bloodbank without a computer

[toelle]

I've found myself in a new position at a new hospital without a bloodbank module. While we are "patiently waiting" to be computerized, can anyone help me remember what was done before computers! I feel like we are doing things redundantly, but I can't find information on how to do this the easiest. Anyone have at least a list and summary of the worksheets we need or an online reference? Thanks.

[adiescast]

When you are manual, you will have some redundancy to allow the tracking you must be able to perform. From what you say, it sounds like the lab has a computer, but the blood bank does not? If that is the case, you will not have to log samples. There should be a blood component receipt book to track all your blood components in inventory and a way to record unit retypes. One place I worked had donor cards for this. Each unit got a card when it arrived and all testing results were recorded on that card. The card was attached to the patient history card when the unit was transfused. For a multi-transfused patient, the packet got rather fat. Each red cell unit would require a sticker to indicate that it was retyped and stickers to indicate any antigen typings done on it. You will need a place to record component prepearations (thawing plasmas, thawing/pooling cryo, pooling platelets, irradiations, etc.). You will need a place to record results for all patient tests performed in your blood bank. Most blood banks used a result book for that. Then you need a place to record blood product issues/returns/transfusions and a patient history card with information about special requirements (leukodepleted, irradiated, sickle negative, fresh blood products), antigen/antibody history, transfusion problem history, products transfused. The issue log will serve as your tracking method for lookbacks. The patient history card would be pulled for each time you encounter the patient so you can look at their history and know what their special requirements are.

That is all separate from any quality control you perform. We still do all of our quality control manually, with forms for each type of activity performed. We also have manual documentation of reference work like antibody panels, antigen typing, etc.

I hope that helps. I have some manual sheets that we use for down time that I have attached here in case you might find them useful.

Downtime forms.xls

[Dr. Pepper]

Takes me back! We had 4 primary forms:

1. Incoming blood log (RBC): our inventory #, drawing facility and #, component, weight, retype reactions and interpretation, tech, date received, ourdate, and disposition (if transfused this was the page in the crossmatch logbook).

2. Crossmatch logbook: Date, donor #, donor type, patient name, patient MR#, room #, XM results, ab screen results, billing record, issue data.

3. Typing logsheet.

4. Incoming FFP/cryo log

Our crossmatch forms had a big face sheet that ended up in the chart as the permanenet record of the transfusion, a smaller copy to be the bag tag, another bag tag that we kept in the BB, and a billing copy with checkoff boxes for the appropriate charges.

If you leave me a private message with a fax #, I'd be happy to fax samples of 1, 2 and 4.

[toelle]

Thanks,

It appears from what both of you have said that we are pretty much doing everything we need to be doing. We do have bloodbank workcards also with the patient type and screen and crossmatch unit results. Maybe I am just so used to computers that it now seems like it would be very difficult to do a lookback and be sure you found what you needed to find. We currently also have a separate receipt log for rbcs, plts, cryo, ffp, etc and the rbc one has the retype info. I also put a space on the receipt logs for the final disposion. Our crossmatch log then is all crossmatched rbcs AND assigned products and then also tracks the dispense and disposition.

We do have the ability to freetext onto a form for the unit transfusion record. This then prints a 3 part form. We also tag the unit with a little card to stay on the unit while it's transfusing. The pink copy stays in bb upon issue with the dispense signatures, then the yellow copy comes back for billing and on file in bbank and pink is tossed. The top copy goes on the chart. Then I check off the transfusion as complete on the crossmatch log, bill for the unit in the computer, then go back to the unit in the receipt log and note its final disposition as transfused. This is the part that seems redundant, but, since all units need to note a final disposition, it seems like the transfusion needs to be noted in both places. Then, I feel like I should note it on the patient's work card as well. I also have a modification log as well. My director thinks that's not really needed, but I'm positive we need to note any changes in expiration due to modifications.

I really, really want to be computerized! I was told 6 months. Doing this manually just seems too risky for typos, as well as the real type errors, etc. I've come to appreciate barcodes more than ever and I miss scanning them.

Thanks for the input.

[toelle]

Thanks Adiescast, your forms gave me some ideas to better arrange my work cards and the crossmatch log. You stated that we wouldn't need a specimen log, but we have one. Just seems like the best way to know who you have specimens on. Our computer system is not very forthcoming with that information.

[adiescast]

Sounds like you do need a specimen log, then. I made an invalid assumption that the lab computer was able to perform that function. Sorry!

[yiams]

Toelle, You ain't alone! As a 180 bed level II Trauma Center with dialysis, oncology and cardiac surgery it becomes quite challenging doing this all by paper. But we do. A Cerner Millenium module is coming. The funds are allocated but no contract has yet been signed. We hope to get this process started soon. From the replies, you're on the right track. Welcome to the world of hand cramps. ;-)

[Barb Thompson]

We are also manual. We write so much we run pens out of ink! Logs, forms and paper everywhere. We are working to go live on Cerner Millenium in May 2011. Can't happen fast enough.

[Deny Morlino]

Paper here as well. The hospital is working on upgrades (hardware and software) to improve the admissions, discharge, and transfer module of the HIS. After this is finished (and debugged ) we will probably look at a blood bank module. Progress at a snail's pace.

[lalamb]

We are also manual. We write so much we run pens out of ink! Logs, forms and paper everywhere. We are working to go live on Cerner Millenium in May 2011. Can't happen fast enough.

WE have been live on Cerner Millenium for about 2 years. We were on Mysis - yuck phth @@#%$^*(^^. Course the move to Cerner was so new to me I had a miney break down. Having said that, now I'm pretty swift w/it. The key to success is to put stuff in , 1 step at a time, in the proper order. !!!

It has a really nice BB pt history file - shows past comments, Ag typing, ab hx, transfused and crossed compnonets. Our sister hospital is also on the system (our patients often go to both places) so we can see their testing.

We still keep all of our old logs/forms for computer down time..cuz downtime for a 2 hour upgrade often translates to 6 hour or 2 days of unexpected computer glitches...That's when I realllly miss paper system.