Electronic Crossmatch in Meditech 5.66

[BankerGirl]

We went live with electronic crossmatch when we did our Meditech 5.66 version upgrade.  This have proved to be very popular and beneficial, with one exception.  Patients with blood types from our history conversion that haven't had an actual Meditech specimen are not qualifying.  The documentation states "Two Blood Type tests on different patient specimens OR on ONE patient specimen and on history match (emphasis mine) are required to be eligible.  Meditech is now saying this is working correctly since there aren't two specimens with testing resulted.  The biggest problem is that the historical conversion blood type is not identified differently from a previously resulted specimen blood type, and we can't tell there is a problem until we actually try to do the crossmatch.  We had a patient in surgery that had a unit delayed by 5 additional minutes while the tech performed a second type.  The surgeon is highly annoyed!  Does anyone else have this problem?

[Dansket]

Is a blood type displayed in the upper part of the Enter/Edit BBK Results?  If you click on the Edit tab at the bottom of the screen and then History Blood Type, is a blood type displayed?  How many patients were in the historical conversion file?  Have you tested a patient from the historical conversion file blood type by entering results of group O for a patient with historical blood type of group A?  Does Meditech warn that blood types do not match?

 

Consider asking Meditech, if it is possible to do a customization so that blood types from the historical conversion are treated as tested blood types.

 

If you have thousands of patients from the historical conversion, you need a computer solution that users can reflex a second blood type test on the current blood sample and result without having to do serological testing when they get the computer warning you described above.  I would build it into your Type and Screen test so that when you answer Y, there is an order group attached to the Y answer that reflexes the second blood type test.

[Dr. Pepper]

We just went live with electronic crossmatches. We had a similar situation, compounded by the fact that we had been live with Meditech before we merged with another hospital which also used Meditech. We piggybacked onto their system, and Meditech, in their infinite wisdom, only lets you do a conversion once, which both places had already done. So we have 4 years of Meditech and 14 years of Sunquest data that has to live in a seperate file that we have to check every time we work on a patient since we can't get it into new Meditech. 

 

So I built a blood type test "Historical Type", nonreportable, that just gets resulted with the blood type test mnemonic (AP, ON etc). If a patient only has 1 typing in the new system but has one in the old system, we order and result the test. Meditech sees 2 typing results and allows the EXM..

[marvy1]

Consider asking Meditech, if it is possible to do a customization so that blood types from the historical conversion are treated as tested blood types.

 

Allow me to translate the above sentence: Consider asking Meditech if it is possible to do a customization so that their Electronic crossmatch actually works the way it is suppose to work.

 

We are going to start working on Electronic XM in Meditech and I'm so impressed that once again Meditech proves they really know nothing about Transfusion Medicine. I was also shocked to hear that someone else did a conversion of historical data in Meditech. It took us over a year (and many many software changes and fixes) to accomplish that conversion. In other computer systems, blood bank conversions can take 1-2 days.

[Dansket]

Hear Ye! Hear Ye! 

 

Also Meditech does not allow electronic crossmatch for blood unit issued uncrossmatched.   Meditech forces you to do serological crossmatches, even after that patient has two blood types on file, a current blood type, a current negative antibody screen and no history of clinically significant antibody!

[Dr. Pepper]

Good to hear from all the other Meditech BBK package fans. It did indeed take a while to do the historical conversion. Sunquest hired seasoned blood bankers to make, modify, instruct on and implement their LIS module. They knew exactly what their customers' needs and concerns were. Meditech primarily hires computer geeks straight out of college who learn the system by playing with it and guess what their customers need. Our initial Meditech instructor told us he never had a chemistry or biology course in college. Another used anti-A as an example of an unexpected antibody. I guess you get what you pay for.........

[tbostock]

 

Hear Ye! Hear Ye! 

 

Also Meditech does not allow electronic crossmatch for blood unit issued uncrossmatched.   Meditech forces you to do serological crossmatches, even after that patient has two blood types on file, a current blood type, a current negative antibody screen and no history of clinically significant antibody!

 

Oh, that's odd...wondering why anyone would give uncrossmatched when all of the above is in place. A lot quicker to just do the few clicks and give electronic crossmatched units.

[Dansket]

 

 

Oh, that's odd...wondering why anyone would give uncrossmatched when all of the above is in place. A lot quicker to just do the few clicks and give electronic crossmatched units.

 

This is not the case.  Uncrossmatched blood was issued appropriately to a patient prior to collection of a blood sample.  Upon receipt of blood sample, Type and screen, and 2nd ABO type test results entered into Meditech.  When attempting to perform crossmatch it was discovered Meditech would not allow electronic crossmatch of the units previously issued as uncrossmatched

Edited October 22, 2013 by Dansket

[pbaker]

Our work around. 

 

If the patient has a blood type history that came across in the conversion, we perform an "ABO verification" by retesting the same specimen.  This allows Meditech to think there are 2 specimens and allow electronic crossmatches. 

 

This is a different test than our "ABO confirmation" which is performed on a completely different specimen when a patient has no previous history.

 

For the uncrossmatched units, it only makes you do IS XM on those units issued prior to specimen collection/completion.  Once all the necessary testing is done, you can perform EXM.

[BankerGirl]

Our work around. 

 

If the patient has a blood type history that came across in the conversion, we perform an "ABO verification" by retesting the same specimen.  This allows Meditech to think there are 2 specimens and allow electronic crossmatches. 

 

This is a different test than our "ABO confirmation" which is performed on a completely different specimen when a patient has no previous history.

 

For the uncrossmatched units, it only makes you do IS XM on those units issued prior to specimen collection/completion.  Once all the necessary testing is done, you can perform EXM.

 

The biggest problem we have is that it is impossible to tell whether the patient's blood type was from the conversion or from multiple previous specimens without checking each one that we aren't sure of.  I guess what I may do is add a calculated test to the required testing for crossmatched products.  I was hoping that someone would tell me that it worked for them, and then Meditech would have to fix it.  (sigh!)

[BankerGirl]

I am still struggling with how to handle this situation.  I have tried to evaluate previous results to trigger the reflex test but I can't seem to get that done.  I asked Meditech for help and they just keep saying that converted blood types are not reliable enough to use, and it only disallows the EXM for the first specimen.  Finding the specimen to do a retype or IS XM when the patient is bleeding in OR because someone forgot to check for a previous specimen is not really desireable, and I don't really want to set it up for every specimen, so I am still stuck. 

[pbaker]

If you have blood type in the history and this is the first specimen you have recorded, then the blood type had to come from the conversion.  Our conversion also has a user name of C12345 that we can see in the history details tab.

[tkakin]

I am starting electronic xm's as well with MT 5.66.  I am in the very beginning stages where I haven't run into your problems yet, but am glad you wrote about them, so I can resource it when it comes up.  My issue is that I have a DTS LAB 10471 that says "An electronic crossmatch does not take place if there is a pending antibody test (ABID type test) a current specimen or on another specimen for the patient's medical record. 

Electronic Crossmatch is not available: A pending Antibody test has been found on specimen: <specimen Number>. "

 

We have a staff that does not always report the ABID's.  Do you have a work around for this, or do I need to push staff to do the report?  I just don't see how not reporting the ABID should hold up the electronic xm???   YES I do AHG xm with it!

Thanks

[Dansket]

I am starting electronic xm's as well with MT 5.66.  I am in the very beginning stages where I haven't run into your problems yet, but am glad you wrote about them, so I can resource it when it comes up.  My issue is that I have a DTS LAB 10471 that says "An electronic crossmatch does not take place if there is a pending antibody test (ABID type test) a current specimen or on another specimen for the patient's medical record. 

Electronic Crossmatch is not available: A pending Antibody test has been found on specimen: <specimen Number>. "

 

We have a staff that does not always report the ABID's.  Do you have a work around for this, or do I need to push staff to do the report?  I just don't see how not reporting the ABID should hold up the electronic xm???   YES I do AHG xm with it!

Thanks

Yes, you do need to change the paradigm.  I would not advise any sort of work-around.  By ABID, I assume you mean antibody identification, is that correct?

 

Was the ABID type test manually ordered or reflexed on the specimen due to a positive antibody screen? 

 

Dan

[BankerGirl]

_TTAKIN,

 

_{This is functioning correctly, as an electronic crossmatch SHOULD NOT occur if there is an antibody identification pending.  Electronic crossmatching must not take place if a clinically significant antibody is present, and unless the ABID is resulted, Meditech cannot evaluate the clinical significance of the antibody to determine if an EXM should be allowed.  Good luck with your validation!  I have to say that our issue with the historical blood types is the only downfall I have experienced, and I LOVE, LOVE, LOVE electronic crossmatch!}

[tkakin]

Yes, you do need to change the paradigm.  I would not advise any sort of work-around.  By ABID, I assume you mean antibody identification, is that correct?

 

Was the ABID type test manually ordered or reflexed on the specimen due to a positive antibody screen? 

 

Dan

Hi Dan,

Yes I do mead ABID- antibody identification

Yes the the ABID would be reflexed due to a positive antibody screen

[tkakin]

_TTAKIN,

 

_{This is functioning correctly, as an electronic crossmatch SHOULD NOT occur if there is an antibody identification pending.  Electronic crossmatching must not take place if a clinically significant antibody is present, and unless the ABID is resulted, Meditech cannot evaluate the clinical significance of the antibody to determine if an EXM should be allowed.  Good luck with your validation!  I have to say that our issue with the historical blood types is the only downfall I have experienced, and I LOVE, LOVE, LOVE electronic crossmatch!}

 

Hi BankerGirl, I am with the understanding that it is acceptable to do EXM with a clinically signinficant antibody .

 

I was informed that at an ask the standards committee they decided to.....

 

Changed title of 5.16.2 from “Computer

Crossmatch” to “Use of Computer to Detect

ABO Incompatibility”, to allow the use of a

computer to detect ABO incompatibility in lieu

of serologic testing when requirements are

met. Effectively allows a computer method

for ABO, which could be used in addition to

an AHG serologic crossmatch for patients with

antibodies.

 

If this is incorrect please please please correct me. 

I want to be clear I am not saying techs are not completing the work up.  They are just not generating the report the ABID in the computer. They are updating HX!

[SMW]

Hi BankerGirl, I am with the understanding that it is acceptable to do EXM with a clinically signinficant antibody .

 

I was informed that at an ask the standards committee they decided to.....

 

Changed title of 5.16.2 from “Computer

Crossmatch” to “Use of Computer to Detect

ABO Incompatibility”, to allow the use of a

computer to detect ABO incompatibility in lieu

of serologic testing when requirements are

met. Effectively allows a computer method

for ABO, which could be used in addition to

an AHG serologic crossmatch for patients with

antibodies.

 

If this is incorrect please please please correct me. 

I want to be clear I am not saying techs are not completing the work up.  They are just not generating the report the ABID in the computer. They are updating HX! It is NOT acceptable to perform only an electronic xmatch if there is a history of clinically significant antibodies. 

 

The title of 5.16.2 was changed to "Use of Computer to Detect ABO Incompatibility" and details what needs to occur if you will be using this method to detect ABO incompatibility.  The intent of this change was to allow either a serologic method or an electronic method to detect ABO incompatibility.  For example, if a serologic xmatch is being performed using gel, it would be acceptable to use either an electronic xmatch (providing all the elements in 5.16.2 are met) or an initial spin tube test as the supplemental test to detect ABO incompatibility (which the gel test is not licensed to detect). 

 

Perhaps it's a matter of semantics for the test codes you are using.  An "electronic xmatch" (only a check of ABO incompatibility) should not be permitted if there is the history of clinicially significant antibodies; however a serologic antiglobulin xmatch result used along with a validated system that detects ABO incompatibility at the point of issue would meet the intent of the Standards. 

(5.16.1.1 If no clinically significant antibodues were detected in tests performed in Std 5.14.3 and there is no record of previous detection of such antibodies, at a minimum, detection of ABO incompatibility shall be performed.)

[Dansket]

 

Perhaps it's a matter of semantics for the test codes you are using.  An "electronic xmatch" (only a check of ABO incompatibility) should not be permitted if there is the history of clinicially significant antibodies; however a serologic antiglobulin xmatch result used along with a validated system that detects ABO incompatibility at the point of issue would meet the intent of the Standards. 

I believe the FDA has stated explicitly that if you are using the Anti-IgG Gel card to do a serological antiglobulin crossmatch you must also use a serological method to detect ABO incompatibility and a computer may not be used to detect ABO incompatibility between donor and recipient.

 

For this reason, we routinely perform both a buffered gel crossmatch and an anti-IgG gel crossmatch on ProVue whenever a patient does not qualify for an electronic crossmatch in Meditech C/S version 5.66.

[tkakin]

I believe the FDA has stated explicitly that if you are using the Anti-IgG Gel card to do a serological antiglobulin crossmatch you must also use a serological method to detect ABO incompatibility and a computer may not be used to detect ABO incompatibility between donor and recipient.

 

For this reason, we routinely perform both a buffered gel crossmatch and an anti-IgG gel crossmatch on ProVue whenever a patient does not qualify for an electronic crossmatch in Meditech C/S version 5.66.

 

Ohhh my, This keeps getting more complicated. 

1. Where do I find this information on the FDA requirement?

2. Does FDA trump AABB?

I appreciate all your help, I do want to do this according to the rules.

[AMcCord]

FDA trumps everybody.