Let's change the Blood Bank world!

[Mabel Adams]

For the 30 years I've been in this business--whether using paper 5 part forms or computers--we have dealt with orders for blood being sent to us when there was already blood crossmatched. So we have to phone and ask if they want additional units set up or were simply unaware that blood is available. Back in the day, you could sort of forgive them because they didn't get a timely update in the chart of completed crossmatches and all we had to do was toss the extra orders. Now with interfaced systems, we have to cancel orders with proper documentation so no one thinks we lab people are taking it upon ourselves to alter MD orders without proper permission.

In the modern world of interfaced computer systems we should be able to do better and quit wasting everyone's time fixing the same problem over and over. What we need is a concentrated campaign directed towards all the computer systems (HIS mostly) that would convince them to make a simple "dashboard" pop-up appear whenever a blood product order was being entered in the HIS that showed any products already available. It should probably stay simple so we don't overload them with data they don't care about--just how many units of what products good until when. Maybe add Type and Screen info with a specimen outdate. Much more and they probably won't get it. It won't stop all of the duplicate orders, but just think how much "leaner" the blood order process would be!

Any takers? I am trying to get this message into the McKesson world at my facility.

[Malcolm Needs ☆]

Excellent idea!!!!!!!!!!!!!

:D:D:D:D

[richardsonj]

Amen!!!

[tbostock]

Ditto the Amen here! We are in the process of implementing a new HIS (Epic) and BB LIS (SoftBank), so I'm gonna try like crazy to see if something like this can be set up.

[Susan.Sullivan]

:highfive:AMEN sista!

[David Saikin]

Sorry Mabel but . . . that makes too much sense so it probably will never happen in our lifetimes . . . but it is a great idea.

[lateonenite]

It's a wonderful idea, and we have a similar process here, although not the pop-up you're describing. I'd love to give that a try!

We have a couple of options here with our system:

duplicate check warnings on orders

patient-product inquiry where the doctor can (and should be looking to) see what is available.

PPI is our best friend but has suffered with implementation (read: not enough training in it - and it's a bit of a pain; being PathNet it makes you enter the patient's MRN again, even though you're in "their" chart).

For our lower-order doctors (you know, the ones who do the ordering), I'd be heavily advertising first that there will be a pop-up box stating how many units were available, and/or specimen expiry, etc.; because after the fact, if you get them on the phone and say "there was a pop-up..." they'll swear black and blue that it never happened, isn't working, etc.

Still a great idea.

[ABQ bloodbanker]

I like it! We have McKesson too! But it does seem too logical to actually work!

[L106]

Great idea, Mabel! Unfortunately, it seems to me that the computer companies put their main focus on other parts of the Lab, like Chemistry, to impress people and make the sale. Most don't really give a XXX about Blood Bank (and that is somewhat understandable, since Blood Bank is never the department that carries the weight in the purchasing decision.)

What system do you use for the Blood Bank, Mabel? We have McKesson Horizon for the Lab and we are interfaced with Mediware HCLL for the Blood Bank Department. (What the nurses & docs see are the MeKesson products Care Manager and HEO.)

[bmarotto]

For years, we have been taking verbal product orders (with readback for verification) or faxed orders for this reason. This is coming to an end with our new HIS/EMR (Eclipsys). We were discussing ways to avoid duplicate orders just last week. After Blood Bank pointing out the many scenarios that could lead to duplicate orders, they are going to try linking the "transfusion" order to the "product order" and Type & Screen. If an MD orders a 2 unit red cell transfusion, the T&S order and red cell product order are implied. The nurse will check to see if there is a valid T&S and if blood is already available and activate the linked order(s) only if indicated. We are still early on and have not begun testing yet but I am for anything that prevents or reduces duplicate orders. I am not so concerned about platelets, plasma, and cryo since we generally only get orders for them when there is the order to transfuse.

[Kellpos]

Lets face it, nurses are never going to understand or look up information that is readily available to them. It's easier to just call us. What is needed are electronic armbands (RFID) that have this information. It's probably available, but what hospital administrator is going to sign off on a major upgrade that will benefit everyone.

[grace]

Mable is right that the change needs to be made in the HIS or physician's portal or EMR......the place where nurses and doctors would see it. I've worked for two different software companies and both of them had more ideas for new development than they could handle at any given time. They both were motivated by customer input to make changes but the best time to force a new idea is BEFORE you buy an application. Make it part of the negotiation. Good Luck!!

[jayinsat]

I really want to be optimistic here, but the realist can't quit laughing. I tend to think they will enter past any pop-up, warning, query, etc., just like they do now. I have personally trained hundreds of nurses how to check if blood is available and made sure they were proficient. What happens? They call anyway and say they didn't have time to look it up, or they are in the patients room, on a mobile phone, away from the computer. I usually make them wait 5 minutes (passive-agressive guy that i am) just to prove that calling is never quicker.

Just my little black cloud over the scene.

[whbb]

We are currently up on MEDITECH, which will have in place a means by which nurses can look for available products for their patient using the STATUS BOARD. This will be implemented to us by the end of the year.

Right now, the nurses could look for available products using PCI (Patient Care Inquiry), but they don't do that. It's so much easier for them to order a duplicate knowing full well that if it is a duplicate, the Blood Bank will call to clarify the order. They also call and ask if a product is ready even though they can look themselves. I don't think there is any way to change this other than training the RNs and "rufusing" to give them information they can obtain themselves. It's not going to prevent the duplicate orders. They just won't call.

When we implement BCTA (bar-coded enhanced transfusion administration) this year, this tool will be used for the nurses to enter transfusions into the computer, and require bedside scanning of the patient's armband and the product to confirm that it is the correct product for that patient. In order to start the pre-transfusion vital signs, the nurse will need pull up their patient's information which will include the products that are ready to be transfused.

All I see is a nurse calling to see if a product is ready prior to them entering vital sign information instead of looking in the STATUS BOARD first. We will see how the training goes.

[rravkin@aol.com]

Whbb,

I experience the exact same senerio. I wonder if the duplication of orders and unnecessary phone calls simply fall under the category of "CYA" on part of the floor staff. If this is the case it will take alot more then a pop-up screen to correct the situation in the long run. I wonder how much edcation the RN's actually get in BB and I wonder if they recieve more training in pharmacy. For that matter, I wonder how the duplication of orders in BB compare to duplication of pharmacy scripts?

[LaraT23]

I will do you one better! Not only do we get the constant phone calls about information they could look up. We have been asked to call when units are ready on every patient that we set up every day. Talk about a waste of time! Then someone doesn't convey the message, so we put in the computer system who called it to and when ( meditech). Sheesh, talk about spoiled! As if we had nothing better to do:mad:

[Brenda K Hutson]

For the 30 years I've been in this business--whether using paper 5 part forms or computers--we have dealt with orders for blood being sent to us when there was already blood crossmatched. So we have to phone and ask if they want additional units set up or were simply unaware that blood is available. Back in the day, you could sort of forgive them because they didn't get a timely update in the chart of completed crossmatches and all we had to do was toss the extra orders. Now with interfaced systems, we have to cancel orders with proper documentation so no one thinks we lab people are taking it upon ourselves to alter MD orders without proper permission.

In the modern world of interfaced computer systems we should be able to do better and quit wasting everyone's time fixing the same problem over and over. What we need is a concentrated campaign directed towards all the computer systems (HIS mostly) that would convince them to make a simple "dashboard" pop-up appear whenever a blood product order was being entered in the HIS that showed any products already available. It should probably stay simple so we don't overload them with data they don't care about--just how many units of what products good until when. Maybe add Type and Screen info with a specimen outdate. Much more and they probably won't get it. It won't stop all of the duplicate orders, but just think how much "leaner" the blood order process would be!

Any takers? I am trying to get this message into the McKesson world at my facility.

This is the 6th (and last) Institution in my 26 years but the first time I have had to deal with duplicat

e orders (as described above). However, I'm not sure your suggestions Mabel would totally solve the problem. Example: Our IT deparment tried to at least solve the issue of duplicate Type and Screen orders (current T&S; want units and order everything again). So, they made a box in the middle of the ordering screen that states: Order ABO, Rh & Abdy Scrn if ABO results not displayed to the right; then there is an arrow pointing to a box to the right; either there is a type, or there isn't; seems simple enought, right? WRONG! The doctors won't even take 2 seconds to look at that! Their unwillingness to take a little extra time to order correctly, takes up a lot of other people's time (BB staff who have to call regarding RBCs as described above and/or call for a Type and Screen that should have been ordered, and/or cancel a Type&Screen and/or XM if duplicate; and phlebotomy who never knows then whether to draw a specimen; and the Nurses who are constantly interrupted and asked to order a Type&Screen, or asked if they need more RBCs because they already have some XM).

This has been a huge frustration of mine here (in case you could not tell). The Intensive Care Director suggested I write up every erroneous order in the Hospital error reporting system and that the Chief of Staff "would" do something about it. Well, 2 problems there; first, we are talking a LOT of orders on a daily basis, and 2nd, my Medical Director does NOT want me to do that.

Bottom line: I agree with you; this has to stop!

Brenda Hutson, CLS(ASCP)SBB

[Bill]

Brenda, why doesn't your Medical Director want you to document these errors? If provider order entry is relatively new, part of any new process is to document and review its effectiveness. If you do not document these errors, that review process will not know of the problems.

[Mabel Adams]

For years, we have been taking verbal product orders (with readback for verification) or faxed orders for this reason. This is coming to an end with our new HIS/EMR (Eclipsys). We were discussing ways to avoid duplicate orders just last week. After Blood Bank pointing out the many scenarios that could lead to duplicate orders, they are going to try linking the "transfusion" order to the "product order" and Type & Screen. If an MD orders a 2 unit red cell transfusion, the T&S order and red cell product order are implied. The nurse will check to see if there is a valid T&S and if blood is already available and activate the linked order(s) only if indicated. We are still early on and have not begun testing yet but I am for anything that prevents or reduces duplicate orders. I am not so concerned about platelets, plasma, and cryo since we generally only get orders for them when there is the order to transfuse.

With our latest computer system (McKesson HCI/HEO, Horizon Lab, Horizon Blood Bank, aka Wyndgate) we finally have everything interfaced and Phys. order entry in place. They have no end of trouble with the concept that nurses need an order to transfuse and BB needs an order to set up blood. I keep saying it is like planning a picnic and only telling one person what everyone is supposed to bring--and he doesn't know you didn't tell the others.

Then, someone wants to make it so all product orders have transfuse orders or vice versa, but that isn't real life either. These things don"t always happen together. We set up blood in case it is needed later, they transfuse units set up previously and they order and transfuse together. The system must handle all these scenarios at least. We have had many delayed transfusions, a patient transfused without orders to do so and many, many annoyed workers. It is starting to get better after 6 months and focused nurse retraining.

We have trouble with the MDs blowing by pop-up boxes telling them of duplicate orders now. I hate to see what we would get if we made all blood product orders give them pop-ups--they would have no way of knowing (without taking some time to look anyway) whether the prior order's units had been transfused.

I look forward to seeing how the Meditech Transfusion module Status Board does with these issues.

This doesn't give me a lot of faith that we can improve health care efficiency if we can't even do this. Surely someone with a black belt in Six Sigma can tell us that their hospital has solved this and we can all learn how.

[KKidd]

I will do you one better! Not only do we get the constant phone calls about information they could look up. We have been asked to call when units are ready on every patient that we set up every day. Talk about a waste of time! Then someone doesn't convey the message, so we put in the computer system who called it to and when ( meditech). Sheesh, talk about spoiled! As if we had nothing better to do:mad:

And I thought we were the only ones that had to do that. I even have to make sure it is a nurse (preferably the patient's) since the ward secretary is not capable of passing along the message. I have encouraged folks to check PCI in Meditech before calling the Blood Bank. Then we get the calls " I checked PCI and it looks like Mr. Smith has 2 units of RBC. Is that correct?" Of course, this always happens on my busiest day .... The ED and floor are not able to communicate and normally the crossmatch is ordered again when they get upstairs. At least it keeps us from getting bored!!!

Thanks for the opportunity to vent!

:sarcastic:meditate::meditate:

[spin]

I agree with "Lateonenite" .... With Patient Product Inquiry, the nurses/physicians can easily see what products are available and what products have been given. The hardest part remains in the training and actually getting them to use it. For some reason, they think it is easier to call the blood bank then to look it up in the computer

[Brenda K Hutson]

Brenda, why doesn't your Medical Director want you to document these errors? If provider order entry is relatively new, part of any new process is to document and review its effectiveness. If you do not document these errors, that review process will not know of the problems.

It is a little thing called POLITICS!!

Brenda

[sona]

i would here like to share with you guys that at our facility we do have a software designed specially for blood bank

we have a crossmatch window which shows requisitions made by doctors about what product of blood the need with other details we call it the MIS it really helps us to tell about the arranged blood by just typing patients identity numbers and helps to see and mange our stock

[JoyDenver]

Terri, We will also be imlementing Epic HIS. I would be interested in yor progess and how it is working.

We are not due to convert for 3 years, but any issues that come up for other users would be gratfully appreciated.

Joy

[clmergen]

I have been through two EMR implementations. The first one was Cerner with a simultaneous Cerner Millenium upgrade from classic. The second was Epic while lab stayed on Cerner classic. My strong suggestion is make sure Lab and Transfusion Services are represented as MUCH as possible and keep with you the standards of AABB and CAP or whatever regulatory requirements you need. Input early on is the key. During the first implementation, we had a lab representative on almost every group and if there was a question he couldn't answer, he would contact the appropriate department. It was much better in the end than the other way around.