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Meditech Emergency Issue & Electronic Crossmatches

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We went live with electronic crossmatches in Meditech 5.66 a few months ago. These are the default XMs for all our RBC components. There is a problem with the emergency issue routine in that we would like to do a regular serologic crossmatch in those cases as for a variety of reasons those patients usually don't qualify for electronic crossmatches. The trouble is that, even if you replace it with a regular crossmatch in Requisition, the system will tack the unit onto an additional electronic crossmatch (it being the default) as you issue it. Is there an easy way around this without having to reset crossmatches, etc? Thanks - Phil

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We are using Meditech C/S 5.66 and the electronic crossmatch.  We don't have the issue you're describing.

 

We have a single X-type Crossmatch test that has two T-type component tests: Immediate-spin and Anti-IgG XM.

 

The X-type test is entered in the Product dictionary on page 4 as an Associated Patient Test. for all red blood cells components.

 

So, whever red blood cells are ordered in Meditech, the X-type test is automatically added to the order or the RBC order count is incremented if it is an add-on to an existing order.

 

If a patient qualifies for electronic crossmatch, Meditech automatically enters a default result of NP for both Immediate-spin and the Anti-IgG T-type tests.  These results are interpreted as compatible according to our entry in the BBK Calculation dictionary.

 

When uncrossmatched blood has been issued (using the Emergency Release routine) and the patient has been subsequently found to qualify for the electronic crossmatch, Meditech does not enter default results of NP.  This has been reported to Meditech and they have acknowledged that this is a 'bug".   We developed a computer 'workaround' to avoid doing serologic crossmatches and entering serologic test results.

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When uncrossmatched blood has been issued (using the Emergency Release routine) and the patient has been subsequently found to qualify for the electronic crossmatch, Meditech does not enter default results of NP.  This has been reported to Meditech and they have acknowledged that this is a 'bug".   We developed a computer 'workaround' to avoid doing serologic crossmatches and entering serologic test results.

What is your workaround?  I am very interested in knowing.

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Essentially, our work-around is to manually enter NP as the test result for both T-type tests.  Based on our BBK Calculation for the crossmatch, manual entry of NP will generate an interpretation of "Compatible ? N". 

 

User then changes the N to Y and is prompted by Meditech that interpretation does not match calculated result.  In our system, user can override this warning. 

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Thanks Dan. I have forwarded this to our IT folks. Our crossmatch tests are set up quite differently, and reinventing the wheel will be a little difficult as we share meditech with another hospital and have different methodologies.

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We have a get around that we book the units into the 'emergency issue fridge' and then print blank paperwork from there. The medic fills in the patient details and then when we get the bags, tags and paperwork back we book it against the patient and do a retrospective crossmatch.

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Seems a bit of a waste of time doing a retrospective in vitro cross-match when a real time in vivo cross-match has already taken place!

Agreed tbh... I can see the reason if the patient has antibodies to determine the possibility of a dtr but policy is policy... At least we don't get fired for not having the flu jab ;)

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BankerGirl,

 

I purposely configured the crossmatch BBK Calculation to report "Compatible? N" so I would have an audit trail if someone tried to bypass the system and to simulate an electronic crossmatch on a patient who does not qualify.

 

Dan

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Thanks, Dansket, I tried this out yesterday, my interpretation was actually compatible, and it worked like a charm.

Meditech has a DTS in developement, will advise whever it is installed on my system.

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Dan,

Wouldn't your electronic crossmatch audit train catch this?  This got me to thinking about this, and if you emergency issue units, there is no message about the patient not qualifying for EXM, it just doesn't seem to even evaluate it.  Now I am really wondering...

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Bankergirl,

 

    Meditech does not evaluate (during BBK Enter/Edit Results entry) emergency issued units for electronic crossmatch. Meditech expects user to enter serological test results for immed-spin and anti-IgG.  Meditech sees NP as a negative result (no different than no agglutination)  so that is why your BBK Calculation interprets your NP entries as "Compatilble? Y".

 

By configuring the BBK Calcuation to not ignore NP, it interprets the crossmatch as "Compatible? N".  User has to override this and that override is captured in the override warning report that I review daily. 

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I can't help with the Emergency Issue/EXM thing, but couldn't you just enter NP for your reactions and then an interpretation of "P" for presumed compatible?

That is what we do if we transfuse Emergency Issued Group O blood and never get a patient specimen (due to the patient dying or something).

 

Linda

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Dansket - How do you charge for the ISXM separately from the AHGXM?  We have meditech cs 6.0.  The charge is attaching to the X type test XM instead of the T type tests XMIS and XMAHG.  I would like to charge based on testing performed, for example if only an XMIS is done and AHG is TNPd then there is only a charge for the XMIS since these tests have different CPT codes.  Thanks!

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We have a charge test built as part of our XM that calculates the charges.  The default answer to this test is NO, but if the AHG has a result other than TNP or NP, then it changes the result to YES and the AHG crossmatch is charged.

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Dansket - I figured out the charges from another facility.  It involved order groups reflexing a charge test based on results entered.  I can get you screen shots if you'd like.

Edited by wagnmell

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Dansket - I figured out the charges from another facility.  It involved order groups reflexing a charge test based on results entered.  I can get you screen shots if you'd like.

 

Please do.

Thanks

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  • Emergency Issue products as necessary, save a DIN label.

Load the specimen with the XMs populated.

Highlight the DIN of the unit.

Scan a label that has that same DIN.

EXM will evaluate.

Success.

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Sunquest Users

If we emergency issue a "crossmatch compatibility" is recorded. If the product has been issued and maybe already transfused, we cannot then go back and complete any other crossmatch that is needed, i.e., IS, EC, AHG. How do you record in Sunquest the subsequent crossmatch without having the original emergency issue written over? Hopes this makes sense.

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Also check the rules for previously transfused and check it is from the date of issue and not for units marked as complete. We noticed ours would allow an Electronic Issue on an expired sample if the units transfused hadn't yet been marked as used.

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