Meditech 6.0 Use of Rh pos blood to Rh neg or Trauma patient

[clmergen]

I need help. The way Meditech 6.0 was set up will not allow crossmatching of Rh Pos blood to an Rh neg patient. There is a customer defined parameter to "override blood types" that we switched from no to yes in test. But that allowed me to emergency issue an A Pos to an Unk blood type, which is completely unacceptable. And I still couldn't crossmatch the B Pos to the B Neg patient. So apparently that isn't the correct setting.

Any suggestions on where these compatiblities may be so that I can get the option to crossmatch and issue Rh Pos blood to an Rh Neg patient?

Thanks

Carrie

[Laurie Underwood]

Go to the Dictionaries - Blood Bank - Blood Type. Enter in a negative blood type (A Neg) and then go to Page 2. You can list the compatible blood types and the components. So you can enter A Pos as an option for all the different red cell products.

Edited May 6, 2011 by Laurie Underwood
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[clmergen]

Thank you.

Follow on question.... If I set this up and the patient has an Anti-D, I should still get a warning that the blood has not been antigen typed, correct? (providing my dictionaries are correct). The place I used to work had quite a few allo anti-Ds on Rh positive patients and I still need that layer of protection.

[Laurie Underwood]

Yes, you will get the warning. Set up your dictionary and then in test, create a patient with Anti-D and try to crossmatch an O Positive unit. You will get the warning that the unit has not been antigen typed for the D antigen. This process should be done to validate your process.

[clmergen]

So..... My LIS person tells me that you can't set up compatibilities by product in 6.0. That it is all or none. So I have to settle with being able to emergency issue A Pos RBCs to an UNK blood type so that I can issue A Pos platelets to the same patient. This doesn't sound right to me. I know when I helped build Cerner Millenium the Capability tables were setup by product. I assumed Meditech 6.0 would be the same. Is my LIS person correct?

[rrcc1974]

MEDITECH 6.0

1) Blood Type Dictionary - Allow Emergency Issue

This prompt determines which compatibility checks are performed during Emergency Issue. It works in conjunction with the Allow Mismatch Override prompt in the Customer Defined Parameters.

If you wish to have the system check product compatibility from page 2 of the Blood Type Dictionary when using the Emergency Issue routine, enter Y.

• If a patient does not have a historical blood type, then any unit can be emergency issued with no warning regardless of the definition of the Allow Emergency Issue prompt.
  
  

• If a patient does have a historical blood type and:
  
  
  Allow Emergency Issue = Y
  
  
  Allow Mismatch Override = Y
  
  

All blood types can be emergency issued but the blood types will be checked for compatibility based on page two of the Blood Type Dictionary. Depending on compatibility, one of two messages will invoke: "Patient and Unit Blood Types do NOT MATCH, but are Product Compatible, OK?" or "Patient and Unit Blood Types do NOT MATCH, OK?" This action is recorded in the BBK Override Warning Report.

• If a patient does have a historical blood type and:
  Allow Emergency Issue = N
  Allow Mismatch Override = Y
  

All blood types will be checked for compatibility. If the unit is product compatible, the unit can be emergency issued. If the unit is not product compatible it cannot. Two warnings will appear. Patient and Unit Blood Types do NOT MATCH, but are Product Compatible, OK? and "Incompatible blood type".

Edited May 17, 2011 by rrcc1974
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[clmergen]

Thanks for the information. I just tested this and HATE it. It is dangerous. I can issue the wrong blood type with a simple override that defaults to yes. And I still can't crossmatch Rh Pos blood to an Rh Neg patient. I have to "emergency issue" it and then do the crossmatch. Did Meditech fire all their blood bankers? This is the stupidest system I have seen. Cerner Classic is better than this.

[rrcc1974]

That is very odd Carrie. With my settings I am unable to emergency issue ABO incompatible units. If I try to issue Rh incompatible units I get a warning they do not match but are Product Compatible.

[clmergen]

It could be that the settings are different. We have limited control over some of the dictionaries. Luckily this is all in TEST. It looks like we are going to attach rules to our blood products which will allow us to crossmatch Rh Pos to an Rh Neg patient. I still can't believe that Meditech didn't build this into the compatibility tables. Of course, all of our override warnings default to yes. One extra <enter> and incompatible blood can be issued. Not sure if that is Meditech or the people who built our system.

Edited May 21, 2011 by clmergen
Grammar correction

[rrcc1974]

On page 1 of the Blood Type dictionary set Allow Emerg Iss? to "Y" only for OP and ON. On page 2 set up your Compatible Blood Types and define what Products or Product Groups are compatible (i.e. OP would be comptible for ON for plasma, platelets and red cells). Either the builders do not know of this or the function is not available in Meditech 6.0.

[clmergen]

I have been told that product compatibilities were not built into 6.0. Compatibilities are based on blood type only which to me makes no sense.

[rrcc1974]

https://www.meditech.com/kb/Custform.ASP?urn=2719

More information on Emergency Issue in Meditech.

[LaraT23]

We implemented 6.0 last July. Compatibilites are based on product and type. You have to configure your blood type dictionary and in the middle box on page 2 you can differentiate by product. I will to try to attach a screen shot. You can also on the first page of the specific blood type dictionary entry say whether or not you can emergency release products of that type.

BLOODTYPE.doc

[OregonBB]

Hi rcc1974,

It sounds like you have your settings set the way we would like them. If you don't mind, would you be willing to share your settings for: (In customer defined parameters): mismatch override (yes or no), restrict of no currenet blood type(yes or no),

and

(In Blood Type dictionary):allow emergency issue (yes or no and for which blood types), and did you allow all Rh Neg types to be compatible for all Rh Pos red cell types??

If anyone else has any tips, they'd be appreciated!

We are having a tough time making this work the way we'd like. Thanks in advance!

Jesse

That is very odd Carrie. With my settings I am unable to emergency issue ABO incompatible units. If I try to issue Rh incompatible units I get a warning they do not match but are Product Compatible.

[clmergen]

What do you do with the trauma patient with an unknown blood type? In order to be able to issue AB plasma units you have to allow the issuing of AB red cells.

Compatibilities should be based on blood type and individual product types. Meditech is missing a parameter to allow us to issue blood safely all of the time.