Neonate Handling in SoftBank Presented by: Tracy Dorgan BSMT(ASCP) LIS Trainer

Session Objectives Identify how to set up the system for neonates including the hosparams involved. Identify how a patient will qualify to be considered a neonate. Identify how to divide a red cell and charge the patient. Identify how to perform a WB exchange transfusion in SoftBank.

Overview Based on the setting(s) of setup/parameters the system can: Recognize a patient as a neonate Prevent unnecessary antibody screen warnings/exceptions at unit selection and issue Prevent unnecessary crossmatch warnings at emergency issue Take both the neonate and mother’s blood type into consideration when selecting units

Neonate Hosparams

Default setting: 0 (not set) hos_Neo_Age Determines the age, in days, after which a patient will no longer be considered a neonate. Example: 120 Default setting: 0 (not set)

hos_NeoMOrdSearch Determines how the system will look for the mother’s specimen. C – current specimen (default) D - Looks back the number of days (defined in a coordinating parameter) Determines how the system will look for the mother’s specimen. C - Looks for mother's blood bank order that is in date at the time of the baby’s product order (default). D - Looks back the number of days (defined in a coordinating parameter) from the baby’s DOB for mother's blood bank order.

Note: Only used with D setting in hos_NeoMOrdSearch hos_Neo_MOS_DOBDays Number of days the system looks back (from the baby's DOB) for a mother's order/specimen. Default: 3 Days Note: Only used with D setting in hos_NeoMOrdSearch

Set Up

Neonatal ABO/Rh Table ABO/Rh table specific for patients that are less than or equal to the age specified in hos_Neo_Age Setup/Blood/Blood Product Select B-Neonat.abo rh Main Products only Define exactly what they can receive Site-specific or client level An ABO/Rh table specific for patients that are less than or equal to the age specified in hos_Neo_Age has been added to Setup/Blood/Blood Product. This table can be accessed in Setup/Blood/Blood Product by selecting ‘B-Neonat.abo rh’ on the navigation bar or by pressing the “B” key.

Neonate Table Example Patient = Baby Mother’s ABO – Linked Mom Table for each baby type Empty no type Mother’s ABO – Linked Mom

Neonatal ABO/Rh Table (ABO example) The system allows for 5 ABO columns

Neonatal ABO/Rh Table (Rh example) There are two Rh columns for each females and males.

Neonatal ABO/Rh Table The system will use the product specific table: Compare the unit’s ABO/Rh to both the baby’s and the mother’s ABO/Rh Select, Issue, and Emergency Issue Determine if the unit is acceptable *Note: This table will be used for all patients that meet the age criteria set for hos_Neo_Age

Neonate Qualification

When The system determines if a patient qualifies for neonatal compatibility checking at the order level.

Two Situations There are two different sets of criteria utilized when determining if a patient is recognized as a “neonate”. Baby and mother (linked) Baby only (mother not known)

Baby and Mother Patient less than age specified in hos_Neo_Age AND Mother is linked and does not have any clinically significant antibodies Mother has a negative antibody screen on a specimen (depends on hosparam setting)

Searching for Mother’s Specimen New parameters hos_NeoMOrdSearch C – current specimen D – number of days hos_Neo_MOS_DOBSearch Number of days to look back

Baby Only (mother not known) Patient less than age specified in hos_Neo_Age AND Negative Antibody screen on current order (Expirable Specimen Type)

Warnings If the patient meets the neonatal criteria, the system will NOT: Warn/generate an exception about an incomplete antibody screen at unit selection, issue, or emergency issue. Warn/generate about an outdated specimen at unit selection, issue, or emergency issue. Warn/generate an exception about the unit being uncrossmatched at issue and emergency issue. Finish the order until the patient is older than the age in “hos_Neo_Age”.

DAT Handling

Neonatal DAT Handling Warn/generate an exception Unit Selection and/or Issue If DAT has not been performed for that patient (stay specific) DAT test must be assigned to the category of “D” in Setup>Tests>Group *Note: There is no DAT completed checking done in Emergency Issue.

hos_POS_DATCmpl_S Format: “Y/N/S,<exception code> Patient less than age specified in hos_Neo_Age Controls the incomplete DAT warning at unit Selection Format: “Y/N/S,<exception code> Default is empty

hos_POS_DATCmpl_I Format: “Y/N/S,<exception code> Patient less than age specified in hos_Neo_Age Controls the incomplete DAT warning at unit Issue Format: “Y/N/S,<exception code> Default is empty

Mother/Baby Linking

How? Mother’s Medical Record Number Patient > Edit > Demographics Prompted when resulting via test category Linked to CABO and CRh

Patient>Edit>Demographics Add Mother’s MRN to Baby’s demographics

Resulting – Test Category SETUP>Tests>Group

Resulting - Prompt Prompted for Mother’s MRN

Verify Mother

Dividing Unit and Charging

Dividing a Unit Method A – Modify then select 3-INVENTORY>Edit>Cr_Product>Divide Method B – Select then Modify 3-INVENTORY>POS>Create_prod>Divide (POS = Product Orders Service)

Divide Unit (A) Select unit Select number of products

Divide Unit (A) cont. Enter divide time (creation date/time) Enter unit volumes Change Expiration date/time, if needed

Adding Supplies Select appropriate unit Select Ctrl+R Supply Select Lot number and amount Add comment, if needed

Perform Label Verification Apply new label to units Scan labels on units to verify label

Instruction for Unit Outdate/Billing Add to Patient Order Instruction will be automatically added for each selected unit Confirm Instruction

Neonatal Syringe Instruction Example Completion Flag = 1, Y, A

Confirm Instruction for New Outdate 3-INVENTORY>Edit>Instr Completion Flag 1, Y, A only Allows you to change outdate to 4 hours automatically Allows you to bill patient if ordered on Patient Capture point must be met

Confirm Instruction 3-INVENTORY>Edit>Instr Select Unit Confirm Instruction – Date/Time

Select to Patient Scan unit and product code No warnings

Issue to Patient No warnings Crossmatch not required

Instruction for Billing Only Add to Patient Order Confirm Instruction At Selection, Issue, or after Issue Completion Flag P only No unit outdate changes Instruction will be automatically added for each selected unit

Instruction for Billing Example

Action Add to Patient Order Confirm Action Billing only Added during unit division

Blood Product Set Up New Divide Field Create Divided Red Cell for Billing only

WB Exchange

Prepare and Pool Products Select Red Cell and Thaw plasma Pool Red Cell and Plasma 3-INVENTORY>Edit>Cr_Product>Pool

Add Supplies Select Ctrl+R Supply

Label Verification Place label on unit Scan label for verification

Select and Issue Select and Issue the unit to the patient

Questions?

Contact Info Name: Tracy Dorgan Email: tracyd@softcomputer.com Work: 727-789-0100 ext. 4230

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