Enter Nursing Data into EMR by Blood Bank staff

[Llehman@ecmc.edu]

Hi Everybody,

I need all your input about this problem:

We are a Level I Trauma Center (I'm the Medical Director of the Blood Bank), and we went "live" with our Meditech LIS Blood Bank Module on 12/15/2009. The Nursing, IT and Medical Records Departments are requesting/demanding that the Blood Bank staff perform what I and the BB staff consider to be Nursing duties. They want us to enter every Transfusion start date/time into the EMR. The Nursing staff perform the transfusion, they enter manually the transfusion start/stop time into a duplicate BB Tag and return the duplicate tag to the BB (the original stays in patient's chart).

I am somewhat aghast at this request. In fact, I wonder whether it is even legal for a BB Tech to enter this information into the EMR, when they did not perform the transfusion.

What I would like to know is: Does any Blood Bank perform this function, or do you know of any BB that does this? And does anyone know of the medico-legal ramifications if this was to be done? Thanks for your input/help.

For obvious reasons, I would like to remain anonymous.

[Marilyn Plett]

I'm not in a hospital nor am I a MediTech user. However, the first question that comes to my mind is: why does the information need to be entered into MediTech? Is there somewhere else that nursing staff enters procedure data that might be more user friendly to them? Computer systems are not always structured to serve all users equally well. My 2nd thought is: why are they entering the transfusion start/time on a duplicate tag that is sent to the blood bank? If you eliminate the returned tag, nursing has no option other than to enter the data either in MediTech or somewhere else that you both agree on.

[Laurie Underwood]

Are you on Client Server for Meditech and do you have the TAR up/running?

[David Saikin]

If you have the EMR then you should not need a tag returned. Nursing should be documenting all their information (ideally in real time).

[tricore]

Is there a place in the BB module to entere start/stop or would the BB techs have to go to a nursing module? Do the nurses enter the start/15 min/stop vital signs into the computer? I am not fasmiliar with Meditech.

[Laurie Underwood]

We are on Meditech Client Server. Currently, our nurses enter in transfusion information in the EMR under the Patient Care area. They have a Blood Administration area where they can log in start time, end time, vitals, signs and symptoms,... We do receive a duplicate unit tag back into the Blood Bank as part of our assessment area for transfusions to monitor that transfusions are being started in the allowed time, they are not lasting over 4 hours, to monitor vitals which are written on the tag...when JACHO came they suggested this. When we get TAR up and going, hopefully items will cross over to the Blood Bank so we will no longer have to receive tags back.

[kdavis]

I am the BB supervisor at the facility where this question originated. We did not have any computer system prior to last December so this is a HUGE adjustment for everyone. We get our tags back for the reasons mentioned by Laurie. We are not ready to give them up yet, but nursing wants as much data recorded electronically as posssible. The problem they are having is that the EMR set up they have requires nurses to go to three separate screens to document and view the start, stop and vitals information, in addition to the duplicative efforts of manual (tag) and electronic recording. Laurie, could you please contact me by e-mail (kdavis@ecmc.edu)? I'd like to see if your IT specialists might be able to help our nursing informatics person with a different custom build for thier documentation. We are in the process of a hospital-wide upgrade that will eventually have TAR available so we too are hoping that will resolve many issues.

[Llehman@ecmc.edu]

Hi Marilyn,

1. At present our Meditech version 5.5 has a lot of flaws in it (we are in the process of updating to version 5.64), & at best, we have a "hybrid" system, some info in the EMR & some info on paper. The only way we have of knowing whether a unit is transfused or not is via the Blood Bank tag (tag is returned 99% of the time). Hopefully, when we go live with version 5,64, we will have the TAR (Tx Adm. Record), which will have Nursing's data cross over to the BB, & we won't need the tags back. Right now, nothing crosses over, & the only thing that shows in the EMR is Issue/Tx date/time - only one time shows, & it doesn't mean anything: we don't know if it's the Issue, Start or Completed time.

2. The second reason why we need the tags back: Joint Commission (JC) both Lab & Hospital-wide Inspectors ask for those tags & check if there are 2 signatures, plus the start/completed date/time of Tx. Again, hopefully, when we get the TAR, JC can look at all of these in the EMR.

[kmt]

I'm in NJ....state requires that information on a physical tag.

[Llehman@ecmc.edu]

Hi Everybody,

I am gratified by all the prompt responses we got, & thanks to all of you.

1. Our BB Supervisor (Karen) has answered all your questions, & Laurie, it appears like we are in the same situation as you. I would certainly be interested in your response to KD.

2. Anybody have any input on the medico-legal aspect of this problem?

[Laurie Underwood]

I have talked to my lab IT specialist. He will talk with nursing and find out exactly how they enter the transfusion info. and then I will get back with you.

[SMW]

Just curious........does nursing or the pharmacy log/enter medication administrations?

[Llehman@ecmc.edu]

I asked the Director of Pharmacy this question, and his reply was: Nursing logs/enters medication administration.

[tbostock]

My two cents: Blood Bank staff should not be doing nursing documentation in the EMR. If the nurses can't or won't enter their own data, then the process should stay completely on paper. And the EMR should not be used to document any aspects of blood administration unless FDA approved to do so (not sure if Meditech is).

[rravkin@aol.com]

Hey Laurie,

Are the nursing staff making the same request of your hospital pharmacy? They should utilize the same system of keeping record of antibiotic administration for blood transfusion. Don't they have to record the same data?

[AMcCord]

All transfusion records go into patient EMRs from the nursing end of things. They built a transfusion flow sheet into the patient care area which simulates the paper flow sheet we used successfully for years. They are supposed to document vitals, units numbers, times, signatures, etc etc real time. It's obvious from some flow sheets that real time is a REAL flexible concept to some of them, but most of them do a good job. No way would I agree to document something which I did not do.

[Abraham]

We use Meditech 5.62 and we do enter the start/stop time into Meditech. We have been doing this for 15+ years and do not find the process cumbersome. We do it for all the reasons mentioned in the above posts (audits, accreditation review erc.)

[Llehman@ecmc.edu]

Hi Everybody,

It was decided yesterday, in spite of our objections, that the Blood Bank enter the Nursing start of transfusion data into Meditech, so we will start doing it next Thursday, 07/22/2010.

Abraham, thanks for your response. I hope the BB Techs (we've designated a few of them to do this) will find out that this will not be a difficult task. Perhaps, the reason why they're apprehensive is that our BB had always been "Manual", and we only went live with the LIS BB Module on 12/15/2009.

Thank you one and all for all your input

[BankerGirl]

We use Meditech and most of our nursing units use TAR to document their transfusions, so the start/stop times, users, pre-transfusion checklists and vital signs flow to blood bank and the EMR. We still have ED and OR that use a different function to document their transfusions, and I enter the start and stop times so my review data statistics are correct. This works fairly well, but I would not do this for every transfusion...that would take all of my time!