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ADawson

Transfusion Administration Records (TAR)

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Hi Everyone,

Is there anyone out there that has experience with Meditech's TAR? We are in the process of validating this for our blood bank. If so I would appreciate your help with the following:

  • Do you use an additional form of identification (Typenex bracelet)?
    • If so are you using it for all products? We currently use typenex for packed cells and Rhogam. We don't require it for ffp, pheresis, or cryo. Our LIS tech is telling me it has to be used for all or none in TAR because of the way the parameters have to be answered.
    • If required for all products do you use a different one for each product?
  • What form of identification or requisition do you require at the time of issue?
  • What information from the unit and/or the patient do you require nurses to verify (scan barcode) at bedside?
  • What other issues have you encountered?

Thanks So much in advance. I really want to keep changes to the process on the blood banks end to a minimum if possible, but will definitely do what's necessary for the safety of our patients. That's what its all about.

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We use TAR.

 

1.  Do you use an additional form of identification (Typenex bracelet)? NO

2.  Our LIS tech is telling me it has to be used for all or none in TAR because of the way the parameters have to be answered. This is correct.

3.  What form of identification or requisition do you require at the time of issue?   We require the patient's full name or MR number.

4.  What information from the unit and/or the patient do you require nurses to verify (scan barcode) at bedside?  They scan the patient's wristband (account number) and all four quadrants of the blood unit.  For RhIG they only scan the patient's wristband since the other info isn't applicable.

5.  What other issues have you encountered?  I can't think of anything specific right now.

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  • Do you use an additional form of identification (Typenex bracelet)?  We use Typenex bracelets for all blood bank samples.  If we draw a Type and screen, with or without crossmatch, type and hold, etc.  The patient gets banded
    • If so are you using it for all products?  Yes we do.  We recently (May 2016) sent Rhogam to pharmacy  We currently use typenex for packed cells and Rhogam. We don't require it for ffp, pheresis, or cryo. Our LIS tech is telling me it has to be used for all or none in TAR because of the way the parameters have to be answered.  That is a dictionary setting.  I believe it is all or nothing
    • If required for all products do you use a different one for each product? No, we use one armband per patient per admission.  If it becomes illegible, we change it when we draw a new sample
  • What form of identification or requisition do you require at the time of issue?  We have a blood/tissue release form.  They have to put a label (name, MR#, DOB sticker) on it and then sign, date, time the pickup.  We also put a Blood unit number on it so we can track if needed.  It's also issued in meditech at that time so nursing can start in TAR
  • What information from the unit and/or the patient do you require nurses to verify (scan barcode) at bedside? Patient hospital wristband, Blood unit number, and product barcode.  Can set up to have blood bank wristband scanned but we haven't done that yet.  They also have to manually check like we did before TAR
  • What other issues have you encountered?  Nursing not documenting Vitals in TAR.  Regular vitals don't flow to TAR if they doc them there.  Other than barcode scanner issues, it's worked really well

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We use TAR -- although we call it BCTA (Bar Code-enabled Transfusion Administration).

  • Do you use an additional form of identification (Typenex bracelet)?
    • We use MobiLab and patient wristbands, so we do not have to have an extra wristband for specimen identification.  We scan in the patient account number barcode to print the specimen labels -- Love MobiLab because the labels include collection date, time, and collector ID.  No handwriting is needed on these labels.  We use the Medical Record number for our "wristband" number -- so it remains the same every time the patient is admitted.  MobiLab makes it possible for us to use an EDTA specimen from hematology morning pickup if a patient needs a new type and screen instead of having to draw the patient a second time.
      • If so are you using it for all products? This is used for all products for the patient.  Pharmacy issues RhIG and factor concentrates.  We had to transfer all "lot number" products to Pharmacy when we went up on BCTA, so we only have PCs, FFP, Cryo, and PLTPH.
      • If required for all products do you use a different one for each product? No.
  • What form of identification or requisition do you require at the time of issue?  BCTA has a pre-transfusion checklist that the nurses print off and bring to the Blood Bank. This checklist also has a copy of the patient wristband, so we can scan in the Medical Record number when issuing products to the patient.  (This is another plus for patient safety.) In urgent situations, they simply bring a patient identification label from the chart or handwritten patient number and MR#.  We require two identifiers when blood products are issued.
  • What information from the unit and/or the patient do you require nurses to verify (scan barcode) at bedside?  BCTA requires Patient wristband to be scanned and then unit Donor Identification Number, product, and blood type barcodes.  If all of those check correctly, the blood product can be administered.  In urgent situations or during computer downtime, two nurses are required to check the unit and patient information.  BCTA is being used everywhere except in emergencies and in the ED (working to get it used here in non-emergent situations).  The nurses on the floors love this because they don't have to find a second nurse to check the unit with.
  • What other issues have you encountered?  None.

As I said, we really love BCTA here.

 

anne

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We use TAR and even though nurses scan the (hospital) wristband and all barcodes on the units.   When we used paper forms, a CNA or other non-nurse could verify, but TAR requires two nurses to verify.  ER is still a hold out for us.  Can't force them to do anything the rest of the hospital is doing!

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On 11/11/2016 at 0:43 PM, mollyredone said:

We use TAR and even though nurses scan the (hospital) wristband and all barcodes on the units.   When we used paper forms, a CNA or other non-nurse could verify, but TAR requires two nurses to verify.  ER is still a hold out for us.  Can't force them to do anything the rest of the hospital is doing!

That is a familiar song.

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This may shock anyone using Meditech TAR at their hospital but we have successfully implemented TAR in ED and OR (i.e. anesthesiologists) this year !

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We have had ED on TAR since the beginning, but Anesthesia is our hold out.  They claim that they don't have the staff to document real time or to do the 2 person verification.  I have thought about eliminating the 2 person verification since the computer verification is acceptable, but I haven't done it yet.  Maybe that would encourage them, but honestly, I doubt it.

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On 11/14/2016 at 8:11 AM, goodchild said:

This may shock anyone using Meditech TAR at their hospital but we have successfully implemented TAR in ED and OR (i.e. anesthesiologists) this year !

Congratulations!!!!

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23 hours ago, BankerGirl said:

We have had ED on TAR since the beginning, but Anesthesia is our hold out.  They claim that they don't have the staff to document real time or to do the 2 person verification.  I have thought about eliminating the 2 person verification since the computer verification is acceptable, but I haven't done it yet.  Maybe that would encourage them, but honestly, I doubt it.

Our Anesthesia staff is very diligent about doing the 2 person ID, even with traumas in the ER. We explained the rationale for the process and they were on board. Historically a pretty high percentage of ABO mistransfusion fatalities seems to be cases in the ER or Surg where 'they don't have time for all that!'.  Pretty high risk attitude. Is there some way you can facilitate the 2 person verification real time that would make it more palatable to them but still be used. Some compromise that would make it easier for them w/o removing that step.

We don't use TAR, but it will be a coming attraction. We do use the SafeCheck lock system and anesthesia expressed concern about that slowing them down too much. The only exception we've made for them is dealing with the SafeCheck lock armband. They didn't want to search under drapes for the armband, so we allow them to pull a sticker from the ID bracelet only when the patient reaches the OR and then place it on the anesthesia record for the case - that sticker is used to unlock blood products only in the OR. That way the lock is still used, but their biggest concern was removed. Nobody else has that privilege. I have no idea what you could do with TAR but maybe there is some safe way to compromise with them. If nothing else, can you approach Quality/Safety for your facility and ask for help?

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On ‎11‎/‎8‎/‎2016 at 0:55 PM, ADawson said:

Hi Everyone,

Is there anyone out there that has experience with Meditech's TAR? We are in the process of validating this for our blood bank. If so I would appreciate your help with the following:

  • Do you use an additional form of identification (Typenex bracelet)? No, only patient's account # from wristband.
    • If so are you using it for all products? We currently use typenex for packed cells and Rhogam. We don't require it for ffp, pheresis, or cryo. Our LIS tech is telling me it has to be used for all or none in TAR because of the way the parameters have to be answered. Rhogam is not TARed.
    • If required for all products do you use a different one for each product?
  • What form of identification or requisition do you require at the time of issue? Type and screen results and crossmatch for RBCs (with MRN and patient's full name)
  • What information from the unit and/or the patient do you require nurses to verify (scan barcode) at bedside? the patient's account number is scanned from the wristband, unit number,product code and blood type. The expiration date is not scanned because we do not have a printer$$$ for new expiration dates ie FP.
  • What other issues have you encountered? More will be revealed...

Thanks So much in advance. I really want to keep changes to the process on the blood banks end to a minimum if possible, but will definitely do what's necessary for the safety of our patients. That's what its all about.

We are in the training process for nursing, go live date in December 2016. Nothing will really change on the BB side, other than easier access to vital signs monitoring/auditing.

Good luck to you!

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19 hours ago, LIMPER55 said:

What do you require with massive transfusion protocol?

Two person identification still?  etc?

If we are giving out blood tagged for a specific patient they are expected to do 2 person ID and they do it without complaint. It's very quick, but it's done. Anesthesia is very good about participating in the process if they are present. We do skip the FinalCheck locks for mass transfusion protocol, so there is one step in our normal process that is skipped. If at all possible we are hand delivering the blood to the patient location. (3 techs on during the evenings and 2 techs on at night to cover the entire lab, but they will call in help if they think they need it.) If we are sending blood to ER for more than one patient, we will post someone in the ER, outside the door to the treatment room, to ensure that blood is going to the correct patient. On evenings and nights that will be someone who has been called in to help. It might be our medical director - he's very good about coming in to make sure that everything is going well. He even answers the phone. (Yes, I do know how lucky we are to have that kind of support!)

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On 11/15/2016 at 9:54 AM, AMcCord said:

Our Anesthesia staff is very diligent about doing the 2 person ID, even with traumas in the ER. We explained the rationale for the process and they were on board. Historically a pretty high percentage of ABO mistransfusion fatalities seems to be cases in the ER or Surg where 'they don't have time for all that!'.  Pretty high risk attitude. Is there some way you can facilitate the 2 person verification real time that would make it more palatable to them but still be used. Some compromise that would make it easier for them w/o removing that step.

Hi Ann,

I didn't phrase that too well so thought I should clarify.  Anesthesia does do a two person check, just not in the computer.  With TAR you have to have a second qualified person enter their user name and password into the module before you can start the transfusion.  Anesthesia does all their documentation on paper and does not want to put anything in electronically, not just the transfusions.  If that were the only thing, we could probably persuade them.

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We've used TAR for years and it works well.  We use the regular hospital ID band (where the barcode is the patient account number) - we do not use a special band.  The nurses must scan the patient ID band and all 4 quadrants of the product label.  We still require that 2 nurses Esign in TAR after completing their bedside checklist. We have built all their necessary non-scanable checks into this checklist (AAB Std 5.28.3).   We use TAR everywhere except SURGERY, since they have their own system (called O.R. Manager) and they do not use Meditech in the surgery suites.  We do not print a paper form for any location but SURGERY.   For blood issue, we use a pick-up slip (we have them preprinted as pads that they keep at the nursing stations throughout the hospital) where they must fill out the patient name, MR#, Acct#, and what product they want to pick up.

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21 hours ago, BankerGirl said:

Hi Ann,

I didn't phrase that too well so thought I should clarify.  Anesthesia does do a two person check, just not in the computer.  With TAR you have to have a second qualified person enter their user name and password into the module before you can start the transfusion.  Anesthesia does all their documentation on paper and does not want to put anything in electronically, not just the transfusions.  If that were the only thing, we could probably persuade them.

That's a real problem. We deal with the paper issue in the OR, too. They still do vitals, meds and blood on paper. I'm hoping that when the entire house moves to Epic that we can force the issue. But they are special!

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Hello TAR users,

Sorry for jumping into this thread, but has anyone had an issue where a unit was not "finished" transfusing by Nursing in the TAR, and Blood Bank has to "finish" it in the BBK module?  Has anyone had a "Transfusing" unit get "stuck" in the TAR because nursing did not finish it and the TAR thinks it is still transfusing?

Thank you.

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23 minutes ago, bldbnkr said:

Hello TAR users,

Sorry for jumping into this thread, but has anyone had an issue where a unit was not "finished" transfusing by Nursing in the TAR, and Blood Bank has to "finish" it in the BBK module?  Has anyone had a "Transfusing" unit get "stuck" in the TAR because nursing did not finish it and the TAR thinks it is still transfusing?

Thank you.

We have about one of these per month.  If I can get an end time I put that time in; otherwise I just enter the end time as 4 hours from start and file a Risk Management variance.

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Just went live with EPIC at the beginning of the month and nursing is using BPAM for blood administration. One problem we ran into was a unit that was started in the ED, but not scanned. Apparently no one noticed that or didn't know what to do about it until after they completed the transfusion. At that point the unit DN couldn't be added. We are missing start times and vitals. We may have to start doing chart reviews on all transfusions for awhile to nip that in the bud (we don't transfuse large numbers of product, so it will be a pain in the....., but not impossible.) At least EPIC makes the review process pretty easy.

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Agreed Malcolm.  With Meditech, there is a BIG red warning when the transfusion time parameters are exceeded, and some of the nurses following the offender will end the transfusion, while some won't.  Some enter a nursing note, and some ignore it.  Most of these happen in our outpatient infusion area where the patient is dismissed before those transfusion time parameters are exceeded and they don't have the chart open anymore, but some still occur on the other nursing units.  Our outpatient nurse manager will always take care of it when I notify her, but the other units do not.

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18 hours ago, Malcolm Needs said:

What I don't understand is why nursing staff can get away with this.  If one of us techs failed to record something, all Hell would break loose.  :angered::angered::angered::angered::angered:

They are very busy you know..................guess we're not. :no:

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Hi everyone. Thanks for all your responses. What reports do you print to verify the entrance of vitals, 2 person check etc?

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Hi everyone. Thanks for all your responses. What reports for TAR do you print to verify the entrance of vitals, 2 person check etc by nursing?

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On 11/29/2017 at 1:54 PM, Malcolm Needs said:

What I don't understand is why nursing staff can get away with this.  If one of us techs failed to record something, all Hell would break loose.  :angered::angered::angered::angered::angered:

Well, I just finished reviewing transfusions for last month and there are 7 transfusions with no end time.:angry:

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