Electronic Crossmatch in Cerner Millennium

[TypeO4life]

Is anyone out there currently using Cerner Millennium for electronic crossmatch?

 

I would mostly like to know how and when the unit is assigned via electronic crossmatch.

Does the computer automatically assign the unit, or is the unit to be electronically crossmatched scanned in to be assigned?

Is the unit assigned in Result Entry for Blood Bank, or is it assigned when dispensing the unit?

 

Any help to these questions would greatly appreciated?

[Sophie1210]

We will be going live with electronic crossmatching on April 1st. I've validated it and will begin training staff soon. Crossmatching takes place in Blood Bank Result Entry. You should be able to select Computer Crossmatch (instead of Serological Crossmatch). You barcode in the units like you do for serological crossmatches and then instead of putting in results, if the unit is compatible with the patient it will automatically fill in as Computer XM OK. You'll hit verify and that should be it.

[butlermom]

We've been live with Cerner since February 2013 and our process is the same.  We get a unit of the patient's blood type from the fridge, go into Result Entry, scan the sample accession label, scan the barcoded BBID (blood bank i.d. from the armband) on the sample, and then scan the unit (however many are ordered).  As soon as you scan a unit, the computer makes the decision that the unit is ABO compatible with the recipient and automatically fills in the interpretation field with Computer XM OK.  Don' forget to pull a segment from the unit as well as a number sticker--we affix the sticker on a 12X75 tube and place the segment inside folded so it won't fall out.  Often we will wait until a nurse comes to pick up blood and just perform a Computer Crossmatch Dispense at that time.  The only thing is you have to manually enter the BBID in the field in the save dialog box when you are dispensing so that it will print on the donor tag.  Since we do not have the sample in hand at that time, I had to figure out a way to be able to quickly find the blood bank armband i.d.  What I did was to build a BBID result field in the ABORh test so that we can quickly look in Order Result Viewer at the most recent type and screen results and see the BBID.  We can then verify it against the blood request form that the nurse brings which MUST have the BBID on it.  We type this into the BBID field during dispense, pull a segment and sticker and we're done.  We never have to handle the patient's sample again.  It took us awhile to get used to this as we went live with electronic crossmatching the same time we went live with Cerner.  Everyone loves it now and we've never looked back, including this "old timer" blood banker!

[TypeO4life]

Thank you Sophie1210 and butlermom for your responses! So it sounds like there are two options for E-XM in Cerner Millennium:

1) E-XM at time of test results from Result Entry.

2) E-XM at time of dispense via Dispense & Assign Products.

 

What have you found are the biggest benefits to using electronic crossmatch?

What are the biggest drawbacks? Have there been impacts on your bottom line for E-XM?

[Maureen]

Our lab initially used E-XM at time of test results from Result Entry, which was not very different from Immediate Spin XM.

 

We implemented E-XM Dispense via Dispense & Assign Products with other process changes in Feb 2012.  

We see several benefits;  Expired crossmatches are not dispensed.  Fewer overrides occur overall.  The techs are diligent about performing ABO confirmation on a second specimen, so we avoid crossmatching O LRRBCs on non-O patients.  We spend less time on inventory management. We use FIFO more consistently, with the oldest units transfused.  The techs appreciate all the automated checking in this process.  We've reduced mistagged components, with IS XM more than one component for a patient occasionally the tags were transposed. 

[TypeO4life]

Hi Maureen,

Thank you for your response. Just to clarify, when EXM is done at Dispense and Assign, does the system automatically know that the patient is eligible for EXM? Or, are you just dispensing the unit? The way our system is set up, when dispensing, if the unit is not previously crossmatched, the system will think it is an emergency dispense and "not crossmatched." Please advise if possible.

[Sandy L]

Hi Maureen,

Thank you for your response. Just to clarify, when EXM is done at Dispense and Assign, does the system automatically know that the patient is eligible for EXM? Or, are you just dispensing the unit? The way our system is set up, when dispensing, if the unit is not previously crossmatched, the system will think it is an emergency dispense and "not crossmatched." Please advise if possible.

 

In Dispense and Assign there are multiple modes that you can select.  These can be selected from the task menu and can also be selected from the row of buttons below "Task".  As you hover over the buttons you will see that the 1st is "Assign", the 2nd is "Dispense", the third is "Emergency Dispense", and the last (with the lightening bolt) is "Computer Crossmatch Dispense".  If you pick Dispense mode, you are correct; the system will think it is an uncrossmatched unit.  If you select the Computer Crossmatch button, the system performs all of the checking to be sure that the patient is eligible, and won't let you proceed if the eligibility requirements are not met.

[Barb Thompson]

Every system is set up differently. This is how we do it. If the patient is eligible for the Computer XM, you can see it in PPI (Patient Product Inquiry).  When we get an order to transfuse from Order Entry, we first go to PPI to see if the patient has a current specimen, what day it was collected (so we know where to find the BBID #), and CXM eligibility.  If eligible, we go to DOE, add the XM test to the accn using the Accession Add On application, then go to Result Entry, scan the BBID (we use BB armbands), then scan the blood unit number of the unit that we take from the fridge.

If the patient is not eligible because there is no 2nd ABO/Rh on file, we go to ORV and see if we can find a lavender drawn at a different time by a different phleb.  If so, we go to DOE and order an ABO Confirm using the Order Entry application and mark it as collected based on the container details from the tube that we found (usually in hemo).  We perform the ABO/Rh and voila - the patient is now CXM eligible.  Then we do the steps above.

 

If we know the patient is getting transfused, we get it ready at the time we receive the order.  But, there are times when blood is ordered "On Hold", and we do not set these up.  We will make sure these patients are CXM eligible if possible. Theses are usually OR patients.  If OR then needs to transfuse, they must reorder the product with a transfuse priority of "Now", call us (to make sure someone is home) and come over to pick it up.  At this time, we can go directly to Dispense and Assign, select the 4th icon from the left (may be different for other facilities) which is Computer Crossmatch Dispense and do the dispense and XM all at the same time.   The unit tag will print after clicking OK. The only thing I don't like about this is that it throws a XM test on to your pending list, but it will fall off after the TS expires.

 

I have found cerner to be quite convoluted, but it is better than what we had before, which was paper.

 

You can't do the computer XM dispense using the regular dispense routine (2nd icon from the left) because you will have to override, even if you can see that the patient is eligible.

[Cathy]

We order an e-xm in DOE and result in Result Entry as others do above. We print a xm tag and tag the unit.  At the time of dispense, we print another copy of the xm tag. The only down side I can see when doing the electronic crossmatch in Dispense and Assign, is that we only get one tag.  We like the two copies so one can stay attached to the unit during the entire transfusion and the two nurses doing the double check can sign the other and place on the chart.  I like to hear ideas of others though!

[Maureen]

Hi Maureen,

Thank you for your response. Just to clarify, when EXM is done at Dispense and Assign, does the system automatically know that the patient is eligible for EXM? Or, are you just dispensing the unit? The way our system is set up, when dispensing, if the unit is not previously crossmatched, the system will think it is an emergency dispense and "not crossmatched." Please advise if possible.

Cerner does 'know' when a patient is eligible for EXM, and this is flagged in both Pat. Prod Inquiry and Dispense by the designated icon.  When you 'click' on it the pertinent (both inclusion and exclusion criteria) display in an informative window. 

With our setup the user does not need to 'order' a crossmatch.  When a pickup order is presented we match it to an open Blood Product Order.  When the Crossmatch order does not yet exist Cerner will create one during the Computer Crossmatch Dispense (CCD) process.

There are no 'overrides' for Computer Crossmatch Dispense, if the patient is not eligible the tech must choose a different option.

We do not utilize a separate BB number - so retrieving the specimen is not an issue for us.  The CCD process is the same for both 'Transfuse' and 'Hold' orders in our laboratory.