How are you documenting the historical record check when a sample arrives in your blood bank? EOC required includes "records of historical checks". We are using HCLL, and the system functionality allows us "to compare ABO,Rh and antibody screen results against previous results to detect discrepancies and identify patients requiring special units".

When I called CAP about this regulation, and even explained the safeguards and features of HCLL they said they require documentation that someone physically viewed the required information. They suggested we add a patient comment that a history check was completed for each new sample received.

This really appears to be duplication of work, but is there any other choice?

We have a mandatory result field call "History Checked?" that is answered Yes/No.

We have a history check field that we fill with "Previous history found" or "No history found" (canned comments both, so the tech only has to press a key to get the wording).

Same here. We have a field where we document prior record yes or no prior record.

Previous hospital had a field to mark history check yes or no. Current hospital has us look up history and physically write it on the order that printed out and initial.

We built a test "HIstory Review". The tech answers with the blood type/nab or pab or none for no record. If there is a previous antibody (PAB) the identity of the antibody is entered into a comment. The test result does not print and is internal for our records.

:excited:

I feel like perhaps my hospital is the sneakiest of the bunch. Our computer system has a built in Previous History / No Previous History field, and autopopulates based off of our history files once you enter any sort of result. If you verify a TYSC and there is no previous history, a "retype" is ordered by reflex.

I feel like perhaps my hospital is the sneakiest of the bunch. Our computer system has a built in Previous History / No Previous History field, and autopopulates based off of our history files once you enter any sort of result. If you verify a TYSC and there is no previous history, a "retype" is ordered by reflex.

Very efficient!

TRM.40300

Historical Record Check

Phase II

ABO, Rh, and antibody screen test results are compared against results of the same tests recorded previously to detect discrepancies and identify patients requiring specially selected units.

Evidence of Compliance:

✓ Written procedure for checking ABO/Rh and antibody screening results with historical results AND

✓ Records of historical checks

~~~~~~~~~~~~~~~~

We have the previous history automatically come up (if it exists) and we check it.

But we do not record that we check it.

How can we?

Liz

Liz,

I am the first to admit that I am an IT idiot, but would not the audit trail of the computer show this?

I have no idea; I'm just asking.

I asked our IT wizard and yes you are right Malcolm it does. So you do know!

Thank you,

Liz

I asked our IT wizard and yes you are right Malcolm it does. So you do know!

Thank you,

Liz

In that case, as far as my IT literacy is concerned, the exception proves the rule!

just had an AABB inspection and the inspector asked me how we check historical data ABO/RH, presence of antibodies, for the past 12 months when the computer system is down. We have cerner classic and we print out the FHR (Freetext History Report) weekly, but he didn't think that was sufficient or practical to look through paper. (I tend to agree) However, he mentioned that there is a way to connect our LIS to a proprietary PC and perform a daily download of that data. If the LIS goes down, the tech uses the PC to perform the history check. Otherwise, he mentioned keeping a card file system, but i don't really want to go back to that. Any thoughts or ideas?

We have Meditech and can download the information daily into a file on the hard drive of a designated PC. Once every few weeks we download onto an alternate PC. This provides us with the necessary history in case the system goes down. It works nicely for us. If you can print your report, is there any way you could do this?

:pcproblem:pcproblem:pcproblem:pcproblem

We have Sunquest and we also download to a file. Our file, if printed, would take up about 2 cases of paper. The downloaded file is almost too big. It was very slow and stalled a couple of thimes during our downtime on Sunday. I would not recommend going back to card files. The only difficulty with the computer file is showing that you can still do your file search if there is a power outage. This means that your backup computer has to be on emergency power just like any other critical equipment.

We downloaded Cerner Classic's FHR daily but unfortunately it was set up before I worked at my previous hospital so I don't know how it was set up. It was on a PC and it had a search function. It wasn't great but it definately gave us the information that we needed.

And now I am working on a Meditech system that isn't doing that yet.......

We use Mediware HCLL and every minute, updated pt data goes to an Automated Patient Backup which lives on a separate PC in the lab. We can look up name, dob, SS#, antibodes, ABO/Rh and the last ABS change. We do not see pt location or actual test results. There is most likely other info there but I am writing this without getting up to check - lazy day I guess.

for cerner classic we have a PC where we import data everyday. It's a manual process. Every morning, we import data.

I believe it's Microsoft Access based programme.

At my previous hospital, we had Cerner Classic then Millennium and the Free Text History report (with a daily upload) worked pretty good. I am now at a hospital that uses Mediware's HCLL product and the Automatice Patient Backup Card (APBC) is better because it updates every minute.

As far as regulatory, you have to have some kind of documentation that shows you actually looked up the patient history. Both places where I have worked we had a test code for History Check (you can have any canned comment you want). The tech performing the testing is responsible for answering this field and are held accountable for performing the history check. If the history check is not completed and the patient has an adverse reaction because of it, the tech answering this test is held accountable. HCLL does check the current ABO/RH & antibody screen results against the patients history but not antibodies. If the antibody is no longer demonstrating (which is what we want to happen) without looking up the history, you will not have a good way of knowing the antibody was ever there to begin with. If the patient has special needs, you need to check the history and make sure this is satisfied. Some computers check the products for special needs at the time the products are set up and some check at the time of issue (this is too late).

I think you should way the effectiveness of your current process to see if you are meeting the CAP standard. It would also be good to check with CAP to see if your current process is acceptable. As an AABB inspector, if you are not documenting this manually, as a comment on the patient or with a test code that says you checked it, I would say that you are non-compliant.

Thank you Shaundrey,

We are not currently CAP accredited, just AABB and JC. We do have documentation in cerner classic that the CLS must answer findings of history check. They enter PHNA, (previous history no antibody), NH (no history), or PHA (previous history antibody) We check for previous antibodies ID'd and special needs, ABORH using another function, PTC. We also check for patient's blood bank history using a program TIQ. The question of compliance was about being able to check patient's ABO/Rh for previous 12 months when the computer is down.

When our computer is down, we have a place on our downtime card to indicate that the history check was complete. If you have the FHR print-out or computer, I would have the techs document on the downtime record or card that a history check was performed and the computer code that would need to be entered when the computer is back on line. The FHR print-out or computer should be enough for you to be compliant with the 12 month rule since it has the blood type of record along with the special requirments and antibodies.

When I asked CAP about checking the audit trail in the computer, they said that it did not fulfill both requirements for EOC. They insisted that there was separate documentation that a tech had physically verified/checked patient history. It just seems that this is asking us to take a step back, when most hospitals are going paperless and are implementing electronic medical record systems.

Most computerised institutions have a place in their test battery to document that the history check was performed. At least one of the respondents below stated what responses their system requires. We have a "history check" test that is part of every test battery in blood bank. It must be answered "previous history found" (PHF) or "no history found" (NHF). We have a spot on our downtime form for the same documentation.

We have been through multiple CAP, AABB, FDA, and JC inspections and had no citations for this requirement.

We use Safetrace and we have the techs enter a comment on the result screen that they have checked history/no record. When system is down, there is a backup program that we can access patient histories.

We have a prompt for either previous history or no previous history. By answering the tech is responsible for also checking the old card file, which is slowly going away, and our blood centers antibody registry.