Bones & tissues in the blood bank...

[johnvb]

Who is responsible for managing transplantable tissues at your facility? With newer regulations in place, and more expected, some are moving this all to the blood bank.

If this is happening, how will (are) you managing:

• Trace/Track-ability requirements
• Vendor qualifications
• Inventory - storage location and date
• Recalls / patient notifications

What problems are/will you have in the BB?

[Lcsmrz]

While the Blood Bank is certainly comfortable with managing tissue products according to regualtions, there is always the inventory problem -- surgery tends not to communicate surgeon requests well, so the appropriate products aren't always available.

Then there is the cost of carrying the inventory and of expired products ...

[Franklyn]

We are, at present, moving all the tissues into the blood bank as part of a "Tissue Management" section. Our first step is to purchase a dedicated tissue management system rather than shoe-horn everything into the Blood Bank system. While we are starting from scratch with setting up a lab, the hospital has been purchasing tissues for quite a while and already has many of the system (e.g. vendor qual) in place. The dedicated system will help us address trace and track, recalls, storage location, etc. Coupled with our centralized monitoring system (for refrigerators, etc.) we should be in pretty good shape.

The hard part is going to be getting the surgical areas used to ordering/requesting what they want rather than going to a shelf or freezer and doing their own "shopping."

[johnvb]

Managing surgeons / OR staff is a recurring message I'm hearing as I cull the industry regarding needed functionality. You might find the process change to be more significant than the technology change.

Another problem I've been hearing about is managing inventory with multiple storage sites. Folks I've talked with say they either don't know what they have or know what they should have, but don't know where it is. One customer had to do an audit and found $40k in expired inventory!

And the level of trackability/traceablity makes this potentially very complex. Do you plan to document who handles - and the state of each material - items that may go to surgery but are not used and returned? The system requirements could be substantial.

I'd be interested in which systems you are looking at and if you are finding dedicated systems out there that will meet your needs. I'm in market research and I haven't found many that look ready for prime time. Tissue vendor software seems too single threaded to be useful. A couple of others offer interesting technology but lack the functional depth.

We're (Mediware) bringing this type of product to market in June and I’d be interested in hearing the core functionality you seek so I can check / balance our product management team. Let me know if you be interested or just post to the board. Thanks

[Franklyn]

At present we are looking at three systems:

Tissue Track Core

Rosebud

QSight

Tissue Track Core is all web based and is a subscription service. You don't install anything locally.

Rosebud used to be marketed by Stryker, but is a standalone system

QSight is from Owens and Minor. They bought Cyrus (the system we originally intended to purchase) and have just discontinued that product. Supposedly they rolled that technology into their QSight product which is (as I understand it) an inventory management system.

Track Core was pretty sweet - but we still have a lot of un-answered questions that we may need to come back and address (e.g. how is billing handled? How is the interface to Surginet setup?)

We are going to see a demo of Rosebud on Monday. QSight still hasn't made good on their promises to contact us and setup a demo, so who knows...

[Bonnie]

I work in the Transfusion Dept in our Hospital and we manage the Tissue Program. Right now we store the frozen and refrigerated tissue and Central Supply stores the ambient. Our plan is to store the ambient tissue in the future. It is also hard with the documentation that is required for Central Supply to comply with what we ask of them. Surgery is hard to deal with also because they just cant seem to think how they could ever get their ambient tissue from Transfusion. Even tho thats where all their blood products come from in a very timely fashion.

We are also later on this year going to work on getting a computer system up to track the tissue products. We will probably try to use our Sunquest System for it. Does anyone know how much the Tissue Track Core System is?

[Franklyn]

Tissue Track Core, QSight and Graft Tracker are all "Hosted" systems. You connect to them via a web browser from any computer in the hospital. So, you installation cost is limited to the bar code scanners and computers "in house" that you need to purchase AND the annual contract with the vendor. Since the cost varies based on a bunch of little things, it's best to contact the vendor and ask for a quote. They will be happy for the chance to sell you something...

[Dave Lindey]

Franklin, if you haven't made a decision yet, you might consider taking a look at Biomedical Synergies' Tracks for Life system. It's web based as well and is getting a lot of attention.

Good Luck.

Dave

[Franklyn]

We are actually in discussion with the Tracs 4 Life folks. Their system came out on top of our comparison matrix but conflicting projects have stalled our progress and we still aren't certain if we will be purchasing their system. Personally, I hope we do, but the final decision will be made much farther up the food chain.

[Mabel Adams]

What kind of price is involved in these various software products--especially the Tracks 4 Life one?

[Franklyn]

That really varies... Tracs4Life can be hosted by the vendor or installed within your corporate firewall. So you actual cost will vary depending on which of the system dependencies you already have in-house, what you have to buy, which service package you are going with, etc. Since there is so much wheeling and dealing done I am not comfortable giving you a price, but I always, mentally, ball park $200K as a base amount for any IT system. If it is less, I am pleasantly surprised.

[Franklyn]

I found a proposal from May of 2008 and the tissue software we looked at and the cost of the software (not including requirements like hardware and a MSSQL license, etc.) was Approx. $25K with an annual service contract cost of just under $10k

Quite a bit less than the $200k I expected.

[bxcall1]

If you can define products in your current blood bank system you should be able to use it for tissues as well. If so there is really no need to

spend $ on new software.

[Franklyn]

Blanket statements are often inaccurate and after over a year of wrestling with tissue services in my institution I must disagree with that statement. While it is almost certainly possible define tissue products in the blood bank system, the fit is often kludgey and poor and the efficacy will really depend on your LIS system and workflow/process model.

Sunquest, for example, does a poor job handling single lot/multi unit items (like RhIgG) and while they have made great improvements I still cringe whenever we talk about defining such an item in Sunquest. Many tissue items (and don't forget pins and screws, etc) are just that kind of item.

If the blood bank is to receive orders for ALL tissue products and dispense them only at request then you have the best chance at getting tissues in a blood bank system to work.

If you are going to use managed cabinets to remotely stock and control certain kinds of tissues, it is not such a good fit and will require a lot of work-arounds.

If you are going to completely decentralize tissues you haven't a chance of a snowball in Guam of getting tissues in a blood bank system to work.

[tbostock]

Just curious...what is the push for moving tissues/bones to the Blood Bank? I understand the rationale that we probably do a better job, but are there actual regulations in place yet? I heard they are coming, and received a very strong verbal recommendation from our Joint Commission inspectors that we take ownership, but I very politely declined. Seems that the JC is looking at regulating this in the future, but for now, I can't find any actual regulations that require it.

Please advise.

[Franklyn]

It all comes down to the JC - they have published (two years ago) regulations regarding tissue management within hospitals. The requirements are nearly verbatim those of blood in birth to death tracking and processing, but lack the testing issues as the products are most often purchased from a vendor. The regs also have a requirement for a compliance oversight by a single individual or group. As the blood bank is already an expert in this sort of tracking (really just inventory management and doesn't even require an MT as no testing is involved) all eyes turned to us.

We really don't want the headache, but we are in the thick of developing the long and short term process changes to, eventually, bring all tissues and implants under the auspices of a "tissue services" lab established by the blood bank. At present, we only handle solid organs (e.g. livers and kidneys) - this would expand on that.

BTW - we defined solid organs in our blood bank system several years ago as part of this project. Salvages vessels, in particular, are difficult to manage. So we do have a lot of experience with the shortcomings of trying to fool a blood bank computer system into managing tissues.

[Kellpos]

I'm with you - why spend money when you can use your exisitng system.

All you need to do is develop 2-4 different groups with specific tissues listed. That way, when issuing (from blood bank) everything is right there.

[LABKOH]

Who is responsible for managing transplantable tissues at your facility? With newer regulations in place, and more expected, some are moving this all to the blood bank.

If this is happening, how will (are) you managing:

• Trace/Track-ability requirements
  
• Vendor qualifications
  
• Inventory - storage location and date
  
• Recalls / patient notifications
  

What problems are/will you have in the BB?

Our hospital has already made blood bank or should I say the lab and it's Medical Director responsible for tissue tracking. It is a headache, but we tackled it. Our MIS department developed a computer program for us to track the tissue and I have written a procedure that follows TJC standards. We have 3 different areas that maintain tissue for implant--general OR, CVOR and our Wound Treatment Center. (Believe me it was a fight to get the different areas to cooperate and buy into what we are doing!!! But with Administration's backing, we did it!!!) I know what we have done is not perfect, but I will be glad to share any information I have, if you are interested. My e-mail is kathy_hadaway@eamc.org

[CABMT]

Our BB began using Mckesson's Horizon Tissue Manager (formerly Rosebud) in March 08. We receive all tissues in BB and I would recommend that the process be limited to only a few people for consistency sake. Room temp items are stored in the OR and refrigerated and frozen items are currently stored in BB. This is a shared process between the OR and BB where we receive, then distribute, then the OR records preparation and implantation information electronically. It satisfies the JC regulations and seems to be working well so long as the OR staff remembers to do their part.

As for vendors qualifications, we made a list of expectations and had them send documentation that proves their accreditations, registrations, etc.

[Kellpos]

Who is responsible for managing transplantable tissues at your facility? With newer regulations in place, and more expected, some are moving this all to the blood bank.

If this is happening, how will (are) you managing:

• Trace/Track-ability requirements
  
• Vendor qualifications
  
• Inventory - storage location and date
  
• Recalls / patient notifications
  

What problems are/will you have in the BB?

Like blood & blood products, each tissue has a unique number with expiration date, vendor, date rec'd. If recalled, we look up unit # (we use Sunquest). We submit a questionairre to vendors asking them to supply us with their licenses, etc, then have our director sign off.

Our tissue bank is just off the blood bank, where we have a Helmer RT incubator, refrigerator, and ultra-low freezer (-80C). Inventory is done daily, and allocated to pt when requested, then issued after we receive a separate release form. A tissue implant record (similar to blood transfusion record) is attached to tissue. The copy comes back to us.

[macarton]

Surgery has the freezers for tissue and heart valves and keeps up with paperwork. Blood bank changes the graphs (JC inspector recommended, long story). Alarms call surgery and blood bank via phone system. Mary

[bxcall1]

Blanket statements are often inaccurate and after over a year of wrestling with tissue services in my institution I must disagree with that statement. While it is almost certainly possible define tissue products in the blood bank system, the fit is often kludgey and poor and the efficacy will really depend on your LIS system and workflow/process model.

Sunquest, for example, does a poor job handling single lot/multi unit items (like RhIgG) and while they have made great improvements I still cringe whenever we talk about defining such an item in Sunquest. Many tissue items (and don't forget pins and screws, etc) are just that kind of item.

If the blood bank is to receive orders for ALL tissue products and dispense them only at request then you have the best chance at getting tissues in a blood bank system to work.

If you are going to use managed cabinets to remotely stock and control certain kinds of tissues, it is not such a good fit and will require a lot of work-arounds.

If you are going to completely decentralize tissues you haven't a chance of a snowball in Guam of getting tissues in a blood bank system to work.

Sorry you have a system that won't easily accomodate new product builds. As much as it pains me to say something good about Meditech,(I hated it when I first got it) it is a pretty simple process to add as many new products as you might need. Our old system, Informedics would also easily accomodate bone and tissue products.

We do process all orders for bone and tissue and the process has been working very well for us.

[Franklyn]

Your mileage will vary by your system. Many tissue products (freeze dried bone chips being the easiest example) are single lot, multi-vial products and Sunquest still doesn't handle them as seamlessly as you might like. Furthermore, as I stated previously, if the Blood Bank is dispensing tissue you have the best chance to make "shoe-horning" tissue into a blood bank system. We will be using a hybrid model that includes managed cabinets - how would you system handle those? Don't forget that part of the JC reg includes regulatory oversight so how do you audit that all tissues requiring reconstitution have the lot/volume/date and time recorded? Even if that is a "clinical issue" at your facility somebody has to have oversight for it. At my facility that is the blood bank and the easiest way to peek into surgery is via a dedicated system that interfaces with Surginet and 'extracts' that information for audit purposes.

I really don't want to get into a "yes it will/no it won't" debate - every facility is unique in it's internal politics, volume, workflow and complexity and what works for one facility may not work for another. I assessed a small hospital once that managed equipment in a way that I could not believe would work, and I dug through the records and talked to staff looking for problems and found none. Their method would have been an unmitigated failure where I work but they were able to comply flawlessly. I think this is another of those scenarios.

[bxcall1]

Even though you might receive several products of the same lot, try receiving them as individual products with their own donor numbers instead of by lot. If I was to try to enter B/T by lot it would probably be as disaster.

[jbrun]

I was wondering if any of you out there know of any regultaion(s) JCAH, AABB, etc. which prohibit the storage of blood and tissue in the same refrigerator. Thanks.