Patient Special Needs

[NightCrawler]

Hello Fellow Blood Bankers,

Asking on inputs on Patient Special Needs (i.e IRR notes etc.) notes. What measures does your laboratory take so that these notes are not missed on order entry? These may be both for electronic and paper orders.

Thank you!

The Nightcrawler:cool:

[Malcolm Needs ☆]

Hello Fellow Blood Bankers,

Asking on inputs on Patient Special Needs (i.e IRR notes etc.) notes. What measures does your laboratory take so that these notes are not missed on order entry? These may be both for electronic and paper orders.

Thank you!

The Nightcrawler:cool:

On most computer systems used by Blood Transfusion Departments in the UK (if not all), it is possible to put any special requirements (e.g. irradiation, CMV-, HbS-, etc) on to the system in such a way that any blood that does not meet these requirements cannot be issued, rather in the same way that ABO incompatible blood, or blood that has not been tested for a particular antigen, in the case of a patient with a clinically significant atypical alloantibody, cannot be issued.

Once on there, it takes a very high level of security to remove this requirement (although, of course, there has to be the ability for its removal from time to time, such as in the case of stem cell transplants, when the ABO group may change).

HOWEVER, Guidelines make it quite clear that the onus to request any special requirements is on the requesting physician, and if these requirements are not made clear on the request form, particularly on the initial request form, and blood not meeting these requirements is issued and transfused, the buck stops (as it should) with the requesting physician.

There is also an onus on the requesting physician to tell the Laboratory, in writing, should anything change (such as further requirements, or the fact that there is no longer a need for irradiated components).

:)

[bxcall1]

Meditech can be set up by entering 'markers in the patient history, to prevent the use of blood products that don't have appropriate markers (ie IRR or CMV neg). It happens frequently that the hematologist will request CMV neg/Irr blood products and later the general practitioner will order blood and neglect to order these 'special needs'. If the markers are entered in the patient history we will be required to use CMV neg/Irr products regardless of the current order.

[adiescast]

We put the special needs in as "attributes" in Sunquest. They cause a stop at issue if they are not met. It sounds like what you are asking is how do they get into the "attributes" when they are first ordered. For us, that is a manual process and has been a problem. The order goes into the HIS on a check screen (and often they get picked even if the doctor did not write it in his order - we don't have physician order entry yet), but it coems across to the LIS as an order comment. The order comment is in a tab that does not come up immediately when you log into the patient; you have to click on a couple of different tabs to make it come up. People have missed these orders and not entered them into the "attributes." Then there is no stop at issue. The nurses are not good about checking those requirements, so we have had to report several of these to FDA as blood product deviations. We tried to get Sunquest to make them come up on the first screen you see when you enter the accession, but without success.

[butlermom]

We are preparing for our CAP inspection and there is a new item on the checklist that has us baffled. It is TRM.42305 "Has a designated physician developed a therapeutic plan for patients undergoing therapeutic phlebotomies and have the goals for the therapeutic phlebotomy been clearly stated?" We do these occasionally mostly on outpatients but the Pathologist approves each prior to the procedure. Does anyone already have this process in place with a "plan....and.....goals....clearly stated?"

[David Saikin]

Our Docs have to order phlebotomies for frequency and desired hct/ferritin (outcome).

Most BBIS's provide for patient special needs in one manner of another. It is incumbent upon the user to validate that they work and that their techs are conversant with that usage.

[bbbirder]

We use Meditech and add a patient marker once we know of the special requirement.

However, knowing of the special requirement is another matter. We require the ordering physician to request it, but we don't have an actual "order" for this, instead rely on comments on the order. Believe it or not, this has worked well for us. We are not that big of a hospital and the nurses and ward sect (and even docs) are not too afraid of us to call us if they have a request like this and notify us.

We also have an automatic print out from pharmacy to notify us if a patient gets Fludara and we add the comment and marker to their BB history that they need irradiated products.

Linda Frederick

[sandramathews]

In the care industry, or in the special schools; it seems to be apparent that parents for one reason or another are blocked from being involved in care of their children.

They want to care for their children, to give input if their children give permission and also to be considered how the child's needs for care affect them.

However there is some considerable evidence that this mechanism is severely choked by various excuses or reasons that are part of rules and ethical laws.

Parents then as a result complain that their rights are not respected.

In some cases parents are left to clean damage or lack of attention give to the children who need to have care.

When I refer to children, it often included adults that need their parents help because the care system is not affective.

Do you think that there is conspiracy that tries to stop parents being considered in anyway?

[Marilyn Plett]

Sandra:

In the blood bank community special needs refers to transfusion requirements such as irradiation, CMV negative, sickle cell negative that are based on the patient's medical diagnosis. As an example, patients with transplants or some other immune conditions are usually transfused with irradiated RBCs to prevent complications. Since these situations are not always made clear in the transfusion request, blood bankers attach "special needs" in the computer system to individual patients to make sure that the patient always gets the correct product.