mrosebug Posted February 17, 2012 Share Posted February 17, 2012 We recently had a vendor come in to our facility to promote a blood vending machine. The idea is to get rid of the lab on the OR floor to save FTE dollars. The alternative being considered is to place one of these refrigerated blood storage devices in OR. We have a large OR and busy Transfusion Service, unfortunately not on the same floor. There is skepticism on this being safe and effective in practice.Does anyone currently use this? Could you advise about benefits, pitfalls, problems?Thanks! Link to comment Share on other sites More sharing options...
Auntie-D Posted February 17, 2012 Share Posted February 17, 2012 We have investigated it and it only works if there are two previous group and screens done in the laboratory. It doesn't work in an emergency situation with a new patient. Basically the medic puts a sample on which confirms group and it dispenses the required number of units. Think of it like EI but taking out the laboratory There has to be previous groups done to eliminate ABO incompatibility as much as possible.Might save on lab time but there is no way to limit how many units they remove. They could empty the whole fridge and then what happens if noone is notified? Bit more serious than no salt and vinegar crisps Link to comment Share on other sites More sharing options...
David Saikin Posted February 17, 2012 Share Posted February 17, 2012 It utilizes the electronic crossmatch . . . I think it is a great idea, wish I had a BBIS so I could get one. And hey, if they empty it out so what . . . they'd just have to get blood the old fashioned way. I have seen places that trained OR nurses to do the e-xm and then they could remove blood from the OR ref. Don't cringe - stuff like this works when everyone buys into it and performes professionally. Link to comment Share on other sites More sharing options...
David Posted February 17, 2012 Share Posted February 17, 2012 They can work without previous types just like you issue uncrossmatched units now, you give only O's. Cedars-Sinai in LA has lots of them in use. With the right computer system set up right they are just as safe as people doing all the transactions. The identity of the person removing the blood is recorded, along with date, time, unit number, all those details we so love. If your OR or ER finds out they can have blood to hang in seconds rather than minutes they might encourage you to get some. Link to comment Share on other sites More sharing options...
Auntie-D Posted February 17, 2012 Share Posted February 17, 2012 The only problem is it comletely eliminates due diligence. How many medics actually label samples for POCT blood gases? How many actually even check the patient? Patient identification can be exceptionally bad as it is - how many samples get rejected each day based solely on this? It is frought with the possibility of misidentification! At least the laboratory is an extra check and the staff have the knowledge of how wrong, wrong can be... Link to comment Share on other sites More sharing options...
tricore Posted February 17, 2012 Share Posted February 17, 2012 University Hospital, the second facility in the US to use the vending machine began in 2008. The system is semi-interfaced into our LIS system via the transfusion form print stream which captures the necessary patient and unit information. This avoids manual entry, thus avoiding demographic mistakes. A complete interface is currently being considered by our LIS vendor. The HemoSafe is located between the main intensive care wards and assigns blood to patients based on the results of the Electronic XM performed in the Blood Bank. It’s a bit of a complex process but seems to work well. Emergency O neg is also available and may be removed for any unknown patient- we do require entRY of some form of ID when the patient is not in our LIS. There’s been some thought towards placing a HemoSafe in the OR but I’m not convinced this is a good idea at this institution- training issues. I suppose it could work for an institution that has well trained staff that are especially concerned about proper care of blood products. When we were first getting started we learned that an eastern hospital utilized a HemoSafe in their OR by first crossmatching the blood in their Blood Bank and transporting it to the OR. Then they retrieved all the blood at the end of the day. I suppose this could work if you have adequate staffing. The BloodTrack system is very versatile with many configuration variations and all the bells and whistles you can imagine. This system does not require a BBIS. Link to comment Share on other sites More sharing options...
David Saikin Posted February 17, 2012 Share Posted February 17, 2012 I think you are mistaken . . . you just cannot take the blood out of the device.The only problem is it comletely eliminates due diligence. How many medics actually label samples for POCT blood gases? How many actually even check the patient? Patient identification can be exceptionally bad as it is - how many samples get rejected each day based solely on this? It is frought with the possibility of misidentification! At least the laboratory is an extra check and the staff have the knowledge of how wrong, wrong can be... Link to comment Share on other sites More sharing options...
Malcolm Needs ☆ Posted February 17, 2012 Share Posted February 17, 2012 I had an idea somewhere in the back of my head that when a unit is taken out, this could be flagged up in the computer in the Blood Bank, so that you would know if the remote fridge was getting low on stock - or is this just something that I have imagined? Link to comment Share on other sites More sharing options...
tricore Posted February 17, 2012 Share Posted February 17, 2012 I had an idea somewhere in the back of my head that when a unit is taken out, this could be flagged up in the computer in the Blood Bank, so that you would know if the remote fridge was getting low on stock - or is this just something that I have imagined?You are correct, Malcom. The refrigerator sends a message to the computer in the blood bank, that stock is low and when emergency blood has been removed. Link to comment Share on other sites More sharing options...
tricore Posted February 17, 2012 Share Posted February 17, 2012 I think you are mistaken . . . you just cannot take the blood out of the device.That’s true, not just anyone can take blood out of a HemoSafe. Users must have access rights. Users identify themselves by scanning a small bar code at the Kiosk that is specific to them. It either gives them access or it doesn’t depending on their individual settings. This is all configurable- many different scenarios of who can do what. Authorized users may remove emergency blood (O neg of course) for any patient. Now, whether they must identify the patient or not also depends on a configuration. We require them to enter some form of identification- a number. It can be any number, but we expect it to be the medical record number that they are using to identify their patient. Of course if they get this wrong the Blood Bank has to investigate. Link to comment Share on other sites More sharing options...
Likewine99 Posted February 18, 2012 Share Posted February 18, 2012 Hey, think about this, it's sort of like a Pyxis (not a plug for the company) drug dispensing unit they used on the nsg divisions. I've never seen a BB dispenser but I've supported EHR go lives on the nsg divisions and they must badge into the Pyxis system to remove drugs for their pts. There's an interface between the EHR, what order the doc writes and the drug dispensed into the machine by the pharmacy. Since the FDA considers blood as a drug why not? Just MHO. Link to comment Share on other sites More sharing options...
Mabel Adams Posted February 26, 2012 Share Posted February 26, 2012 Puget Sound Blood Center in Seattle is using them at several of their hospitals as is the Oregon Health and Science University in Portland. They are tightly integrated into computer systems so aren't very easy to abuse if the software is configured right. There are smaller free-standing versions and systems for attaching them to existing fridges that aren't so secure. Haemonetics sells one and Mediware another I believe. Link to comment Share on other sites More sharing options...
Annadele Posted February 28, 2012 Share Posted February 28, 2012 As a new technologist, I've often lamented that the best I can possibly hope for is to be as good at most of the tasks I perform every day as a machine would be. I think utilizing the technology that you have available when/if you can frees up technologists to focus on tasks that aren't as routine and prevents that mind-numbing that might lead to errors. AnnadeleWe recently had a vendor come in to our facility to promote a blood vending machine. The idea is to get rid of the lab on the OR floor to save FTE dollars. The alternative being considered is to place one of these refrigerated blood storage devices in OR. We have a large OR and busy Transfusion Service, unfortunately not on the same floor. There is skepticism on this being safe and effective in practice.Does anyone currently use this? Could you advise about benefits, pitfalls, problems?Thanks! Link to comment Share on other sites More sharing options...
Auntie-D Posted February 29, 2012 Share Posted February 29, 2012 As a new technologist, I've often lamented that the best I can possibly hope for is to be as good at most of the tasks I perform every day as a machine would be. I think utilizing the technology that you have available when/if you can frees up technologists to focus on tasks that aren't as routine and prevents that mind-numbing that might lead to errors. AnnadeleUnfortunately though - rubbish in, rubbish out. An analyser is only as good as the person operating it. My fear is that samples that haven't been properly checked are going to be put on the analysers. If we think how many samples we reject due to them not meeting our criteria - all of these would be put on the analyser as 'our' check is removed. Link to comment Share on other sites More sharing options...
Generic Posted February 29, 2012 Share Posted February 29, 2012 I believe Shands at the University of Florida had one of these machines because of a very long walk (approaching 10 minutes) between the OR and blood bank due to construction. If I remember correctly, the machine was only stocked with O's and was only for use in emergent situations. If it was actually only used in those situations, I have no idea. Link to comment Share on other sites More sharing options...
Mabel Adams Posted March 1, 2012 Share Posted March 1, 2012 Auntie-D, these machines don't do any testing. The specimens are still sent to the lab for a type and screen by whatever means they choose. The vending machines may be interfaced to the BB computer so that when ID is scanned a door for a compatible unit opens, the computer does an electronic xm and prints the labels or tags which the nurse then attaches to the unit and takes it to transfuse. These systems (and less complicated ones) can also be stocked with universal donor blood. If an antibody is present, the units must be xmed in the lab and then can be stocked in the vending machine behind a door that will only open when that patient's ID is scanned.Now, if you want to talk about automated testing, that is a different discussion. Link to comment Share on other sites More sharing options...
Auntie-D Posted March 1, 2012 Share Posted March 1, 2012 Auntie-D, these machines don't do any testing. The specimens are still sent to the lab for a type and screen by whatever means they choose. The vending machines may be interfaced to the BB computer so that when ID is scanned a door for a compatible unit opens, the computer does an electronic xm and prints the labels or tags which the nurse then attaches to the unit and takes it to transfuse. These systems (and less complicated ones) can also be stocked with universal donor blood. If an antibody is present, the units must be xmed in the lab and then can be stocked in the vending machine behind a door that will only open when that patient's ID is scanned..Nope. The one our trust is looking at involves a sample being put on the analyser part of the fridge and group and screen is confirmed before issue. It is supposed to be interfaced with the BB computer system and only allow release of Group Compatible if a previous group and negative antibody screen have been done. If there is no prior group it will issue ONeg, same if blood is neaded without time for an antibody screen.I am very, very uncomfortable about it, even with these checks in place. It's not my problem any more though as I handed my notice in last month... Link to comment Share on other sites More sharing options...
Mabel Adams Posted March 3, 2012 Share Posted March 3, 2012 Wow. Nothing like that is approved in the US yet. Interesting. Link to comment Share on other sites More sharing options...
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