The Impact of MAK Implementation at a Hospital Transfusion Service LaboratoryS.Delanghe, K. Eckert, K.Leigh, H. Elgie, K. Hodgins, L Thomson

London Laboratory Services GroupLondon Ontario, Canada

The Canadian Blood Service introduction of the MAK PROGESA computer system required changes of practice both in the hospital blood transfusion service and at the patient’s bedside.

The introduction of MAK necessitated the Blood Transfusion Laboratory (BTL) to foresee and plan for all changes and to keep at a minimum any occurrences or errors that could result from the change in the blood product labels. In addition, the changes that were required had to be ready, validated and staff trained prior to the “live” date.

Introduction

Challenges

• Redevelopment of BTL computer (Cerner) processes

• Notification to clinical areas

• Notification and inservice training of the BTL staff

Redevelopment of BTL Computer Processes

• Modify product codes• Recode scanners to rearrange the date to Cerner format• Redesign Cerner product label• Standardize hospital product definitions on the Cerner

product label • Rebuild modification tables for new products created in-lab• Rebuild inventory categories• Change prefix code from centre code to include the last 2

numbers of the centre code and the last 2 digits of the donation year

• Rebuild blood group type definitions and translation tables for the new products

• Validate the computer system after completion of rebuild and modifications

Notification to Clinical Areas of Product Label Changes

This included:

• Creating a poster that compared the old base labels to the new ones. This was to be posted in a visible area within the clincial areas. A smaller version of the poster was created to be placed in each area communication binders

• Notifying transfusionists via electronic notice that a change was being made and what it involved

Notification to BTL Staff and Inservices

• Data entry errors when products are received into hospital inventory from the CBS, were a problem pre-MAK

• The MAK labels are bar coded, manual entries are no longer necessary, therefore entry errors were expected to decrease

• Types of data entry errors were compared pre-MAK (Jan-Mar 2003) to post –MAK (Jan-Mar 2004)

Product Receiving: Data Entry Audit

Benefits of the MAK System

• Reduced product entry time into inventory when products received from the CBS due to ability to scan more data into the Cerner system

• CBS vouchers are more comprehensive

• Previous to MAK implementation duplication of product numbers was an issue if the product number had not been purged. Now duplicate donor numbers can be accepted into the Cerner computer system. This was accomplished by creating new supplier product prefixes which include the last two numbers of the centre code and the last two numbers of the year of collection

• Historical phenotypes are available on the label

• Manual calculation of expiration date no longer required

Problems Encountered Post-Mak

• Delays in routine product delivery from the CBS centre

• End labels peel off frozen products

• Window on frozen product boxes too small for scanning the product within.

• When the bar codes on the right hand side of the end label are printed too close to the edge, the bar codes cannot be scanned

• Unable to scan “special” products such as HLA matched platelets and directed donor products because CBS component codes do not distinquish between random and recipient specific products

• Centre code on the end label may be different from centre code on the collection label

• Patient’s name on Autologous end label may differ from patient’s legal name, required by hospital admitting. CBS uses the health card as a patient identifier.

• HEMA-QUEBEC and CBS end label formats are different

• Small print on the end labels has contributed to:

- Increased time sorting blood products/managing inventory by expiry date

- Complaints by nursing and lab staff about reading unit numbers

• Lack of colour on the end labels has contributed to:

- Increased time to receive/enter products into the hospital inventory since sorted by blood groups and attributes (anti-CMV, Irradiated)

- Batch ABO testing of donor segments more difficult without the colour coding of the collection label stickers

Conclusion

The implementation of MAK Progesa at the CBS had a major impact at the hospital level. With advanced notification from the CBS, the hospital transfusion service was able to have the hospital computer system ready and validated and the staff training completed.

The data collected on product receiving errors has shown that bar code scanning has decreased the number of data entry errors. Unfortunately scanning errors have increased with the product barcode not always matching the recipient specific products produced (i.e. HLA matched and directed donor units). Also contributing to increased errors is the close placement of bar codes.

Good communication between the CBS and the hospital transfusion services will need to continue in order to resolve any outstanding issues.

Training included:

• An indepth explanation of the appearance of the base and end label. A visual copy of the new label, along with a description of each field was posted at each site

• Managing two inventories (pre and post MAK labelled blood products)

• Exceptions to scanning in products codes (HLA platelets, directed products)

UNIT NUMBER SCAN ERRORS

15

6

4

1

18

7

0

2

4

6

8

10

12

14

16

18

20

ABO/Rh barcodescanned

Centre codescanned

Attribute scanned

Entry Error

# o

f In

cid

en

ts 2003

2004

Chart #2

DATA ENTRY ERRORS

27

41

14

20 1

70

10

0

10

20

30

40

50

60

70

80

ExpiryDate

ABO / Rh ProductCode

Centrecode

Entry Error

# o

f in

cid

en

ts

2003

2004

Chart #1

Improvements

• No expiry date ertry errors (chart 1)

• ABO and/or Rh entry errors decreased from 41 to 1 in the 3 month period (chart 1)

• These were significant errors pre-MAK and in that way the MAK labels have improved transfusion safety

Concerns• Major increase in incorrect product code entered (Chart 1)

- Irradiated products are now a different product code and therefore must be sorted and entered separately

- HLA matched and Directed donations are NOT a different product code for the CBS but do require a separate product code in the hospital system and must be manually entered

• Major entry error by scanning the wrong bar code when entering the unit number caused by the close proximity of the bar codes on the label (Chart 2)

End Label

CollectionLabel

BaseLabel

The BTL laboratory is comprised of 4 sites across the city. The inservice was done as a travelling presentation in order to facillitate training of all BTL staff