[jayinsat]

We moved rhogam to pharmacy more than 10 years ago for all 7 of our hospitals in our system. It has been great! It poses no more issues than any other transfusion or lab related process that is under other-than-lab control (POC, transfusion administration, etc). We get a report printed from pharmacy (autogenerated) every morning that inform us when patients received rhogam, fludara, or IVIG. We print a report daily in blood bank that shows all rhogam candidates (females of child bearing age that typed rh negative). The patients on that list are evaluated to see if they were rhogam candidates and if the workup has been ordered (if necessary) or dispensed. Our L&D and ED have very little problem with the process. There is the ocassional missed dose or inappropriate dose in ED but that is relatively rare and has been the same as before moving it to pharmacy.

My experience is that it is better in pharmacy than blood bank. Your mileage may vary.