can you provide some insight on how pharmacy accomplishes dispensing Rh Immune Globulin for Rh prophylaxis? We have closed our family birth center, but have an active ER. We use Rhophylac, and Pharmacy is to transition to Rhophylac for ITP use. Does Pharmacy call the BLood Bank to verify Rh?

would appreciate any guidance!!!

1. Albumin - Blood Bank

2. Clotting Factor concentrates - Blood Bank

3. Rh Immune Globulin-intramusular - Blood Bank

4. Rh Immube Globulin-intravenous (WinRho) - Pharmacy

5. IVIg - Pharmacy

Our Pharmacy Dept handles all 5 of those products. Many years ago our Pathologist insisted that we turn over our Rh Immune Globulin to the Pharmacy Dept so that it could be dispensed with a written order from the physician (the same as any drug.) I was very much against this course of action, but it has worked out just fine.

At our institution, the physician has to evaluate the patient and test results and he makes the decision whether or not the patient should receive Rh Immune Globulin. If the answer is "Yes", he orders it from Pharmacy.

The one unfortunate thing about our Pharmacy Dept issuing "Win-Rho / Rhophylac" for ITP: I have asked our Pharmacists to please let the Blood Bank know when they dispense it, but they never notify us. Thus, the poor staff technologist is thrown for a loop when she/he gets these strong, bizarre test results on the patient who had no problem two days ago. (We see it so rarely that rotating techs usually don't think about "Win-Rho" as the likely culprit.)

Thanks. We established a protocol with Pharmacy years ago for potential WinRho use. Our reasoning was WinRho is not efficacious if patient is Rh negative. See below:

"1. Upon entry of an order in the Pharmacy Department’s computer system for WinRho for the treatment of ITP, the Pharmacy Computer will prompt a “Dispense Message” stating the following:

“Contact Blood Bank at 44620 that patient is receiving WinRho. They need to be notified whenever a patient has received it.

Ask them for the patient’s blood type. WinRho should not be used if a patient is Rh negative. The physician must be called. If the Blood Bank does not have a blood type on file, the physician must be contacted to order a blood type.”

2. Obtain the patient’s first and last name and medical record number from the Pharmacy Department. Check the Blood Bank files (current and previously discharged) to determine if patient has an ABORh on file. [WE'RE STILL MANUAL!!!]

3. If a current/previous record is located, communicate the ABORh to the Pharmacy Department. Confirm with the Pharmacy Department if the patient is to receive WinRho. If yes, document in the “Comments” section of the Blood Bank Record: “Patient received WinRho....date received”.

4. If a current/previous record is NOT located, communicate this to the Pharmacy Department. It is then their responsibility to contact the physician to order a blood type.

THE PROTOCOL ABOVE IS WHAT I'M THINKING OF DOING FOR RhIG IN GENERAL, BUT ONLY WITH CURRENT ABORh. That's why I'm reaching out!.

Thanks!

Clotting Factors-BB, all others Pharmacy

My main question with this thread would be for the sites who do issue the clotting factors (not so much RhoGam), how does your computer system handle it? We are in the process of moving toward SoftBank and there are real issues with the inventory and issues of clotting factors. RhoGam does not seem to be an issue at all.

Thanks,

Laura

BTW,

1. Albumin - Pharmacy

2. Clotting Factor concentrates - Blood Bank

3. Rh Immune Globulin-intramusular - Blood Bank

4. Rh Immube Globulin-intravenous (WinRho) - Blood Bank

5. IVIg - Pharmacy

All pharmacy

The only product on your list that we (BB) carry is the RhIg.

All are carried by the pharmacy except RH-Immune Globulin (#3 + #4) ... and I'm planning on working on moving those, too. (They aren't blood products, they are officially pharmaceuticals ...)

Rationale: Does the Chemistry department stock/dispense insulin because they perform the glucose tests? No.

I like JPCroke's analogy of chemistry handling insulin!!!

We keep and issue RhIg in Blood Bank.

Pharmacy controls the derivatives, but the refrigerated ones are stored in BB refrig and we keep up with tracking and usage since the BB is responsible under AABB

1. Albumin- PHARM

2. Clotting Factor concentrates- NOT STOCKED. We so rarely need it that if we do, we have a taxicab bring us a dose from a neighboring hospital's BB.

3. Rh Immune Globulin-intramusular-As we have no maternity, we keep 2 doses on hand for emergency use. We get these from another neighboring hospital's BB. We barter reagents for payment, usually MTS cards.

4. Rh Immube Globulin-intravenous (WinRho)- PHARMACY. We have full access to patient's EMR and use it extensively in our BB to better our patient care. We can view meds administered, including WinRho.

5. IVIg- PHARMACY.

Hi Bev. Pharmacy dispenses all of the above

1. Albumin - Pharmacy

2. Clotting Factor concentrates - Pharmacy

3. Rh Immune Globulin-intramusular - Blood Bank

4. Rh Immube Globulin-intravenous (WinRho) - Pharmacy

5. IVIg - Pharmacy

Rh Immune Globulin-intramusular is the only thing we keep in Blood Bank. If we do a fetal screen we order the Rhogam and get it ready. Mary

For those of you that have pharmacy dispensing the intramuscular RhIG... how do they know how many vials to give? - do they access lab results or does lab send them the info if KB is positive? How is the paperwork (filling out the Control Form that comes with the RhoGAM) handled? We'd love to give this up, but need to know the nuts and bolts to make it function smoothly.

Thanks

For those whose Pharmacy handles RhIG, do they have a way to track recipients by lot number? How do they handle product recalls? Do they give 1 dose immediately with more later if needed, or do they wait until the fetal bleed screen and KB are done?

1. Albumin - Pharmacy

2. Clotting Factor concentrates - Pharmacy

3. Rh Immune Globulin-intramusular - Blood Bank Rhophylac

4. Rh Immube Globulin-intravenous - Blood Bank - same product Rhophylac

5. IVIg - Pharmacy

pharmacy to all the above. The only time we get involved is in the case of a positive fetal screen and pos quantitative. We calculate the number of vials of Rhogam to give if it exceeds one vial.

1. Albumin - Pharmacy

2. Clotting Factor concentrates - Pharmacy

3. Rh Immune Globulin-intramusular - Blood Bank

4. Rh Immube Globulin-intravenous - Blood Bank

5. IVIg - Pharmacy

Albumin & IVIg - Pharmacy

Clotting factors, Rh immune globulin (im) & Rh immune globulin(iv) - Blood Bank

1. Albumin - Just changed to pharmacy in the last year due to billing concerns.

2. Clotting factor concentrates - Pharmacy

3. Rh Immune Globulin-intramuscular - Blood Bank

4. Rh Immune Globulin-intravenous (WinRho) - Blood Bank, just moved to blood bank in the last year, so that we could track the patients that received this.

we recently moved RhIG to Pharmacy (we use Rhophylac). Once it was moved, the responsibility for tracking lot #s and product recalls was also moved to them.

Unfortunately, at present time, can't answer fetalbleed questions, as our birth center has been closed (but soon to reopen). When that happens, we still plan on keeping the product in Pharmacy.

We communicate with Pharmacy via telephone, informing them of Rh type and antibody screen result. We hope to educate on looking up results in the computer in the future.

Would definitely be interested in hearing more about the process used by"LaraT23"!!!!

1-Albumin- Pharmacy

2-Clotting factors- Pharmacy

3-Rhogam- Blood Bank

4-WinRho- Pharmacy

5-IVIg- Pharmacy

Same as Jane here. I have worked in a BB before that tried to handle all the clotting factors....it was a nightmare. Probably, well certainly, due to our lack of education on the topic...but a nightmare non-the-less.

We handle all except IVIG (used to do that too!).

We do all the calculations for extra IM RHG, IV RHG for ITP is a standard dose for Rh Pos pts. For Clotting factors, our Med Director is actively involved in selecting the correct product, dosing and treatment length. Thankfully, we have only a dozen or so hemophiliacs we routinely follow, and then a few more referred to us for surgery.

We also use an EMR, and we've worked hard to have a template built for ordering factors - the template will calculate dose based on weight, according to our specifications of dose/kg.