Electronic Transfusion Record Documentation (TAR)

[goodchild]

My hospital has made the move from paper documentation to use of the Meditech TAR throughout the hospital, with a only few exceptions (ED, OR, Oncology, and specials like GI, cath lab, etc) to the rule. We have been running into a few bumps in the road and the question was raised, how are other hospitals handling the transition?

Does anyone else have any stories to share, suggestions, comments, etc as far as getting the transfusing staff up to speed with using the electronic documentation? We would love to hear some effective strategies at getting nurses to use the TAR effectively and fully integrate its use into the general practice of administering blood products.

We're also curious how many other users of electronic documentation use a system that positively identifies the patient and the blood product(s). What exceptions to use of the TAR do you permit? How are you reviewing the transfusion records and how do you track/follow up with non-compliance?

Thanks !

[MAGNUM]

We use BCTA here, and have for about 2 years. The only department that is exempt (for the time being) is the OR, all others are required to use BCTA. I have found that a verbal counseling is usually all that is required for the care givers to be more compliant. If we do have a deviation from compliance, we have at least one nurse manager that will have her people come back in from home to complete anything that they have failed to complete as it pertains to BCTA. If there must be deviations from compliance because of equipment issues, the affected floor is required to get approval to "go onto paper" from me thru the nursing supervisor. So far I have had to approve only a couple of situations. If Meditech is down, that is a different story. I review all transfusions on a daily basis when the blood tags are returned to the blood bank.

[sgoertzen]

We've been using Meditech TAR for a little over a year now in all areas except outpatient (HEM/ONC) clinics and Surgery. We still issue paper forms to those areas. We had extensive hands-on training for every nurse in the TEST system prior to Go-Live which included creating mock products, tags, labels, & armbands so every nurse could go through the entire transfusion process (scanning, vitals, begin, reactions, end). It took 9 weeks to get everyone trained and was a massive endeavor. We audit every transfusion to ensure that begin to end times are no longer than 4 hours (wrote a custom report that pulls outliers) and I file a hospital QA report on each of these. Usually, they forgot to "End" the transfusion in the computer, but it still stands as the official transfusion record so its not OK. The number of these dramatically dropped after the directors realized they would be getting QA reports on every outlier and would need to write an explanation. We also audit 25 transfusions per month (75 per quarter) to ensure that all of the nursing checklist and vitals are done appropriately. I file hospital QA reports on each of these outliers as well, and again, it took about a 6 month learning curve and diligence with filing QA reports, but things have greatly improved and now we are only seeing a few fall out each quarter.

Did you set up the nursing bedside scanning and checklist with the bypass option? We chose to not allow the nurses the option to bypass any of the TAR system, so if they are going to document the transfusion at all, they have no option but to use TAR (or if they are having trouble with scanning in TAR, they can always call the blood bank and ask for a paper form which must then be scanned into the electronic record).

[DOGLOVER]

We went live with Cerner hospital wide MAR in Feb. Definitely a learning curve involved but really went pretty well. We still give paper tags to the OR's because they say they don't have time in an OR setting to put the info into the computer. It is scanned in later. We also supply blood to a pediatric outpatient clinic and they are not on our system, so they still get paper. Tricky part for us is that nursing is on Cerner Millenium and the lab is still on Cerner Classic so we are not seeing the same screens they see. Also, different areas set their screens up differently. Makes it a little difficult to help them with ordering questions.

[BankerGirl]

Did you set up the nursing bedside scanning and checklist with the bypass option? We chose to not allow the nurses the option to bypass any of the TAR system, so if they are going to document the transfusion at all, they have no option but to use TAR (or if they are having trouble with scanning in TAR, they can always call the blood bank and ask for a paper form which must then be scanned into the electronic record).

What version are you on, sgoertzen? We are currently on v5.65, have been using TAR for several years and are having issues with scanning some of the blood component codes when they transfuse. Meditech cannot seem to figure it out. Predominately the pheresis codes are what cause us problems so we had to allow the scan override option.

As for how we got the nurses to use it, I also wrote QA reports for 2 years on all that failed to use TAR unless the system was down, and I found that was the most effective measure. Now the nurses are so used to it that when the system is down, they forget that they have a paper form and can't figure out how to do their documentation.

[goodchild]

We're on 5.65 as well. We did set up bedside scanning as a patient safety measure but we don't allow any bypasses. Our quality and patient safety department, and the blood bank itself, really like the idea of bedside scanning to prevent mistransfusion. For hemodynamically unstable patients we have instructed the ICU team to scan the blood product as a safety measure but do all paperwork on the attached paper record at their convenience. This has been met with great resistance.

We do 100% review of TAR documentation: start-stop, vital signs, correct use of reaction interface, volume transfused, the whole nine yards.

[Malcolm Needs ☆]

We're on 5.65 as well. We did set up bedside scanning as a patient safety measure but we don't allow any bypasses. Our quality and patient safety department, and the blood bank itself, really like the idea of bedside scanning to prevent mistransfusion. For hemodynamically unstable patients we have instructed the ICU team to scan the blood product as a safety measure but do all paperwork on the attached paper record at their convenience. This has been met with great resistance.

We do 100% review of TAR documentation: start-stop, vital signs, correct use of reaction interface, volume transfused, the whole nine yards.

Sorry, as a limey, what is "the whole nine yards (obviously, I know what you mean, but what is the derivation of "the whole nine yards")?

[BankerGirl]

Well, I am still curious how those of you who use TAR and scan are able to accomodate those pheresis barcodes. Maybe my Meditech folks could talk to your Meditech folks and figure it out.

As for the phrase "the whole nine yards", no one really knows where it came from, but several theories are out there. All anyone can agree on, it seems, is that it was first used in print in 1962.

[goodchild]

I'd be curious to hear which product codes were being used and what the dictionary settings are for those products. I know that every single product needs to be set up perfectly.

[BankerGirl]

I suppose I should have stated that we are still using Codabar since our supplier is Red Cross. The codes that we have tried and cannot scan in TAR are 03820 and 03330. What dictionary are you referring to when you ask about dictionary settings? Meditech tells me there are no translation tables that address this.

[sgoertzen]

We are also on 5.65, but we are ISBT128 and don't have any problems with product code recognition during bedside scanning. Do you have separate product dictionaries built for each of your products, or do you have multiple codes mapped to one pheresis product? Just wondering whether maybe that could be the problem?

[BankerGirl]

We do not have a separate product dictionary built for ALL of the components, and I did think of that. There is a separate product built for one of the codes that is not working, so I do not think that is the entire explanation. I have changed some EMR ID's on the test side to see if that helps, and so far, it does not. I guess I will try to be patient and hope Meditech figures it out.