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Crossmatch at dispense


gene20354
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My facility performs electronic crossmatches on all patients that do not have clinically significant antibodies. Our current practice is to perform the crossmatch when the order is received. We would like to change this practice. We are looking into performing electronic crossmatches at the time of dispense. This should free up a lot of units that are crossmatched but never dispensed. Is anyone else doing this? If you are, would you mind sharing your procedure with me or offer some advice?

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Basically our policy is that they must have no clinically significant antibodies, 2 blood types on file, current antibody screen negative and no other QA failures on the current specimen such as ABO discrepancy to qualify for EXM. Our policy also states that blood must be available for the patient should they require it. So, if for any reason we can't just grap a unit from the fridge and do an EXM we would do an EXM prior to dispense.

JB

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We are also looking at changing to EXM on dispense. The main consideration that I can see is that the transporter would have to wait while you do it if you don't know they are coming. We are considering getting the floor to send us something that tells us they are coming. This can be a computer message that prints in blood bank, a fax to blood bank, a tubed message, or a phone call (I prefer to stay away from the call, we get enough of those as it is!). I am still working on this process, but those are my thoughts at this point.

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Just before I left we were in the process of installing Wygate's SafeTrace TX. This was to be our first chance to actually enter the 21st Century of electronic crossmatching. My intent from the beginning was to crossmatch at issue. I left before the project was complete and I've been told that they are having problems figuring out just how to do it. I don't know the details but I hope they get it figured out. It should make inventory management much more efficient.

:confuse:

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If a patient qualifies for an electronic crossmatch, we do not set it up unless we know they are coming for it. We do set up outpatients, open hearts, & auto units. The process works very well; however, it is very difficult explaining blood availability to Nursing. That is usually how we know they are coming because they call 1st :(

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If a patient qualifies for an electronic crossmatch, we do not set it up unless we know they are coming for it. We do set up outpatients, open hearts, & auto units. The process works very well; however, it is very difficult explaining blood availability to Nursing. That is usually how we know they are coming because they call 1st :(

We handle it pretty much the same way. If they call and ask if blood is available, we always say yes, if the screen is complete. If they ask how many are ready, we ask them how many did they want! Nurses and doctors just don't get it no matter how many times we try to explain it to them. A couple of the surgeons and anesthesiologists are starting to catch on.

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We don't wait for issue to actually crossmatch but we are light years ahead now in that we don't "hold" blood any more. We only set up what is going to be transfused unless there is a specific need to have units ahead (MBT, OR Cardiac etc.). I love the EXM.

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A large facility I previously worked at, did perform electronic crossmatches at dispense. When you think about it, a lot of the blood ordered to be crossmatched, is never sent for.

I think the biggest issue you need to look at is your staffing; is it such that there would always be someone available to drop what they are doing at any given moment, and set-up (electronic XM) and label 1 or more units.

If you do not have the staff for this 24/7, it could put undue stress on your staff. If you only have the staff on Day shift (and maybe PM), you might have to be selective in what patient population would fall into this category (i.e. maybe Outpatient Transfusions for example; usually Day Shift).

If there would be a LOT of patients that fall into the category (waiting until dispense) and you work at a really busy Institution (and like many of us these days, have minimal staffing; AKA sweat shop ;)), you will need to weigh all of this.

Brenda Hutson, CLS(ASCP)SBB

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I haven't heard anyone mention this aspect, so would I be correct to assume that Transfusion Services that use the EXM are typically larger institutions (with a large blood inventory?)

I could see that small-to-medium-size facilites could encounter surprise inventory shortages if they did electron crossmatches at the time of dispense if they did not get some type advance notice of the patients' estimated needs. How have smaller places handled this issue?

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I haven't heard anyone mention this aspect, so would I be correct to assume that Transfusion Services that use the EXM are typically larger institutions (with a large blood inventory?)

I could see that small-to-medium-size facilites could encounter surprise inventory shortages if they did electron crossmatches at the time of dispense if they did not get some type advance notice of the patients' estimated needs. How have smaller places handled this issue?

Hmmm...goot point. I did not comment on size in my e-mail because the 2 places I did this were large, such that running out of inventory did not occur to me. Yes, that would be another factor.

At the Institutions where I performed electronic XM at dispense, yes, they were both very large; so inventory was not at all an issue.

Glad you brought this other issue up because I am now at a medium size community hospital (about 400 beds) so that will be something I need to consider when I get up up on Electronic XM (hopefully this year).

Brenda Hutson, CLS(ASCP)SBB

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If the ordering pattern did not change, then it should work out. So, if the doctor orders a 2 unit crossmatch, you would do the type and screen and ensure that you had the two units in inventory, but you would not tag them until they came to pick them up. As I am looking at setting up the units on dispense, I was not planning to say anything to the clinical staff about changing how they send through the orders. That way I have an idea of what they expect to use just as I do now.

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How do you keep track of what is ordered versus what is dispensed. Example: Day 1 you receive a type and screen an order for 4 units of red cells. One unit is crossmatched at the time of dispense on this day.

Day 2 no blood is picked up.

Day 3 someone shows up and wants to pick up another unit. Before the tech can perform the crossmatch the tech is going to have to investigate the following:

· Figure out how many units were originally ordered

· How many units have already been dispensed on this order

o If only 1 unit was dispensed the tech could dispense 3 additional units, if 4 units have been dispensed, tech would have to request a new order.

I can see this being managed 2 ways, on paper or in LIS. LIS will work but will require several steps to look up all of the information. If we keep the paper order we could place a mark on the order each time a unit was dispensed. This could also become time consuming when you have to look through 3 days worth of orders.

Does anyone have a easy way to manage this?

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