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confirming blood types on products


tkakin

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We had a company that confirmed the blood type on the products for us, and now we need to do it ourselves.  I was hoping you might share some ideas on creating a procedure for doing this.  Do you do the confirmation when the products arrive or before crossmatch?  How do you flag the unit that it has been confirmed?  How do you make sure units are not leaving your lab with out the confirmation?  I use Meditech computer system.  I appreciate any help.

 

Thanks

Teresa

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We also use Meditech. We have it set up so that units brought into inventory default to 'entered' status and a unit blood type specimen is created/ordred. Once that blood type is resulted and verified the unit switches to 'available' status. We cannot crossmatch/assign/issue units unless they are at 'available' status. 

 

We retype units when they are brought in, and we pull our seg to save at that time as well. We do not use any stickers or anything on the unit to show that it has been retyped, they are always retyped before they are placed in stands on the stock shelves.

 

Unfortunately I cannot help you much with the Meditech setup, but hopefully this gives you some ideas.

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We have Meditech 5.65 and we do the same thing for Meditech that Teri does.


 


We do use the "ABO & Rh of neg confirmed" stickers.


 


I also am not sure how this works and thought it was part of their default blood bank setup. Which version of Meditech are you using?


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If you are using Meditech, on page 3 of the Product dictionary, you are going to have to create an ORDER GROUP for the RETYPE test and enter the name of that order group under "Non-Affiliated Source".  Also on page 3, for products requiring a confirmation to be performed, the "Default Blood Type" needs to be answered as "U" unknown.  On page 1 of the Product dictionary, "Typing Required?" should be answered as "Y".  Now when this product is entered into inventory, users will need to perform the retype test on the unit that is defined in your Order Group prior to use.  You need to set these up "backwards" in order to create the Order Group. 

1)  create the component T-Tests for your Group Type test for your retype "RETYPE".  Ex: anti-A unit, anti-B unit, anti-D unit (anti-A,B unit).

2)  create your B-Type Calculation for your RETYPE Blood Type (RTYPE)

3)  create the G-Type Test using your component tests and blood type tests (RETYPE)

4) create the Order Group  (BBRTYPE)

***Order Type:  ADD

***Spec Type:  NEW

***Coll Date:  T

***Time:  N

***Priority:  R

***Received?:  Y

***Recv Date:  T

***Time:  N

***BBK Test:  RETYPE

5)  Enter the retype order group on page 3 of product dictionary non-affiliated source:  BBRETYPE

Every defined product that requires a retype will need to have "BBRETYPE" added on page 3 of Product Dictionary.

 

To perform the retype test, find the specimen associated with the retype order for that product, users can enter "BU#" (blood unit number) and then scan the unit number and the retype order for that product will be there for resulting.  Once the product has been retyped, the blood type when turn from "unknown" to the confirmed blood type performed.

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We use Sunquest but the above advice is what we do.  We enter the unit and on red cells only a type recheck ( not the same code as for a patient) is automatically ordered.  We also have a visual inspection test ordered on all components.  We result this on all components before they are "available" in the computer. 

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Just one additional thought.....if you have the typing results in the computer; and if your computer system will not allow you to Test and/or Issue Products unless that confirmation testing has been done, you do not need to place stickers on the units indicating that they have been confirm typed (it is just an extra step....extra label supply...and more time).  And to eliminate finding out "later" in the process that a unit was not confirmed, would recommend you have a shelf where you place "Units in Progress" (or whatever title you want to put on the shelf; just so it is known to all what the status of those units are).  Should not be placed on an Available shelf unless they are truly "available."

 

Brenda Hutson

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Brenda brings up a great point, those confirmation stickers don't add anything of value to the retype process and in my experience fall off of the units if you live in a humid area (like St. Louis).  And are an additional expense and sometimes confuse the person transfusing the product.  (as in "why do they come on the blood and not the plasma or plts?).

 

Set up your computer system to put the units in a not tested status upon receipt into the BB then once retyped status can change to available.

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Sorry for your troubles, Teresa.  Back in the day when we were a depot for other hospitals, we used a little red dot sticker and wrote the date and our initials on it. It had no printing.  At that time, we did not retype units until the first time we crossmatched them because we might send them to the other hospitals, but that was before we got a BBIS. Once we got a computer system that required units to be retyped, we dropped the sticker.  We were not sending units out by then either so we started just leaving the units on the incoming shelf until they were retyped.  Once in the drawers you knew they were available in the computer.  When we got Meditech it did come with the Retype testing defaulted in but since our supplier retyped the units and documented it (CAP did not require that it be done on-site) we created a label verification procedure and turned the retype test off.  We did not ever do electronic crossmatch. Once you are JC accredited you have to retype units on-site.  

 

Where I work now, we retype O units using anti-A,B rather than 2 separate tubes for anti-A & anti-B.  Quotient and Bio-Rad both sell cheaper typing sera.   Also, remember that you don't have to do the Rh on units labeled Pos. Set up the computer for the procedure that you decide to follow.  Using the anti-A,B does require a separate retype test (at least in Safe-Trace Tx).  So you end up with a different Retype test for O neg units than for O pos units, than for all other Rh neg units and all other Rh pos units. If you don't use anti-A,B you still might need separate tests for Rh neg and Rh pos units.  I will let those that know Meditech say for sure. I am too rusty on it now.

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Our LIS is set up so it will not allow the units which are not confirmed. We also have separate area for the storage of 1) Unconfirmed units 2)Confirmed units & 3) Crossmatched units.

 

I do not see any value to putting sticker if you have your LIS and process set up. When I go inspect the hopitals which are doing the same I always recommend them to see if they can cut few steps for the techs.

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I think the reason we decided to keep the stickers was as a "feel good" measure for downtimes.

 

Consider that you have blood products that were appropriately received during computer uptime, logged into the system and tested and placed on a shelf and you didn't use the confirmed stickers.

A downtime occurs the following day, how do you verify that the units weren't placed on the incorrect shelf - you don't have the computer system verification that testing was complete. Would you have to retype all of the donor units that you had already performed and add that to your increasing mountain of downtime worksheets?

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We have Meditech and I have a retype worksheet built that only has the A, B, D immediate spin on it and use a spreadsheet to result.  If you use the specimen desktop, go to worklist, spec batch, BBK compiled by, and it the to and from test put the first couple of letters of your retype test code, it will only bring up the retypes, otherwise will bring up all pending tests.  You can click the check mark at the top left and mark all of them and click spreadsheet, and lookup the name of your worksheet.  They will be in order how you logged them in. We also use seg safe to make it quicker as it is a tube and pipet combination and really speeds things up.

Mary

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We have Meditech and I have a retype worksheet built that only has the A, B, D immediate spin on it and use a spreadsheet to result.  If you use the specimen desktop, go to worklist, spec batch, BBK compiled by, and it the to and from test put the first couple of letters of your retype test code, it will only bring up the retypes, otherwise will bring up all pending tests.  You can click the check mark at the top left and mark all of them and click spreadsheet, and lookup the name of your worksheet.  They will be in order how you logged them in. We also use seg safe to make it quicker as it is a tube and pipet combination and really speeds things up.

Mary

Thanks Mary, can you clarify for me what a specimen desktop is? I don't recognize the prompts. 

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I agree with goodchild.  We are a small hospital.  We just have about 125 units on our shelves, but we put green 3/4" Avery dots on ours, with no writing, to make sure one unit didn't slip into a slot before it was retyped.  I know we could do without them, but they add comfort and they aren't that expensive.

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  • 4 weeks later...

 

 

For a visual cue that the units need to be confirmed we will put the on the shelf with the ports facing to the right and the label facing the back of the drawer.

 

When the units are confirmed we will place them with the ports facing the left and the label facing front.

 

I have another question.  In order to get meditech to interpret the blood type it has to have the D/Rh included in the test.  In the case of Rh positive products we do not need to confirm the Rh.  Do I need to have the computer people build me a new test that will interpret a blood type without the Rh or is there a short cut.

 

Thanks

Teresa

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For a visual cue that the units need to be confirmed we will put the on the shelf with the ports facing to the right and the label facing the back of the drawer.

 

When the units are confirmed we will place them with the ports facing the left and the label facing front.

 

I have another question.  In order to get meditech to interpret the blood type it has to have the D/Rh included in the test.  In the case of Rh positive products we do not need to confirm the Rh.  Do I need to have the computer people build me a new test that will interpret a blood type without the Rh or is there a short cut.

 

Thanks

Teresa

 Teresa,

 

When you log units into your inventory, you are scanning the ABO/Rh barcode on the blood container label.  This is stored in Meditech.  For the unit to be updated to Available status after you enter your unit confirmation serological test results. those results must generate an interpretation that matches the ABO/Rh that you scanned from the blood component container label.

 

As posted by whbb, a calculation must be devised to generate, e.g. OP without an anti-D result or ON with an anti-D result.  This is possible

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  • 4 years later...
On 7/4/2013 at 12:27 PM, whbb said:

If you are using Meditech, on page 3 of the Product dictionary, you are going to have to create an ORDER GROUP for the RETYPE test and enter the name of that order group under "Non-Affiliated Source".  Also on page 3, for products requiring a confirmation to be performed, the "Default Blood Type" needs to be answered as "U" unknown.  On page 1 of the Product dictionary, "Typing Required?" should be answered as "Y".  Now when this product is entered into inventory, users will need to perform the retype test on the unit that is defined in your Order Group prior to use.  You need to set these up "backwards" in order to create the Order Group. 

1)  create the component T-Tests for your Group Type test for your retype "RETYPE".  Ex: anti-A unit, anti-B unit, anti-D unit (anti-A,B unit).

2)  create your B-Type Calculation for your RETYPE Blood Type (RTYPE)

3)  create the G-Type Test using your component tests and blood type tests (RETYPE)

4) create the Order Group  (BBRTYPE)

***Order Type:  ADD

***Spec Type:  NEW

***Coll Date:  T

***Time:  N

***Priority:  R

***Received?:  Y

***Recv Date:  T

***Time:  N

***BBK Test:  RETYPE

5)  Enter the retype order group on page 3 of product dictionary non-affiliated source:  BBRETYPE

Every defined product that requires a retype will need to have "BBRETYPE" added on page 3 of Product Dictionary.

 

To perform the retype test, find the specimen associated with the retype order for that product, users can enter "BU#" (blood unit number) and then scan the unit number and the retype order for that product will be there for resulting.  Once the product has been retyped, the blood type when turn from "unknown" to the confirmed blood type performed.

Is there a way to make this Specific to only reflex on Oneg and Opos units?

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On ‎09‎/‎02‎/‎2018 at 1:02 PM, dmed03 said:

Is there a way to make this Specific to only reflex on Oneg and Opos units?

The non-affiliated source is blacked out and we can't seem to add our "RETYPE" order group back to our red cells? any pointers about this?

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  • 2 weeks later...
On ‎7‎/‎7‎/‎2013 at 9:21 AM, Brenda Hutson said:

Just one additional thought.....if you have the typing results in the computer; and if your computer system will not allow you to Test and/or Issue Products unless that confirmation testing has been done, you do not need to place stickers on the units indicating that they have been confirm typed (it is just an extra step....extra label supply...and more time).  And to eliminate finding out "later" in the process that a unit was not confirmed, would recommend you have a shelf where you place "Units in Progress" (or whatever title you want to put on the shelf; just so it is known to all what the status of those units are).  Should not be placed on an Available shelf unless they are truly "available."

 

Brenda Hutson

We stopped using the labels about 8 years ago.  We place the untested units in a designated shelf.  After testing they are moved with the available units.  We use Meditech and have a hard stop that prevents using untested units.

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