Issuing blood in Cerner with e-XM

[lab1234]

We currently use Cerner for blood banking and I just have a few questions. When using the computer crossmatch, do we still need to use an issue date and time and signatures of who it was issued to and issued by and visual inspection according to the AABB guidelines? Also when dispensing blood in Cerner, do you dispense blood before it is picked up by nurse or at the time it is picked up. We have been told that if you do not dispense blood when blood is given that it is an FDA infringement.  What exactly is happening in dispense mode? Is this just the trail that the unit is even blood bank?  Thanks!

[pbaker]

The "issued by" is captured at the time of issue by who is logged on and performing the task.  We scan employee badges to capture the "issued to" employee.  We do not assign/XM/dispense anything until the courier is at the window to pick it up. Cerner does that for you when you use computer issue.  (Unless it is a RBC for patient with an antibody, then full XM ahead of issue) 

[Maureen]

In Cerner there are two Computer Crossmatch options.  One requires you 'order' a crossmatch, then 'result' as a computer crossmatch which updates the rbc status to crossmatched and generates a crossmatch tag.  We don't use this option, except for scheduled downtimes.   Our preferred process is, as described previously by pbaker to computer crossmatch dispense in one process, capturing the all required information in real time (but we don't have the tools to scan employee badges, so we type).   We now have a customized Transfusion Tag, on which we record the date & time dispensed, and sign.  The transporter signs the tag when they handoff the blood to the transfusionist.

[lab1234]

We use the crossmatch option that generates a crossmatch tag. We were told that we do not need to issue date/time/to whom/by whom the tag anymore. I have read in the AABB guidelines book the 17th edition I believe and it states that according to their guidelines it has to be signed out with a date/time/to whom/by whom. I have not been able to read the latest 18th edition and was curious if anyone has and would be able to tell me if this has changed where you do not need to or if it still remains that if you are using a paper trail that the above listed documentation must be complete? We do use the manual dispense option but we are not utilizing it the way I believe it should be. We are being told that as soon as we finish ordering and reporting the crossmatch that we should go into dispense right away and dispense the unit even though at this time there is not a nurse picking up and sometimes can be hrs+ before the unit is picked up and hung by nursing

[Jane12]

We use Cerner Millennium at my work place. we do not issue until the nursing staff is at the window to pickup the unit. Issuing ahead of time creates problems with the status of the unit because the transfusion needs to be completed within 4 hours of issue. usually products are XMed and saved in the refrigerator until they are picked up. when we do a dispense an electronic record is saved but, we also sign the crossmatch tag for paper trail. At our facility, we follow all the AABB guidelines. 

[Eagle Eye]

I do not think it is a good idea to dispense before the unit is ready to be picked up...

Inventory reconciliation will be mess...unless you dispense only several units/day...

[mrmic]

Along with this topic.  Could you issue multiple units for multiple patients to the nurse/courier picking up the blood from the transfusion service?  It appears if you issue prior to the person being there to pick it up, you could do this...  It seems to me that the practice of only dispensing 1 unit for 1 patient at the transfusion service window is a pretty standard policy (exempt massives, emergencies, etc).  However, I could not find any Standard that indicated the 1 for 1 was a requirement.....