Our organization is migrating into the electronic medical record on the pt care side and we are in the throes of a heated debate with nsg personnel re: bedside indentifcation at start of tx.

The EMR software has a transfusion flow sheet that the nsg staff uses to record vitals, positive pt id, blood types of donor/recipient etc. Nsg is finding it cumbersome when they get to the floor for one person to log into the EMR, do all of the clerical check, blood types, etc, then log out, have the witness log in and complete the second witness "signature".

Their proposal is that after we sign the unit out of the BB system, they want to sign into the EMR, while still in the BB, do the initial clerical checking steps, log out of the EMR, have us log into the EMR and perform the second "signature" so when they get to the floor they will be ready to hang the unit.

As you can imagine the BB is going nuts . AABB stds and tech man say this needs to be done at the bedside.

I know I am preaching to the choir here but if anyone has any suggestions as to what to say to these folks to deter them from this practice I will greatly appreciate it. BTW, the EMR is brand new, the lab system is 15 years old and won't be replaced till 2012 so we aren't able to bar code scan units and link to pts.

Thanks for the input!

Question, When they (the nurses) are at the beside are they "scanning" anything into the computer, ie. patient's barcoded wrist band, blood unit information, etc? If so then the computer is the "second" person.

That is the whole point of being able to barcode the patient and the unit of blood!!!

If your computer system is Windows based both nurses should be able to log on at the same time.

We ran into the same situation. The solution was that the nurses would physically sign the tag attached to the unit. This would then get scanned into the EMR so that signatures would be on file.

Don't let them ever think that checking the unit and its paperwork and the computer is sufficient if they aren't checking that the unit is for that physical patient. That has to happen at the bedside. Think about what sort of error could come up with their system and write up a scenario about it (like they take the blood into the wrong room and hang it on a different patient) to demonstrate the risk in an eye-opening manner.

We still generate a paper flowsheet and require two signatures for the id section (at the bedside). The rest of the documentation can be done on the paper flowsheet or EMR.

Some computer systems allow for a second check signature by one nurse while another is logged on (or so I have heard).

Check with your pharmacy staff also... if they are doing Bedside Medication Verification, some of these meds also require 2 signatures. If pharmacy has been up with this for a while, they can also tell you the work-arounds nursing has tried.

Linda Frederick

What Mabel said.

I have audited many transfusions, and it is sad to say that I found that in many cases the nurses were doing their "bedside" checks with the unit clerk in the unit station. As Gomer Pyle used to say: Shame, shame shame!

Don't bother citing FDA, AABB or CAP- the only thing nurses fear is JCAHO.

BC

New National Patient Safety Goal 2009 should help you fix the problem of nurses not wanting to comply:

NPSG.01.03.01

Eliminate transfusion errors related to [patient] misidentification

go to JC website for details: with 2 persons required at bedside

or

1 person and a computer (automated ID such as barcoding)!

I would also check what you currently have for nursing policies and transfusions. Hopefully, there is a policy requiring the 2 person bedside check.

How about letting the nurse that comes to BB to pick up the blood, log in and verify while the BB Tech is checking the unit out to her. Then only one nurse would have to do it on the floor before it is hung. There is no way I would allow what they are asking....would they really check once they got back to the patient's room???

We require two nurses check at the bedside, since part of the verificatrion process is to check not only the paperwork and the unit but also the paperwork, unit and patient's identifying information, including the unique BB armband number.

Edited April 28, 200916 yr by bxcall1
typo

We require two person check (one has to be RN) @ bedside, must check unit, paper work, pt's ID band and ID band for transfusion...and must sign the form before starting the transfusion.

We share the same protocol that aakupaku follows.

We require two person check (one has to be RN) @ bedside, must check unit, paper work, pt's ID band and ID band for transfusion...and must sign the form before starting the transfusion.

Ditto! except our check is done by 2 RNs at bedside.