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MEDITECH TEST ORDERS FOR NEONATAL TRANSFUSION

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We recently had emergency release situations on two newborns, first one I can remember in my 7 years here.  The day after the O neg PRBCs were issued, I was trying to figure out what testing was required and how to order it.  We do NB types and DAT on all babies.  My thought was to create a new order for PRBC.  If I do that, it will order a type and screen.  Since we have already done a type on the cord blood, we would TNP the results?  We would still just give O units, Rh compatible. Or would you put in the results from the cord blood with the comment that it was performed on cord blood and TNP the back type and credit the type.

Then we perform the screen on the mom's blood, with an external comment, but the order is under the baby's account.  If the mom has already had a TS right before delivery, would you put in the results from her screen there and credit that screen, so she isn't double charged?  

I'm kind of thinking out loud, but I would appreciate any feedback.

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Did you use Meditech's Emergency Release routine to issue these units?

Edited by Dansket
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32 minutes ago, Dansket said:

Did you use Meditech's Emergency Release routine to issue these units?

No, the techs just issued the units on paper forms and did the testing.  They did a TS on the mom under her account, and also ordered one under the baby's account.  I had the mom's TS credited.  They did a crossmatch but forgot to issue the unit in the computer, so I did that the next day.

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Using the Meditech Emergency Release of Units routine will automatically issue the unit and automatically order a Type and Screen for whomever blood is issued.

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We keep 2 O Pos and 2 O Neg PRBCs tagged for emergency release and make up the papers that have the unit stickers on them for the doctor sign. I've tried to tell the techs that it is almost as quick to issue through the computer, but they get frazzled easily because they don't do it often. 

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We do not use cord blood specimens for any crossmatching purposes because the cord blood specimens are labeled with mom's armband label and are not always labeled at the time they are collected.  When any Packed Cell is ordered, the computer automatically orders a type and screen with the crossmatch.  We have the NICU draw us 1 ml of blood in EDTA, and we do the type and screen (in gel).  If the screen is negative, we can result on that specimen until the baby is 4 months of age.  We do not do any crossmatches on the baby unless the antibody screen is positive, and in that situation, a new specimen is needed every 7 days until the antibody screen is negative and a crossmatch is performed.  If we need to test using the mom's plasma, we would enter results and add a result comment that the antibody screen was performed on mom's plasma.

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How did you program Meditech so that it allows a type and screen to qualify as 'current' for longer than the standard 3 days?  We perform electronic crossmatches so maybe it is more strict & does not allow you to go past the 3 days for all patients including newborns.  Meditech told us that we had to 'crossmatch' even on a newborn that the system doesn't just allow you to 'assign' an RBC unit to a newborn although when I used Sunquest in a previous position it allows us to just 'assign' an RBC for up to 3/4 months.

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5 hours ago, tconnors said:

How did you program Meditech so that it allows a type and screen to qualify as 'current' for longer than the standard 3 days?

Meditech is not flexible and will not allow you to make exceptions for a specific patient population, but you can extend the outdate of individual specimens up to 999 hours.  It still flags that the blood type and antibody screen are not current, but these can be overridden to allow you to use the specimen for crossmatching.  It will, however. fail on the EXM, so you will have to perform an actual crossmatch.

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On ‎8‎/‎13‎/‎2019 at 5:06 AM, tconnors said:

How did you program Meditech so that it allows a type and screen to qualify as 'current' for longer than the standard 3 days?  We perform electronic crossmatches so maybe it is more strict & does not allow you to go past the 3 days for all patients including newborns.  Meditech told us that we had to 'crossmatch' even on a newborn that the system doesn't just allow you to 'assign' an RBC unit to a newborn although when I used Sunquest in a previous position it allows us to just 'assign' an RBC for up to 3/4 months.

We simply add the new packed cell to the original TS specimen -- adding a comment to indicate what we did. We "NP" the IS and gel crossmatch results and result as Compatible.  We write up a credit for the crossmatch and the packed cell and only charge for the aliquot and making the aliquot.  We also do electronic crossmatches here, but we don't perform a crossmatch at all on the baby if the antibody screen was negative.

We also do not use cord blood for any transfusion purposes because we have found that the specimens are not labeled at the time they are collected.  We only use the mom's specimen for the baby's antibody screen if the baby has a positive screen -- otherwise, the NICU collects a new specimen for our testing on the baby.

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