Meditech and TAR

[mollyredone]

We have a terrible compliance issue with nurses not filling out the transfusion forms completely. Right now we are using paper, since TAR hasn't been installed. I did a complete audit for April and found verification signatures missing, vitals missing, initials on vitals missing, breath sounds missing and volumes missing.

If anyone has TAR, are these fields required? Do nurses have to fill out verification signatures,etc?

TIA,

Mari

[goodchild]

First of all, TAR is great once all of the nurses are trained and up to speed. One thing I have on my to-do list is to get rid of our paper transfusion records and switch to stickers.

 

Verification information is captured via the use of the electronic barcoding system. They have to enter their electronic signature/PIN.

They could always choose to neglect to do vitals but for us it was better that it was on the TAR because a) it matched their current mode of documenting vitals into the EMR critical care units have the option of transmitting data from monitors.

The volume transfused is captured when they electronically stop the transfusion.

Everything is auditable in lab module and EMR. Depending on how your team decides to set things up, all data are editable for up to 99 hours by nursing personnel.

[jschlosser]

We went live with TAR in January and I'm quite disappointed. The only advantage is the barcode scanning of the patient identification to product. In the lab we have delta checks and other flags that ask us if we need recheck an abnormal value but in TAR nurses can enter a 0 blood pressure or a 500 degree temperature with no checks or alerts. Why isnt there criteria that if a temperature increases by a certain amount TAR alerts the nurse that a transfusion reaction may be happenning or if the oxygen saturation declines think TRALI? Is this something that is possible with TAR and our IT just hasn't included?

[mollyredone]

Thanks, Goodchild! When I informed nursing about the missing info on the paper forms, I was told that they are documenting in the computer, but obviously, without TAR, the verification and volume are not noticeably documented. Do you require documentation of pre and post breath sounds? Our paper form has it listed, but many times that is also missing. Also, if more than one unit is issued, do you have a way to verify that the PRBC has been kept at proper temp, especially if it is the second unit? We have a stamp for Safe-T-Vue that they are supposed to initial when they start the second unit.

[mollyredone]

Jschlosser, I would be interested in finding this out as well. We are supposedly going live in September. Do you use separate BB bands? We still do, but I'm hoping to get rid of them, since their patient band has a barcode. I'm still hoping to start the process for electronic crossmatch, but we've had so many other updates that I've had to put it off for the past two years!

[jschlosser]

We stopped using a seperate blood bank band when we went live with TAR.

[BankerGirl]

We went live with TAR several years ago and it has made my life much easier.  I think there is a way to document the vitals through TAR, but even if they don't do it that way, all of the vitals entered into Meditech end up in the same "bucket" eventually, so I had our NPR writer design a report for me that pulls all vitals entered on the patient from 1 hour prior to 15 minutes after the end of the transfusion.  This can pull a lot of vitals if the patient is being monitored very closely, but I would rather have too many than not enough.

[ESIZENSKY]

Thanks, Goodchild! When I informed nursing about the missing info on the paper forms, I was told that they are documenting in the computer, but obviously, without TAR, the verification and volume are not noticeably documented. Do you require documentation of pre and post breath sounds? Our paper form has it listed, but many times that is also missing. Also, if more than one unit is issued, do you have a way to verify that the PRBC has been kept at proper temp, especially if it is the second unit? We have a stamp for Safe-T-Vue that they are supposed to initial when they start the second unit.

 

First of all, TAR is great once all of the nurses are trained and up to speed. One thing I have on my to-do list is to get rid of our paper transfusion records and switch to stickers.

 

Verification information is captured via the use of the electronic barcoding system. They have to enter their electronic signature/PIN.

They could always choose to neglect to do vitals but for us it was better that it was on the TAR because a) it matched their current mode of documenting vitals into the EMR critical care units have the option of transmitting data from monitors.

The volume transfused is captured when they electronically stop the transfusion.

Everything is auditable in lab module and EMR. Depending on how your team decides to set things up, all data are editable for up to 99 hours by nursing personnel.

[goodchild]

Do you require documentation of pre and post breath sounds? Our paper form has it listed, but many times that is also missing.

 

Yes we do.

 

Also, if more than one unit is issued, do you have a way to verify that the PRBC has been kept at proper temp, especially if it is the second unit? We have a stamp for Safe-T-Vue that they are supposed to initial when they start the second unit.

 

In the issue units interface in Meditech we have a 'customer defined' field for "Issued in transport container." The transport container number is tracked on our requisition form used to issue blood and/or in the issue units comment section for follow up.

 

So if we saw a unit of blood that was issued and a lengthy period of time passed before it was started, we could check that it was issued in a transport container, but we don't get any more detailed than that.

 

 

We also don't use blood bank wrist bands, use a second specimen to verify the blood type (memonic RETYPE), and implemented EXM last year (best thing ever).

Edited August 13, 2015 by goodchild

[mollyredone]

We have quite a dilemma with giving up BB bands. Our outlying collection areas don't have the ability to use hospital bands, plus our ED is NOT going with TAR. They are so ridiculous! So outpatients will still be BB banded, as will ED patients. When the patients are drawn at our cancer care facility, which is our most frequent transfusing area, they will be BB banded, and when they are transfused they will get a hospital band and the nurses will use TAR there.

So if a patient needs to be transfused in the ED, they will BB banded and the transfusion will start and finish on paper. If they are admitted and need further products, they will be transfused in TAR.

ARGGGH!

Suggestions if anyone has the same mixed bag like that.

[sgoertzen]

Our entire hospital uses TAR...except Surgery. They refuse to use Meditech and use their own O.R. Manager system which does not interface with Meditech so their transfusions are still done on paper and are scanned into the EMR.  So our big problems are with units started on the floor and transported with the patient to Surgery, and units started in Surgery and transported with the patient back out to the floor. We have to print paper transfusion forms for documenting either the beginning or end of those transfusions.   We have never used separate BB bands but use the regular barcoded hospital band - both for inpatients and outpatients.  We really like TAR.  You can build the nursing checklists and vital screens with whatever fields you want completed.  Unfortunately, Meditech has not built all screens/interventions/assessments with the capability of setting a requirement that the field MUST be completed prior to filing, so we occasionally still see some missed vitals, or missed checklist items (like a check for special requirements).  Those "missing" items are now being tracked and reported as part of our ongoing quality monitors, and we've seen compliance get much better.   

[mollyredone]

I discovered that the checklist items, such as consent signed are not required to start a unit. Since we are still building it, I hope we can make it required. Do you do the monthly audits? We are doing them. The vitals pass into the lab module, but I don't think the checklist does, or any overrides when scanning the patient band and unit.

As I said we don't have hospital bands available at our outlying draw sites, and ER is not going with it either.