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Blood Bank Armbands


glewis
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We are transitioning from Cerner computer system to Epic and Wellsky for transfusion services.  We are faced with a dilemma as to the workflow for nurses ordering products in Epic, since there is no place that the bb armband can be documented in Epic.  Anyone have similar circumstances? We are a 700 bed hospital and dispense many products, and we opted to keep the additional blood bank ID band for patient safety reasons.  Have any suggestions other than having the nurse go to the patient's bed and jot it down before calling the blood bank for delivery??  We would like to have it documented on the nursing side in EPIC as well as Wellsky.  

 

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I’m sorry but your post indicates that you are effectively going to make things way more complicated for the nurses. In my experience this will make the nurses extremely creative in negating the safety benefits you are trying to maintain or implement. I suggest discussing the flow with the nursing staff to figure out the most practical flow that will ensure safety. Talk to all the areas (especially the ER and L&D) as there can be large differences in requirements.  Simplicity Reduces the potential for confusion, which minimizes errors and thereby increases safety. 
All that being said; keeping the option of armbands for down time and any glitches when you switch over sounds like a very good idea. 

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If you have matching turned on in the Epic BPAM module, you'll see that it does a wonderful job of ensuring the unit matches the intended recipient. Nurses have to scan the patient's hospital armband, then unit number, product code, etc. are validated against the patient.  Not sure why you'd want nursing to document the Blood Bank armband number in Epic, although I do understand the difficulty in letting go of this piece of the process.

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Ensis01 you expressed my thoughts far better than I ever could have.  I've never been a fan of blood bank specific arm bands and fought against them most of my long and storied (:wacko:) career.  Complicating a process never made it better and often made the problems far worse than the one folks are trying to address.  My answer to glewis is that this is a perfect time to get rid of the blood bank specific armband.  Let the computer and nurses do their jobs in the simplest most efficient way possible.

:coffeecup:

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2 hours ago, John C. Staley said:

I've never been a fan of blood bank specific arm bands and fought against them most of my long and storied (:wacko:) career.

My profuse apologies John.  I initially read this as "I've never been a fan of blood bank specific arm bands and fought against them most of my long and sordid (:wacko:) career"!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

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I highly recommend you use this opportunity to discontinue using a separate BB ID band. Using the patient’s regular ID band works great. If you’re using scanned PPID from the wristband for specimen collection & labeling, adding another ID band into the process no longer adds any safety benefits. You’ve already created your closed loop system using the regular hospital ID band and scanning it for both specimen collection and blood administration in BPAM. 

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We are ready to consider discontinuing the BB armband.  Phlebotomy has worked hard to reduce the number of 'scan overrides' in Epic when collecting our specimens. We still have some work to do on Nurse Collects.  That is an important milestone for me.  The transfusion side (BPAM) does a good job of accurate ID but I want the specimen collection to be equally accurate before I switch.  We still have concerns about pre-op patients who aren't wearing any Epic band to scan when their pre-admit specimen is drawn. (I'm taking advice on how others manage these.)  Likewise for outpatient transfusions.  As of now, we have a blank line on the Epic blood release form that the nurses record the BB band # on before they bring or send it down to blood bank.  We have those forms print on the nursing unit.  The BB band # is not documented in Epic, but we have a custom flowsheet row where they acknowledge that it was checked and matches.

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Re:  We still have concerns about pre-op patients who aren't wearing any Epic band to scan when their pre-admit specimen is drawn. (I'm taking advice on how others manage these.)  Likewise for outpatient transfusions. 

Epic told us that their system is not designed to use the process of banding outpatients and pre-op patients.  WE INSISTED since 1) we've always banded any patient getting their blood drawn... especially for blood bank testing, 2) we were determined to meet AABB Std. 5.14.5.3) requiring an electronic (scanned) identification system, and 3) we decided that we were NOT going to go backwards after all these years and create a new system in Epic that was less safe just because they said that's their design.  I insisted that PPID scanning be used for the specimen collection/labeling and that the same armband be presented on the day of their admission or outpatient transfusion. The patient is given strict instructions (an instruction sheet that they must sign and is scanned into the EMR) that they are to keep the band on or at least have it in their possession on the day of admission/transfusion. The original band used for specimen collection is replaced with their new encounter band only after the 2 bands are compared side-by-side and match exactly for Name, MRN, DOB.  It was a bit of a struggle to get everyone on board to veer from the Epic "Foundation" methods, but we were finally able to convince people that this was a significant patient safety issue and was necessary.

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We use the FinalCheck armband and lock system with Epic BPAM. We also use electronic patient identification for specimen collection. The armband code is not documented in Epic or anywhere else on the floor, only in Blood Bank. The blood product is locked in a bag at issue and the combination to the lock is the code the nurse takes from the armband at the bedside. No armband, no blood product (except emergency or MTP). Once the unit is removed from the opened bag at bedside, the identification process continues w/ 2 person verification and BPAM. It is not cheap, but it closes a loop for specimen collection. The process works smoothly. We lose very few armbands. There are more problems with BPAM, most of which are related to somebody forgetting to check a box in Epic to begin the transfusion, forgetting to enter a volume, or scanning the wrong barcode.

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  • 1 month later...

From my experience requiring a BB armband # and EPIC you will find that EPIC doesn't support a BB armband #. The BB ID number is strictly a Wellsky function.

What you WILL find is that in order for nursing to be able to scan a unit into EPIC during the transfusion process they will have to have a "transfuse now" order that has been released by nursing. In our case release of  the "transfuse now" order  is designed to also to print a "blood pick up slip". This is what nurses are required to bring to Blood Bank when having products issued. This is also the form where they document the BB ID number that is verified during the issue process.

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On 5/2/2022 at 10:18 AM, bxcall1 said:

From my experience requiring a BB armband # and EPIC you will find that EPIC doesn't support a BB armband #. The BB ID number is strictly a Wellsky function.

What you WILL find is that in order for nursing to be able to scan a unit into EPIC during the transfusion process they will have to have a "transfuse now" order that has been released by nursing. In our case release of  the "transfuse now" order  is designed to also to print a "blood pick up slip". This is what nurses are required to bring to Blood Bank when having products issued. This is also the form where they document the BB ID number that is verified during the issue process.

And that transfuse order has to be from the same 'phase of care' where the patient will be transfused. If the transfuse order was entered in the ED or the OR, that order will not work for an IP on the floor - lets say ICU. BPAM won't work until a provider order is entered for that IP/ICU phase of care. Learned that one the hard way when we first went live with EPIC.

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I agree with the others who state to consider getting rid of the separate blood bank ID bands.

We do not use these currently. We have Cerner LIS and Epic EMR. The nurses scan blood bags and patient armband at bedside when starting the transfusion.

As an aside, we do bedside collection labeling in Epic. We do track Wrong Blood in Tube. When we first went live on Epic, those numbers increased, but once workflows were reinforced, the number is now very low.

The one WBIT we had in 2021 is where someone found a way around the system I believe someone mentioned it above, "scan overrides". Problem detected in blood bank when confirmatory sample did not match original type and screen blood type. Luckily this person no longer works here. :)

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