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Dr. Pepper

EXM validation in Meditech 5.65

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Hi all - We are in the process of validating electronic crossmatches in Meditech CS v. 5.65. We are following meditech's validation plan. Our question is, in addition to that, should we test every component with every donor type for every patient to see if the system says yay or nay? We have not modified the blood group compatibility truth tables at all, and these were thoroughly tested before. Thanks - Phil

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I am not familiar with Meditech but I would not forget to test some oddball scenarios to make sure the logic holds. For example, if you divide units try dividing both before and after performing EXM. If Meditech allows the user to edit/delete a unit blood type you should test that as well, especially after the EXM has been performed but before the unit is issued. What if units are electronically crossmatched on yesterdays sample and you get a new sample today and identify an antibody? If you try to issue the EXM compatible units does the system alert you? When you validate, you try to poke holes in the existing logic. The straightforward scenarios will likely validate just fine.

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I am not familiar with Meditech but I would not forget to test some oddball scenarios to make sure the logic holds. For example, if you divide units try dividing both before and after performing EXM. If Meditech allows the user to edit/delete a unit blood type you should test that as well, especially after the EXM has been performed but before the unit is issued. What if units are electronically crossmatched on yesterdays sample and you get a new sample today and identify an antibody? If you try to issue the EXM compatible units does the system alert you? When you validate, you try to poke holes in the existing logic. The straightforward scenarios will likely validate just fine.

We have validated the electronic crossmatch with Meditech CS 5.65 and I agree with bmarotto. We followed the Meditech validation plan, but then also created additional "stress" situations as mentioned above (age of specimen, aliquots, modified products, previous positive Ab screens, different types of antibodies, etc.). The computer is using rules and logic from several areas to determine whether the EXM should invoke or not, but this isn't RBC product code dependent. I don't feel it's necessary to validate every single product with every possible donor type, since Meditech is simply looking at whether the product requires a crossmatch or not, and if it does, all the EXM rules automatically trigger. You've already validated all of your blood type compatibility truth tables. Good luck with your validation. You will love using the EXM!

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Just encountered another problem today. We have the EXM Expire Hours set at 72. Back in our non-EXM live area, we have the autorelease parameters set for release by collection, hours 72, time 2359. This is nice; it enables us to use a spec up to 2359 on the 3rd day after phlebotomy. By setting the EXM to 72, though, it limits us to the same time on that 3rd day as the time the spec was drawn, and will prevent us totally from "using" PAT specimens drawn a week or two before surgery. We don't want to redraw our preops just to have a T&S result in the 72 hr window that EXM requires. Is there a way around this? Thanks - Phil

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We are on Meditech 6.06. In order for the EXM to be extended to 2359 on the Day 3, we created a "dummy" antibody screen that is reflexed when the patient has a NEGATIVE antibody screen. The "dummy" antibody screen extends the specimen's expiration time to 2359.

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We are on Meditech 6.06. In order for the EXM to be extended to 2359 on the Day 3, we created a "dummy" antibody screen that is reflexed when the patient has a NEGATIVE antibody screen. The "dummy" antibody screen extends the specimen's expiration time to 2359.

Would you order a similar dummy screen on, say, the day before surgery, in order to use a PAT specimen drawn several days earlier for the day of surgery and 3 days post-op? And what about a typing? Doesn't the EXM rule logic want to see a typing in that 72 hour window as well?

I'm not particularly happy with having to make a bunch of dummy tests to put real test results in without actually doing a test. We have a situation already where we merged our Meditech into another facility's Meditech. Trouble was, we had both already done a history conversion, and in its infinite wisdom Meditech decided that you can only do a history conversion once, so we have 15 years of history data that we have to maintain but look up seperately every time we work on a patient. I have already built a dummy typing test to get typing results from the old system avauilable for the new one to look at for the 2nd typing. Too much room for error with this stuff!

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The dummy AS is reflexed so we do not have to order it. Actually, the test called a TS-EXM and includes both the Blood Type & AS. The AS has a rule so when the true AS is resulted as Negative, the dummy AS is automatically resulted as negative. The tech then goes into the TS-EXM specimen number to enter the Blood Type result. The TS-EXM has a specimen expiration automatically assigned to expire in 3 days @ 2359. I know it sounds confusing, but it works for us.

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The dummy AS is reflexed so we do not have to order it. Actually, the test called a TS-EXM and includes both the Blood Type & AS. The AS has a rule so when the true AS is resulted as Negative, the dummy AS is automatically resulted as negative. The tech then goes into the TS-EXM specimen number to enter the Blood Type result. The TS-EXM has a specimen expiration automatically assigned to expire in 3 days @ 2359. I know it sounds confusing, but it works for us.

How did you set the TS-EXM specimen expiration to expire in 3 days @ 2359? Is that a separate rule?

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Just encountered another problem today. We have the EXM Expire Hours set at 72. Back in our non-EXM live area, we have the autorelease parameters set for release by collection, hours 72, time 2359. This is nice; it enables us to use a spec up to 2359 on the 3rd day after phlebotomy. By setting the EXM to 72, though, it limits us to the same time on that 3rd day as the time the spec was drawn, and will prevent us totally from "using" PAT specimens drawn a week or two before surgery. We don't want to redraw our preops just to have a T&S result in the 72 hr window that EXM requires. Is there a way around this? Thanks - Phil

We have our EXM set to 96 hours.

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We have our EXM set to 96 hours.

Dan - So a spec drawn at, say 23:00 today could be used potentially into the 4th day after phlebotomy up to 23:00? Is your staff trained not to do that if the patient's been pregnant or transfused in the last 3 months? And how do you handle using preop specimens drawn a week or two earlier? Do you create a fake type and screen and result so those tests are there within your 96-hour window? Thanks - Phil

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Dan - So a spec drawn at, say 23:00 today could be used potentially into the 4th day after phlebotomy up to 23:00? Is your staff trained not to do that if the patient's been pregnant or transfused in the last 3 months? And how do you handle using preop specimens drawn a week or two earlier? Do you create a fake type and screen and result so those tests are there within your 96-hour window? Thanks - Phil

We don't collect specimens more than 3 days in advance of the intended date of transfusion.We generate a custom report titled Crossmatch Aging Report every morning. This report lists all crossmatched patients with elapsed Days since the date of specimen collection. Any listing for 3 days is routinely released from crossmatch (physically detach form and Cancel Product Order in Meditech), unless patient is scheduled for surgery on day 3 (day zero being the day of specimen collection) or there are orders to transfuse on day 3.

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I see. Our preops get drawn anywhere between the day of surgery and 2 weeks prior. We will have to figure out the best way of handling that.

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On 4/4/2013 at 7:48 AM, Dr. Pepper said:

I see. Our preops get drawn anywhere between the day of surgery and 2 weeks prior. We will have to figure out the best way of handling that.

Hi Dr. Pepper!

Did you ever figure out a way of handling this problem?  Samples greater than 96 hours?

sandra

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Sorry for the delay but I've been retired for 2 years and have not been hitting this site much. We would order the blood on a new accession number that also had a nonreportable test SAMPLE USED to record/trace the original sample.

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