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Blood product info at the Bedside


sgrassley

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We are looking at entering (barcoding) the specific information about the unit (Unit #, Blood Type & Expiration of the unit) when we issue it directly into a Communication order in the EMR. This would pre-populate the record and be available when the 2 nurses do the bedside check. Is anyone doing something similar to this currently?

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You really shouldn't use the EMR for anything involved in the administration of blood unless the EMR has an FDA approved blood administration module. If something goes wrong, it will come back to haunt you, and the Blood Bank could be held ultimately responsible.

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We are currently using the EMR for all of the bedside documentation. Right now the nurse has to type in all of the information, including the entire ISBT unit #. (They are better at this than you would expect. :) )

We are looking at improving the process and exploring all options.

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We are currently using the EMR for all of the bedside documentation. Right now the nurse has to type in all of the information, including the entire ISBT unit #. (They are better at this than you would expect. :) )

We are looking at improving the process and exploring all options.

 

I'm thinking if they have to type in the unit #, then it is probably not FDA approved as they are big fans of barcoding. What EMR do you have?

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We are just starting the process of upgrading Cerner Classic to Milennium. Seeing as Classic will sinset in 2015 your facility will have to do something soon. The upgrade willl improve the blood administration part immensely. Nurses currently have to type in the whole ISBT number. Not good. Our facility has hired a Blood Bank consultant (not Cerner) to work with us and Cerner to make sure we get what the BB needs in this project; barcode scanning of specimens, products,and anything else. I think this will really help us, otherwise we tend to be ignored.

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We have SoftBank and are "paperless" for inpatients only.  (We still print paper transfusion records for Oncology, Surgery Emergency Department and a few other locations). 

 

The nurses who are paperless have a home-grown transfusion flowsheet built into Clinical Suites which is the EMR.  They do their two person check on this flowsheet.

 

They do not type and unit number, nor do they barcode it, the nursing creators of this flowsheet were too afraid of typos and errors, so they chose not to include the number in this flow sheet.

 

But the numbers of the units transfused are stored in SoftBank, so we are covered for traceability.

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bldbnkr

 

I find it interesting that you do not have a record of the unit transfused on the pt chart.  Has your process been through the inspection process?  I  would cite you because you can only infer that the unit was transfused to the pt that you have documented it was crossmatched to and released for.  There is nothing in the pt's medical record to substantiate your computerized assumption.  Then the regulatory gurus at wherever (AABB, CAP, JCAHO, ad nauseam) could make a final, binding decision. 

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bldbnkr

 

I find it interesting that you do not have a record of the unit transfused on the pt chart.  Has your process been through the inspection process?  I  would cite you because you can only infer that the unit was transfused to the pt that you have documented it was crossmatched to and released for.  There is nothing in the pt's medical record to substantiate your computerized assumption.  Then the regulatory gurus at wherever (AABB, CAP, JCAHO, ad nauseam) could make a final, binding decision. 

 Thank you David, no, this is an entirely new process, we have not yet been inspected.  - it was driven I think by an effort to be environmentally friendly and "green" and get rid of the paper.  SoftBank does have the unit go into a "presumed transfused" status so you are correct, we are assuming that the unit is transfused.   We could have the nurse type the unit number into the flow chart, but if this homemade flowsheet is not FDA approved, that would not be good.  I think there might be an upgrade so that the barcode reader can scan in medication to other flow charts on the floors, so perhaps we could have the nurses barcode in the unit?

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We are looking at a Communication Order form that would accept the Unit information. We could barcode information from the unit in Blood Bank when we issue it directly into the form. Then this information would be available at the bedside when the transfusion was starting. I wondered if any one was already doing something like this.

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We have Allscripts. We have flowsheet that we built. It is very cumbersome. Our Blood Bank system is Cerner Classic and doesn't link with the hospital system. Maybe when we upgrade. (It's on the wish list!)

Yes cerner classic is retiring in 2015 then you will have to opt to something else. & Cerner classic doesn't link to most of the hospital system 

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We have SoftBank and are "paperless" for inpatients only.  (We still print paper transfusion records for Oncology, Surgery Emergency Department and a few other locations). 

 

The nurses who are paperless have a home-grown transfusion flowsheet built into Clinical Suites which is the EMR.  They do their two person check on this flowsheet.

 

They do not type and unit number, nor do they barcode it, the nursing creators of this flowsheet were too afraid of typos and errors, so they chose not to include the number in this flow sheet.

 

But the numbers of the units transfused are stored in SoftBank, so we are covered for traceability.

 

Like David said.......you will get cited for not having unit number on chart. if you are AABB accredited

 

5.27       Medical Record Documentation

5.27.1     The patient’s medical record shall include: transfusion order, documentation of patient consent, the name of

                     the component, the donor identification number, the date and time of transfusion, pre- and post transfusion

                     vital signs, the amount transfused, the identification of the transfusionist, and, if applicable, transfusion related

                     adverse events.

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