Meditech TAR-Beside verification

[bankeratheart]

I'm looking for Meditech users that have implemented Meditech Transfusion Administration Record. I am currently starting the process and I have some questions.

What identification are your patients wearing for transfusion bedside verification?

General Hospital band with Acct and Med Record # barcodes?

Unique barcode numbered Blood bank wristband with Med Rec or other barcode #'s?

Any particular manufacturer's item that worked for you?

Denise

[Lcsmrz]

We implemented TAR a few months ago at our small facility, using exisiting patient wristbands that already contained a barcoded visit number. The nurses love it, our paperwork virtually disappeared, and very few problems were encountered. We just had a CAP and JCAHO inspections within the past two months, and both inspectors were impressed with the implementation.

One encountered problem was the lack of bedside verification of RhIg injections. We code them now as Medications, rather than a BBK product.

One caveat: you must relabel components with an ISBT label for the system to work properly.

[samson]

We are in a process to implement Medinfo. blood bank system. Can anyone who is using this system give me some information as to how it works and how good it is?

[BankerGirl]

One caveat: you must relabel components with an ISBT label for the system to work properly.

I am curious as to why. We are just beginning to try this as well, and have encountered a problem with the unit barcode not matching. Meditech seems to not have a clue why as of yet.

[Lcsmrz]

Our TAR system asks that the patient writband plus all 4 unit barcodes be scanned for the bedside verification. The "Veify" step starts the transfusion process in the computer.

For FFP and cryo, the product barcode and the exp date/time must change after thawing, hence the need for an ISBT label overlay to make sure all 4 barcodes will pass the bedside verification.

You can turn off the bedside scanning for products and exp dates, but it must be done for all units, reducing the effectiveness of the bedside verification.

[BankerGirl]

OK, thanks for the reply. I hadn't gotten that far, and had obviously not thought of that.

[bankeratheart]

Is the re label for expiration date / time & component name changes on components. . Particularly FFP. We do have the capability to reprint labels in both Codabar and ISBT. Which 4 unit barcodes ?

Type / componnet / expiration/ unit # DIN ???

[Lcsmrz]

The four major ISBT barcodes are unit number, product code, ABO/Rh, and exp date/time

[SMW]

According to 21CFR606.121, the four items on a product label that are required to be machine-readable at the point of transfusion are:

1. Lot number related to the donor, e.g., donation identification number

2. ABO and Rh of the donor,

3. Product code, and

4. Unique facility identifier, e.g., FDA registration number.

The expiration date/time is not required by CFR to be machine readable although your computer system may have additional requirements beyond CFR........

[bbbirder]

From what I understand, there are some problems with TAR related to the timing of vitals by nursing. Something like, if you are late on one, the time for the next set of vitals runs from the time the previous ones were taken, vs the actual time due (I don't think I explained that correctly.)

I am also hung up on the volume problem. Can you use a default volume for RBCs? If it is a fat unit and nursing tries to transfuse 'more' than the default volume, is it allowed? What if the unit is smaller than the default? is there volume left over?

I would like to use TAR, we just aren't there yet.

[kriti]

We were testing this today and the scanners the nurses use could read the ISBT numbers, but not the codabar numbers. That is why some of our barcode scans were not matching up.

[korchek]

Positive identification systems that use bar-code scanning at the bedside for transfusions are considered blood bank software. Make sure that your vendor is cleared by the FDA.

[lkg1972]

We have been up on BCTA (that's what they called ETAR) for about 6 weeks. Some of the problems and solutions we have encountered are:

1. If more than 1 unit is at an issued status at the same time - make sure the correct unit is

highlighted. If the wrong unit is highlighted the computer will give them a warning that

the unit doesn't belong to that patient.

2. If the patient is crossmatched on one account number and admitted with a different account number - the computer will not let them proceed.

3. Sometimes the scanner "loses" its mind. It will scan the account number and the BB Bracelet number but not the product code. Have the nurse try another scanner.

We print a Blood Bank bracelet number out of Meditech that is used in addition to the hospital bracelet.

[goodchild]

From what I understand, there are some problems with TAR related to the timing of vitals by nursing. Something like, if you are late on one, the time for the next set of vitals runs from the time the previous ones were taken, vs the actual time due (I don't think I explained that correctly.)

I am also hung up on the volume problem. Can you use a default volume for RBCs? If it is a fat unit and nursing tries to transfuse 'more' than the default volume, is it allowed? What if the unit is smaller than the default? is there volume left over?

I would like to use TAR, we just aren't there yet.

We're coming into this same problem. I don't know if you still frequent the forums or if anyone else out there has come up with a solution that they would be willing to share. Our products come in as "from 500mL whole blood." The additive units have a default volume of 350 and the non-additive units have a default of 250 - nursing is reporting a wide, wide variety of volumes and wants us to hammer this detail out.

[MAGNUM]

I'm looking for Meditech users that have implemented Meditech Transfusion Administration Record. I am currently starting the process and I have some questions.

What identification are your patients wearing for transfusion bedside verification?

General Hospital band with Acct and Med Record # barcodes?

Unique barcode numbered Blood bank wristband with Med Rec or other barcode #'s?

Any particular manufacturer's item that worked for you?

Denise

BCTA is very easy to use. We implemented about 1 year ago. When scanning we use the hospital band which is barcoded, but we also have a unique blood bank band that is also barcoded. We set up our BCTA to scan the hospital band, then the bb band, then the 4 quadrant barcodes.

I looked at several different bands and due to ease of use I chose to use the Typenex flexiBLOOD system. I use their red armbands product #FLX999, their large bb card that includes 16 individual barcoded labels for the units, 2 barcoded band inserts, and they even include instructions for use on the back of the card product #FLX001, for cases where the band must be removed in the OR or the patient is exceptionally large I use the Typenex R3 system product #4R4700.

There are 10 of the R3 bands to the box, 100 cards to the pack, and 200 bands bundled 10 to the bundle per box of bands.

Hopefully this helps.

[MAGNUM]

We're coming into this same problem. I don't know if you still frequent the forums or if anyone else out there has come up with a solution that they would be willing to share. Our products come in as "from 500mL whole blood." The additive units have a default volume of 350 and the non-additive units have a default of 250 - nursing is reporting a wide, wide variety of volumes and wants us to hammer this detail out.

To remedy this, and keep the nurses from having to think toooooooooooo much, we weigh our units prior to issue, so that is the volume that is charted in BCTA to finish transfusing the unit.

[goodchild]

Thanks MAGNUM. That's definitely one of the options we came up with too, we just hate to add to the work flow of the techs. Did you guys request tare bags from your supplier or did they give you the tare weights? What about the specific gravity for the weight->volume calculation?

[sgoertzen]

To remedy this, and keep the nurses from having to think toooooooooooo much, we weigh our units prior to issue, so that is the volume that is charted in BCTA to finish transfusing the unit.

We are a children's hospital who started using TAR almost a year ago. The volumes of all of our products vary so much and are critical for our patients (they watch intake/output so closely), so weighing all of our products (as we receive them from the donor center and put them into our system) and also as we aliquot them into new split products has always been an important part of our procedure. My product dictionaries have no default volumes, and we enter the volume of each one as we weigh it. If you are off by a few mL and the nurse's pump shows that she transfused 257 mL even though the product was issued with the volume in the computer as 268 mL, it is fine. The entire unit gets the status of "transfused" as soon as the nurse hits the "End" button in TAR, and there are no pieces of product left hanging out in the computer somewhere. The nurse also has the ability to track in TAR additional saline flush volumes given at the Begin and End of the transfusion.

We do not use a separate armband since our regular hospital armband has the patient account number in readable and bar code format. Prior to TAR, we did not pay much attention to the Acct # and used the name and Medical Record # for the issue process, but TAR is Acct # driven, so we've now incorporated reading the name, MR#, and Acct# as part of the issue process. If the patient was drawn under an outpatient Acct# and then gets admitted prior to transfusion (gets a different Acct#), you do have to use the "Move to Account" routine to move the products to the new inpatient account, or else TAR will not work.

Please let me know if I can help you with anything. It "takes a village" to get it all put together, working correctly, validated, and everyone trained!

Sheri Goertzen

sgoertzen@childrenscentralcal.org