Hello,

We use Horizon Blood Bank 'Emergency Release to a Known' patient when issuing uncrossmatched units in an emergency. Our staff find  the process of using the computer and attaching the labels somewhat time consuming. Further, under stress to issue units Stat,  they sometimes freeze. (despite periodic training)

Is there a quicker more stress free process to issue unmatched blood using HBB or a process that involves quick release of units followed by computer entry afterwards? Even non Horizon Blood Bank. Is there a best practice consensus for speed and simplicity? Or should the approach be to have an algorithm in Emerg and OR establishing reasonable time lines for unmatched units?

Thanks,

 

Richard

 

We're in a similar boat with HBB.   Almost everyone has completely given up using the computer and going back to paper method.  

For us the worst part comes after we've issued the units.  The steps to follow are a pain and confusing for the techs to follow.  

 

A lot of times they make a photo copy of the unit.  Have the nurse sign the downtime book. And give them an emergency release form for the doctor to sign.    Then they'll use the photo copy to sign out the unit.  

 

We have Oneg red cells tagged ahead of time with uncrossmatched tags and temperature indicators applied.  That helps somewhat.  We do an emergency release in the computer.  I would hesitate to bypass the computer for safety reasons.  I have my trainees practice it every day while in training.  Good luck!

Cathy

At our facility, we have LTE units ready with indicators & uncrossmatched tags attached ready to go. We rotate them on a regular basis when new inventory arrives. When there is an emergency release, we make photocopies of the face label of the units & issue them in the cooler. Transporter has to sign the emergency release form and sometimes we have to send the ER form with the units for the physicians signature. Computer entry is done later on since there is paper trail for the units issued. Our goal is to get the units out within 5 minutes because we have audits that keep track of the time frame. Hope this helps.

As a well-known Information Technology idiot, am I missing something here?

I thought that computers were supposed to work for us and help us in what we are doing, and not us work for the computer and help the computer in what it is doing.

Should not the programmers be given a swift kicking, and told to get the programme in gear, or is that naivety on my part?

Maybe we're just lucky with the functionality in our LIS but we successfully use the emergency release routine in Meditech C/S. Transitioning from a completely paper environment to the computer was actually a big undertaking where virtually every technologist had a learning curve/resistance. The computer routine actually makes things faster because you don't have to do any writing.

Edited March 23, 20169 yr by goodchild

Malcolm, 

The Horizon Blood Bank (HBB) Emergency Issue feature is simple enough to use. However rotating staff do freeze when a near hysterical nurse or transport assistant are waiting impatiently for blood because their patient is bleeding out. The issuing process including packing a validated cooler can take up to 10 minutes. I see some respondents have aimed for 5 minutes with paper to expedite and prevent the freeze factor. What do you feel is an acceptable time from pick up request at the window to issue?

Jane12

Do you remove a sticker from the units and affix to your emergency release form? How do you match the 4 units for which you have photocopies to the patient for computer entry post issue. Do you have product ID Tags for the units ready to go and if so what do you call them ie Trauma ONEG or Trauma OPOS

Amym1586

What information is initially in your downtime book? Do you place a sticker there as well and what time are you aiming for? Do you have product ID Tags for the units ready to go and if so what do you call them ie Trauma ONEG or Trauma OPOS

 

Thank you for your thoughts.

Richard

 

 

We built a 'test' in Sunquest that is simply 'allocate (using barcode reader), press 'OK', sign-out, tag the unit, hand it over'.  The advantages are computer assisted QA only when appropriate (e.g. trying to allocate A POS to an untyped patient), no handwriting and accurate recordkeeping.

We also have Meditech.  We do pretag 2 ON units and 2 OP units with our downtime forms, unit info and temperature indicators and save 2 segments in a cup.  We also prelabel our emergency release form with the unit stickers and information, along with a copy in case the first one gets lost before it is signed.  We also keep a box with ice ready on every shift, which is replaced if taken.  And we rotate the units when necessary.

However I encourage techs to issue units in the computer if we have a patient name.  It's better documentation that way.  The unit tags print right after the units are issued, so we tag them and box them, then print paper transfusion forms, since the ED doesn't document in the computer.  I would say it takes 5 minutes to do it that way if the tech isn't totally rattled.

4 hours ago, richj said:

Malcolm, 

The Horizon Blood Bank (HBB) Emergency Issue feature is simple enough to use. However rotating staff do freeze when a near hysterical nurse or transport assistant are waiting impatiently for blood because their patient is bleeding out. The issuing process including packing a validated cooler can take up to 10 minutes. I see some respondents have aimed for 5 minutes with paper to expedite and prevent the freeze factor. What do you feel is an acceptable time from pick up request at the window to issue?

Hi Richard,

I would have thought that 10 minutes would be okay.  When there is a "new" bleeding patient, very often they need to stabilise the patient as much as possible, which they can do for those few minutes using saline and/or albumin (or similar).  After all, when you think about it, those poor unfortunate soldiers in Iraq, Afghanistan and other theatres of war, seem to survive quite horrific injuries, but they don't get blood given to them in five minutes, and very often a lot longer than 10 minutes (I've just attended an excellent lecture on the subject from a Biomedical Scientist/Technician, who had done a long tour in an advanced field hospital in Afghanistan).

 

Edited March 23, 20169 yr by Malcolm Needs
Removed a quote box with nothing in it!

19 hours ago, mollyredone said:

We also have Meditech.  We do pretag 2 ON units and 2 OP units with our downtime forms, unit info and temperature indicators and save 2 segments in a cup.  We also prelabel our emergency release form with the unit stickers and information, along with a copy in case the first one gets lost before it is signed.  We also keep a box with ice ready on every shift, which is replaced if taken.  And we rotate the units when necessary.

However I encourage techs to issue units in the computer if we have a patient name.  It's better documentation that way.  The unit tags print right after the units are issued, so we tag them and box them, then print paper transfusion forms, since the ED doesn't document in the computer.  I would say it takes 5 minutes to do it that way if the tech isn't totally rattled.

How do you manage the pretag units in Meditech? I have Meditech 5.67 and have problems with labels printing on emergency release. How do you manage the labeling products for a MTP ?

On ‎3‎/‎23‎/‎2016 at 1:51 AM, Malcolm Needs said:

is that naivety on my part?

Yes, it is Malcolm. I have been trying to have several simple "no brainer" regulatory items fixed in our system for years (10). Work arounds are horrible.

We had a custom report created by Iatrics for Meditech C/S 5.6x that prints the form that we attach to the unit for emergency release.  The program requires only 3 inputs, patient name, unit number and MD name.  This gets the RN out of blood bank as quickly as possible.  Then we made a second entry using the Meditech Emergency Release routine at our leisure.

On ‎3‎/‎23‎/‎2016 at 7:56 AM, richj said:

 

Amym1586

What information is initially in your downtime book? Do you place a sticker there as well and what time are you aiming for? Do you have product ID Tags for the units ready to go and if so what do you call them ie Trauma ONEG or Trauma OPOS

 

 

Down time book consists of basically everything we would go over at issue:  Patient, Blood type, Medical record number, BB wrist band #. Unit number, blood type, visual inspection, Date, Time, Tech that signs it out and the nurse that signs it out.    We have uncrossmatched stickers to put on them.  We average 1-2 Emergency Releases a month. I'm not sure we would benefit from pre labeling.

If they chose to do it on paper then they also fill out this form to go with the unit.

BB.f.er.release.1.odt

I'll ask the IT guys.  We use  a bi-fold tractor feed card that prints a unit tag and a unit ready slip and it is programed to print the cards automatically once the unit is issued through emergency release.  We have to manually print the transfusion forms since ED and OR are the only departments that will not use TAR (they're special) for transfusion data.

Thank you to everyone for your input. 

Richard

I figured out that you can't upload files in IE.  So here is my paper transfusion form.

 

HIGH RISK TRANSFUSION & EMERGENCY RELEASE FORM.doc