RhIg Dispensing

[Darren]

Howdy all. I'm working on getting RhIg out of the BB and into pharmacy. They're for it, we're for it. I was wondering how it's dispensed at hospitals where the RhIg is kept by pharmacy. We're using Meditech 6.0 and are working on how and who orders the injection. What I'd really like to know is if anyone dispenses it from a pyxis or omnicell. That's what we'd prefer because it would be more convenient for everyone involved.

[Auntie-D]

We took it back after it was issued to a man as 'he was the problem'

[MAGNUM]

When we went live with BCTA in 2008, all of our hospitals in our division moved the RhIg to the pharmacy. The injection is ordered by the floor, after we perform a fetal screen/KB. So far we have not had any problems..

[jayinsat]

We switched about 3 years ago.   Our facility does not have OB or Pediatric services so the only time we see RHIG orders is from our Emergency Department on pregant females threatening miscarriage or trauma.  Our physicians order an ABO/RH and, if rh negative, we perform an antibody screen and they request the rhogam through pharmacy via OE. 

 

Our pharmacy generates a daily report on any patient who receives RHIG, Fludarabine or IVIG.  If I see a patient on the report having received RHIG, I go and check to make sure we performed an Type and Screen and the patient was indeed a candidate.  We've only experienced a few instances where the E.D. physician gave RHIG without first performing an ABO/RH based solely on the patients word that they were RH negative.  Our Pharmacy is supposed to check to see if a completed TS has been recorded before dispensing the RHIG. 

[Rapundaa]

We gave up our RhIg about 10 years ago. It's stored in pharmacy. After the work is completed in the LIS we order the RhIg in PowerChart (the hospital's Cerner program) which prompts Pharmacy to issue. We can use one or more doses as needed. It's given an obscure pneumonic to keep the physicians from being able to locate it and order it without the appropriate blood bank work first.

[Veejay]

I'd prefer that RhIg be issued by the Transfusion laboratory so that it is tracked in the Blood Bank's computer. It is an important blood product that the lab staff need to know about, its not an insignificant antibody.

[Darren]

I'd prefer that RhIg be issued by the Transfusion laboratory so that it is tracked in the Blood Bank's computer. It is an important blood product that the lab staff need to know about, its not an insignificant antibody.

 

My thinking is that its no different than a passive vaccine like an antivenin or rabies shots. Pharmacy can handle all of that deftly so I figure RhIg isn't much of a trick. I'll have a SQL report written that will alert me if a doc gives the shot without testing first so that I can make the CEO smack their hand.

[tbostock]

We have it in our BB. The Pharmacy had it but signed one out for the baby. Thank goodness an astute nurse did not administer it. The Pharmacy does have a supply of Rhophylac but only for IV administration for ITP patients.

The Pharmacy does, however, have to sign off on it as it is considered a medication by the FDA. So we have a "double" order where one goes to BB so we can do the testing and dispense it. The other goes to Pharmacy for review and sign-off by a pharmacist.

[AMcCord]

We also dispense RhoGAM from Blood Bank with a Pharmacy review. We recently got a new director in Pharmacy and we asked her if they'd like to have RhoGAM so it could be dispensed through Pixis - she declined, emphatically.

[pbaker]

The different opinions from the pharmacies are very interesting.  At my last job, pharmacy insisted that it needed to come from them, since it is a drug.  I have tried to give it to them at my current position, but the BB med director will not let it go.

[Auntie-D]

At my last job, pharmacy insisted that it needed to come from them, since it is a drug.  I have tried to give it to them at my current position, but the BB med director will not let it go.

 

It's not a drug though, it's a blood product

[David Saikin]

Actually it is a blood derivative.

In the USofA blood is considered a drug by the FDA - to get better remuneration for his staff one of my previous lab mgrs had all the blood bank staff assigned to the same pay scale as the pharmacists - pretty ingenious I thought.

[LAS]

We have Meditech 6.0, but we own all things Rhogam related.  Our pharmacy does not want it.

[tbostock]

It's not a drug though, it's a blood product

The FDA has put it in the same category as drugs, and requires a pharmacist review. Probably not in the UK though.

[Kimster]

It is considered a drug because it has a NDC number just like IVIG, coag products all of which are plasma derivatives.

[Dansket]

Being able to respond to an inspector's inquiry for evidence that patients identified as candidates for Rh Immune Globulin and verify the injection is essential to the process, whomever dispensed it whether Blood Bank or Pharmacy. If your process can accomplish this, it shouldn't matter which department dispensed it.

[bldbnkr]

Hi everyone ~ revisiting this topic (or visiting it for the first time) since I am in the midst of a Meditech conversion/build/implementation.

(We are currently Softbank but the entire hospital is converting to MT)

We just tested the eTAR and I am really not happy with the RhoGam administration on the TAR - it wants a barcode on the product, it wants the patient to have a Blood Bank Bracelet/Band, it wants an ABO/RH on the donor product, it wants the product checked for clots - the TAR people tell me the parameters built on that side are all or nothing - and of course we need those checks for Blood/Blood products.

I see that other hospitals administer RhoGam in Meditech on the eMAR through Pharmacy.  Is anyone in this forum doing so?  One local hospital says they do all of the blood bank work and then "forget about it", that someone the clinician is alerted that the product is ready to be given and they go to Pharmacy and get it - no telephone notifications needed.

 

Anyone else using Pharmacy for RhoGam in Meditech?

 

Thank you!

[BankerGirl]

What version Meditech are you implementing?  We are on v5.67 and our TAR is set up differently for RHIG where only the patient armband is required to be scanned.  If you are changing to v6.x this might have changed, but it might be worth investigating.

[bldbnkr]

Version 6.15, I should check with the TAR guru on that one.  Thank you.