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Does anyone have experience with MTP documentation in EPIC with or without concurrently documenting in BPAM?  My facility is going to EPIC and we'd like to get rid of the BB armbands since Rover and BPAM will allow us the necessary patient identification steps but I am told that MTP is not usually documented in real time which means there would be no scanning of the patient armband prior to transfusion.  I would be fine with this if we were not issuing type specific blood and sticking with group O RBCs/AB or A FFP but we routinely give type specific in our MTP protocol.  It makes me very nervous to think about crossmatched blood not being appropriately checked against the patient. 

We have been told to document MTP on paper which to me seems like it would be more labor intensive than scanning the units.  We are also eliminated paper transfusion records with the exception of computer downtimes and MTP.  To me it seems like the RNs would be less competent using a form that they rarely see (we do MTP once a quarter or less) than using the computer which they will become accustomed to quickly.  Plus we are going to a new BBIS so our paper transfusion records will look completely different than they do today.

Is it weird to any other EPIC users that EPIC suggests going back to the middle ages for the most critical transfusions?  In general I am completely unhappy with BPAM and how immature and unfinished it feels despite being released several years ago.  I'm very tempted to continue to use paper transfusion records until they can figure out how to make it better.

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We have Meditech instead of Epic, but we also do all of our MTP documentation on paper.  We have a designated recorder that is responsible for documenting transfusions, vitals and lab results.  We have a few more MTPs than you from what you said, but there is no way they could do this in the computer.  We never know where the MTP will occur and getting the recorder access to a mobile PC that she can move along with the patient (they almost always end up in OR at some point) would be a nightmare.  The documentation is usually not ideal, but the situations themselves rarely go as they are "supposed to go" so we analyze every MTP after the fact and try to do better the next time.  

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There is an emergency transfusion option in Epic. We are not using it yet, but I've seen a demo - our mother ship for Epic is still playing with that. It is pretty slick. It allows the patient and the unit to be scanned, then quick notes for the infusion. These entries can be added to very easily as the transfusion is continued and finished. Info can be added later if something is missed or there isn't time when it's happening. It looked like it would be just as fast or faster than hand written notes when the trauma coordinator was showing it to me. The sticking point right now is that we don't have a blood bank information system, so chances are good that some or all of the units that are emergency released are not going to be in Epic. When we get caught up, if we get caught up, the units will be there. That takes time as everything is a manual entry at this point. Nursing staff just doesn't get that. Once we bring up SafeTrace Tx, hopefully by the end of the year, we'll have emergency release through the system and everything will be in Epic. I hope we can implement that piece in Epic.

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We are an Epic user and use BPAM for everything but MTP, Trauma, and uncrossed units.  Surgery is an interesting hybrid of paper and OpTime (Epic anesthesia module).  I chair our MTP committee, and BPAM is simply not fast enough for rapid administration at this point...it basically creates a flow sheet of documentation for every unit.  I’ve seen a mock of an MTP module, but so far it’s only for Op Time (not trauma bay, L&D, EMD, cath lab, etc...) We have, however, created some ways to get the units documented on paper into the patient’s I/O.  

We don’t use Blood bank bands for most patients, but were still using for patients admitted with an alias (most trauma admissions).  We are about ready to discontinue in that setting as well. Rover is a great thing!

What B.B. system are you on?  I’m happy to share all we have learned the hard way.  Message me, and maybe we can find a time to chat?

Edited by Carrie Easley
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1 hour ago, John C. Staley said:

Wow, out of the business for a couple of years and I don't have a clue what most of the acronyms in this thread mean!!  :cries: 

You are by no means alone John, but (I THINK) most of these acronyms are to do with Information Technology (IT) than actual blood confusion!

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3 hours ago, John C. Staley said:

Wow, out of the business for a couple of years and I don't have a clue what most of the acronyms in this thread mean!!  :cries: 

Malcom is, of course, correct.  Epic is a hospital information system/electronic medical record.  They have a laboratory module called Beaker, but do not have a blood bank information system.  Epic users have to integrate a stand-alone B.B. system (Meditech, SoftBank, Sunquest, etc...) with it.  Epic has a blood product administration module (BPAM) that allows electronic scanning of patient and unit at the bedside (in lieu of paper records).  It’s not really fast enough for a massive transfusion situation at this point so we struggle to find an alternative in the most stressful times.  Rover is a handheld device that phlebotomists use for positive patient ID and real-time collection label printing.  

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We are using both Epic and Softbank which, for the purpose of MTP , do not play well together.  OR uses the MTP workflow which does allow realtime documentation for units that are selected to the actual patient -where we run into trouble is the units that are emergency released or in the first MTP cooler.  These units are pre-selected to a 'dummy' patient and Epic will not allow unit scanning for the particular patient and gives the user a scanning error of something along the lines of "this unit is not intended for the patient" - always great to see on the transfusion end during a high-stress chaotic event where there is massive blood loss.

We send paper transfusion records with all MTP units so that they can be scanned into Epic later.  The OR flowsheet for MTP is fairly good for units after the first cooler once you have an experienced user doing the transfusion documentation.  We have developed a similar flowsheet for emergency released red cells and plasma for use in the ER - could be expanded to other locations but it works differently than BPAM and requires user education.

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We are going to Softbank and I really wish hospital administration would seriously consider purchasing the SoftIDTX module which works similar to BPAM but WAY better.  For example, it looks a lot more like the anesthesia BPAM module than the nursing BPAM module.  You can see every unit available for the patient on one screen and simply click "start" or "stop" when you begin and end the transfusion.  It does a better job of prompting for vitals as well.  It would work fabulously well in an MTP situation.

 

For those of you who don't use BBID armbands, how do you meet the CAP requirement for a secondary method of patient identification?  I get that rover does the ID at the time of draw and BPAM does it at the time of transfusion but do we just get a pass for MTP situations?  As I brought up with EPIC and nursing, it is not out of the realm of possibility to have 2 MTPs going at the same time who are different blood types.  This terrifies me. 

 

For those that DO use BBID armbands, how do you get EPIC to acknowledge the armband as a patient identifier?  Can they add a field in BPAM to scan or type the armband number and bounce it back to something?  I feel like we need to keep the BBID armband for MTP situations since I will have literally nothing else to make sure the correct patient gets the blood.

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On ‎7‎/‎5‎/‎2018 at 9:01 AM, AMcCord said:

There is an emergency transfusion option in Epic. We are not using it yet, but I've seen a demo - our mother ship for Epic is still playing with that. It is pretty slick. It allows the patient and the unit to be scanned, then quick notes for the infusion. These entries can be added to very easily as the transfusion is continued and finished. Info can be added later if something is missed or there isn't time when it's happening. It looked like it would be just as fast or faster than hand written notes when the trauma coordinator was showing it to me. The sticking point right now is that we don't have a blood bank information system, so chances are good that some or all of the units that are emergency released are not going to be in Epic. When we get caught up, if we get caught up, the units will be there. That takes time as everything is a manual entry at this point. Nursing staff just doesn't get that. Once we bring up SafeTrace Tx, hopefully by the end of the year, we'll have emergency release through the system and everything will be in Epic. I hope we can implement that piece in Epic.

It was my understanding that the emergency transfusion option was really just an Is/Os flow sheet that doesn't perform the patient/unit safety check that BPAM performs.  How in the world are you surviving without a BBIS?  Can you even use BPAM without any information crossing back to EPIC?

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1 hour ago, applejw said:

We are using both Epic and Softbank which, for the purpose of MTP , do not play well together.  OR uses the MTP workflow which does allow realtime documentation for units that are selected to the actual patient -where we run into trouble is the units that are emergency released or in the first MTP cooler.  These units are pre-selected to a 'dummy' patient and Epic will not allow unit scanning for the particular patient and gives the user a scanning error of something along the lines of "this unit is not intended for the patient" - always great to see on the transfusion end during a high-stress chaotic event where there is massive blood loss.

We send paper transfusion records with all MTP units so that they can be scanned into Epic later.  The OR flowsheet for MTP is fairly good for units after the first cooler once you have an experienced user doing the transfusion documentation.  We have developed a similar flowsheet for emergency released red cells and plasma for use in the ER - could be expanded to other locations but it works differently than BPAM and requires user education.

We are going to Softbank and I used Soft over a decade ago at another facility.  We never used a dummy patient for our emergency release.  I can't remember the exact process now, but we always released the units to the real patient.  Maybe you can tweak your emergency release process to make things easier for the first MTP cooler?

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On ‎7‎/‎7‎/‎2018 at 1:38 PM, Malcolm Needs said:

You are by no means alone John, but (I THINK) most of these acronyms are to do with Information Technology (IT) than actual blood confusion!

blood confusion!  Ha ha, that's probably a typo but it is definitely how I feel about our LIS/BBIS conversion!  The number of acronyms used by EPIC are in the hundreds, it is overwhelming.  And every employee in the company appears to be under the age of 28 so they have plenty of mental resources available to remember them all whereas all of us in the hospital are staring in wide eyed fear.

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37 minutes ago, Jessica A said:

We are going to Softbank and I really wish hospital administration would seriously consider purchasing the SoftIDTX module which works similar to BPAM but WAY better.  For example, it looks a lot more like the anesthesia BPAM module than the nursing BPAM module.  You can see every unit available for the patient on one screen and simply click "start" or "stop" when you begin and end the transfusion.  It does a better job of prompting for vitals as well.  It would work fabulously well in an MTP situation.

 

For those of you who don't use BBID armbands, how do you meet the CAP requirement for a secondary method of patient identification?  I get that rover does the ID at the time of draw and BPAM does it at the time of transfusion but do we just get a pass for MTP situations?  As I brought up with EPIC and nursing, it is not out of the realm of possibility to have 2 MTPs going at the same time who are different blood types.  This terrifies me. 

 

For those that DO use BBID armbands, how do you get EPIC to acknowledge the armband as a patient identifier?  Can they add a field in BPAM to scan or type the armband number and bounce it back to something?  I feel like we need to keep the BBID armband for MTP situations since I will have literally nothing else to make sure the correct patient gets the blood.

We are also Softbank/Epic users.  We currently use a BB armband for alias patients, but are moving away from it.  Even with patients admitted with an alias, we have at least three unique identifiers without the BB armband.  The patients are rapidly admitted with a unique, pre-built, never to be repeated alias name, an MRN that will stay w/ them the entire admission (merged to a prior MRN after discharge if applicable), and the CSN/stay number that stays with them throughout the admission.  These pieces of info are on hospital armband, specimen labels, transfusion records, and all compatibility labels.  Even after MRN's are merged, you can search for the alias MRN and it will take you to the actual MRN.  It's all extremely traceable.  We have experienced multiple traumas and MTP's simultaneously.

I was told that Epic does not offer a field for the BBID.

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1 hour ago, Jessica A said:

It was my understanding that the emergency transfusion option was really just an Is/Os flow sheet that doesn't perform the patient/unit safety check that BPAM performs.  How in the world are you surviving without a BBIS?  Can you even use BPAM without any information crossing back to EPIC?

How do we survive without a BBIS? Well, it takes a boatload of paperwork and even more time to deal with the paperwork. We've never had a BBIS, so we don't truly know what we're missing (though I have a vivid imagination, did work with a BBIS validation years ago, and I am soooo looking forward to getting SafeTrace Tx up and going - I have been the squeaky wheel for years pushing for a system and they finally said YES :strong: ).

We've given as many as a thousand units of red cells a year with paper records, though we are currently down to 700ish with patient blood management taking effect. I track products with an Access data base and we had a DOS data base before that . We use report forms built into our LIS - the LIS we are using now and what we were previously using. These are strictly reports, nothing more. All other documentation of testing, etc. is on paper. Prior to that (and not so many years ago) we typed our reports on a typewriter - I kid you not! Our entries in the LIS are made manually from drop down boxes, a minimal number of free text boxes and using barcode scanners for DINs and product codes. We have rules in the LIS to remind staff about required testing. All entries are verified by a second tech and are further reviewed at a later point by myself or a designee. Old school, but it works. The pertinent information passes from our LIS to EPIC, so BPAM works. I wish we were going to use the SafeTrace blood admin module, but that decision was made for us.

I stress to every nurse that I talk with about patient ID that the information that BPAM is checking is a manual entry, so is not a guarantee of anything. If something doesn't look right, they are instructed to stop instantly and contact us. The 2 person bedside check of armband and unit tag/bag information that we were doing prior to BPAM is still critical. And our medical director and I meet every new nursing hire for a pep talk in Blood Bank about patient ID, transfusion safety and MTP/emergency release.

We pass Joint Commission, CLIA and CAP inspections w/o issue and transfuse our patients safely because I am a well known, absolute DRAGON :threaten: about following procedures and doing things right! (Did I mention that I can't wait to get SafeTrace up and running ??? ;))

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  • 3 weeks later...

We were the first Epic site in the country to do MTP in BPAM with matching turned on.  Be aware that the Epic "foundation" way is to document the transfusions but with the ID checks that are on for routine transfusions turned off.  We still use a separate blood bank band because certain patients do not wear hospital bands (e.g. pre-ops drawn in advance of surgery) and I don't trust everyone's workarounds when they aren't playing nice with Epic.  I find that SafeTrace Tx and Epic are like two spoiled toddlers--each wants everything exactly its own way and they aren't very good at communicating exactly what that is.  We made some significant decisions about using BPAM for MTPs that let the computers do what they are good at (recording numbers accurately) and the humans do what they are better at (thinking) and left out some of the verbal checks of long unit numbers that are still required for routine transfusions. We turned off dual verification in Epic for MTPs.  They still do it, but don't have to take the time to document it.  Our MTPs require 2 people pretty much dedicated to the process of giving blood.  We do about 1 a month but a "real" one who gets more than about 6 RBC units only happens every few months so we are still seeing if this works.  We went live in April.  We did extensive training on the MTP BPAM process before go-live.  We think it is faster than paper, although they still drop back to that if there are any problems.  Like others above I had to argue intensely to make them understand that the whole MTP is not universal donor, uncrossmatched blood.  Some of the lines I heard from nurses-turned-IT people like, "it's an emergency, you don't check anything" just made my blood run cold.   You can contact me directly if you want to see what we came up with and what problems we have faced, although it is still a work in progress--especially at our smaller hospitals that are expected to use the same process once a year.

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  • 3 weeks later...

This workflow is supposed to work anywhere we have an MTP--ED, ICU, OR and OB.  Our regular, routine transfusions in OpTime have dual sign off turned off because they had trouble finding space for the nurse to get to the anesthesiologists' computer to document dual sign-off.  Again, they do it, but they don't document it in Epic.  We actually still provide them with paper downtime transfusion records just so they can document that the nurse also checked the ID when they gave blood.  I hope to get OpTime to create an easy way for them to note that the nurse did it and who it was but it hasn't happened yet and may require an enhancement.  Definitely still hitches in the process there.  Also, there is an option in OpTime for uncrossmatched blood and they can hang anything they want if they click that button.  They used it once to hang blood that was, in the computer's brain, for a different patient and it let it happen.  It really was for the same patient, but they were using his real ID in Epic but the original uncrossmatch request had come into the BBIS under a trauma alias which to Epic was a "different patient".

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10 hours ago, Mabel Adams said:

This workflow is supposed to work anywhere we have an MTP--ED, ICU, OR and OB.  Our regular, routine transfusions in OpTime have dual sign off turned off because they had trouble finding space for the nurse to get to the anesthesiologists' computer to document dual sign-off.  Again, they do it, but they don't document it in Epic.  We actually still provide them with paper downtime transfusion records just so they can document that the nurse also checked the ID when they gave blood.  I hope to get OpTime to create an easy way for them to note that the nurse did it and who it was but it hasn't happened yet and may require an enhancement.  Definitely still hitches in the process there.  Also, there is an option in OpTime for uncrossmatched blood and they can hang anything they want if they click that button.  They used it once to hang blood that was, in the computer's brain, for a different patient and it let it happen.  It really was for the same patient, but they were using his real ID in Epic but the original uncrossmatch request had come into the BBIS under a trauma alias which to Epic was a "different patient".

That's frightening! I will hold that thought as we move forward with OpTime.

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