PAS/ Merges and MHRA!!

[RR1]

Some more MHRA non-conformances for folks to digest. All comments and suggestions would be gratefully received. These surround computer systems- both the lab LIMS and the hospital PAS system:

Merging record was not appropriately controlled in that:

Merging of patient records on the LIMS, whilst subject to procedure was not effectively controlled as evidenced by:

1.There was no process in place to enable an unmerge to be performed.

2.Evidence was observed where a patient had been merged on the system without appropriate approval of suitably qualified BT staff.

Merges at the PAS level (referring to medical records dept)were completed with procedures that:

1.Were out of date in that there was no evidence of formal periodic review since its issue in XXXX In addition there was an emboldened note on the procedure that stated the procedure was not to be used after the review date of XXXX

2.The procedure lacked sufficient detail to enable a merger to be safely employed.

3.There was no involvement of suitably qualified Blood Transfusion staff in PAS merges where the patients had Blood Transfusion or testing history.

4.There was no unmerging procedure available to enable the records to be separated in future should this be required.

[kate murphy]

Sounds like you need a policy/procedure to define the process and who is allowed to do it, under what circumstances.

I'm not sure about all LIS, but our lab system (Sunquest) can limit who has access to the Merge function. Only 3 people (out of 150) in the whole lab can do mergers.

Our policy states that 2 identifiers to be used, but if 2 patients have the same name/DOB, then we also use social security number. In the lab, we would also use Blood Type.

The hospital side is a more liberal - there is a shift supervisor for Patient Registration on every shift and that person can do merges.

You are not alone with this headeache!

[jayjay]

Merging of patient records on the LIMS, whilst subject to procedure was not effectively controlled as evidenced by:

1.There was no process in place to enable an unmerge to be performed.

2.Evidence was observed where a patient had been merged on the system without appropriate approval of suitably qualified BT staff.

So who is undertaking the merges? Are they lab staff or PAS administrators. Who ever it is they should be working to a policy/procedure which the TLM or QM has contributed to and authorised and be trained to the policy

Merges at the PAS level (referring to medical records dept)were completed with procedures that:

1.Were out of date in that there was no evidence of formal periodic review since its issue in XXXX In addition there was an emboldened note on the procedure that stated the procedure was not to be used after the review date of XXXX

2.The procedure lacked sufficient detail to enable a merger to be safely employed.

3.There was no involvement of suitably qualified Blood Transfusion staff in PAS merges where the patients had Blood Transfusion or testing history.

4.There was no unmerging procedure available to enable the records to be separated in future should this be required.

Again the procedures should be part of the transfusion document control and written with input from transfusion staff. The policy should clearly state how many identifiers would be used to merge and this perhaps should include group were available.

Perhaps they should send a request from PAS administrators to BT about whether patients can be merged or not as if you need to unmerge you may have to print out the details of both patients and all testing and components issued etc

[RR1]

Thanks for your comments Kate and jayjay.Our LIMS does allow unmerges to be performed but only up to 30 days post merge, after that I think that only the LIMS software suport provider can do this process. Thats why I think we need a technical agreement properly stating this process. Currently merges are only performed by a handful of designated lab and path IT staff (and i've opted out of this for the time being). We do have a merge procedure in place.

Thanks for input about PAS merges- lots of things I hadn't considered, but again I would have thought that a short technical agreement could be put in place with Medical Records, but then a procedure stating transfusion staff involvement might just be easier to do?

[Malcolm Needs ☆]

, but then a procedure stating transfusion staff involvement might just be easier to do?

[RR1]

Technical agreements are not that difficult to write you know-and they do clearly set out responsibilities of each side- infact I prefer them, as they are more 'legally binding'

[Malcolm Needs ☆]

Technical agreements are not that difficult to write you know-and they do clearly set out responsibilities of each side- infact I prefer them, as they are more 'legally binding'

Oh yes Rashmi. I agree that writing the Technical Agreement is easy enough. Getting them to take any notice whatsoever is another thing entirely.

As you know, we have Service Level Agreements with all of our hospitals, and this covers the hospitals responsibilities to us, as well as ours to them. One bit of this involves providing samples that are fit for purpose (fully labelleed, adequate in volume, etc), and yet we have to reject a goodly proportion of samples sent to us because they are either poorly labelled or are just plain inadequate in volume (and this is after me regularly having a rant at TAG meetings).

[RR1]

PAS merges continued.......

We are currently in the process of developing links with our Medical Records dept to have better control over the PAS merges. However the obstacle found is that there are many, many personnel in the hospital in various depts,that can merge these details on PAS, this is not solely controlled by M.R dept. I presume this is the same problem in most hospitals.

Please could I have some feedback as to how others are managing to control this process

Thanks

[adiescast]

I think it would be difficult to require that the blood bank be consulted before all HIS merges. Large hospitals do merges on many patients that have nothing to do with blood bank. It would be possible to request to review and have input into their procedure for performing merges in the hopes of improving the process. Like Kate, we have Sunquest and have only a few people who are permitted to merge patients in the LIS. There is a written procedure for how this is done and it is coordinated with the HIS merge. We get a printed report daily on all merged patients for Sunquest and we review all of the ones with blood bank data to ensure that there is no discrepancy and that no data is lost in the merge. We retain those merge logs for 5 years. We have occasionally discovered merges that should not have occurred and were able to get those repaired.