Patient Test Results Entry; RBC Selection; Searching for Antigen-Specific Units; Reference Lab

Antigen Typing RBCs

Product Selection/Crossmatching

Reporting Reference Lab Results

Routine Patient Testing – No Products

Search for Patient’s Available Components

Search for Patient’s Transfusion History

Sending Patient Work to the Reference Lab

Search for Special Products (antigen negative, CMV negative)

I. Principle:

SafeTrace Tx is a blood bank transfusion service LIS (Laboratory Information System) module with record keeping and defined logic that warns users of discrepancies in the result to interpretation process. It is also an easily accessible database where all records pertaining to the operation of a blood bank transfusion service are permanently stored.

This procedure addresses the multifunctions of SafeTrace Tx such as recording patient test results and selecting RBC products for transfusion.

Note: See “FFP, PLT, CRYO Product Selection” for other component orders.

II. Procedures:

1. Routine Patient Testing - No Products:

A. In the Patient/Order module click on PW (Toolbar). The Pending Work log opens.

B. Click on the Red Question Mark (Query) to bring up all pending tests.

C. Highlight the test(s) to be performed. (More than one test may be selected at a time by holding down the Ctrl Key while selecting.)

D. Click on RE (Toolbar). The “Result Entry” screen opens:

E. The cursor appears in the Specimen ID field.

a. Barcode:
Barcode the Specimen ID number found on the specimen tube. Once verified, the cursor automatically moves to the first test field. If verification fails the cursor does not advance and a warning message displays.

b. Manual Entry:
Manually enter the Specimen ID number; tab to move the cursor from the Specimen ID field to the first test field. Tabbing from the Specimen ID field triggers the verification of the Specimen ID; once verified the cursor advances to the first result field. If the ID verification fails, the cursor does not advance and a warning displays. Click OK and enter the correct number.

Note: Minimize or tile the screen instead of closing it; each time an RE screen is opened, the specimen ID step is required before advancing to the result field.

F. Enter results. (Use “Find”, the Binoculars icon.) Use the tab key to move between fields.

G. Enter interpretations. (Use “Find”, the Binoculars icon.)

H. Valid interpretations complete the test and become part of the patient’s permanent record when “Saved”.

I. Invalid interpretations keep the test as incomplete and stay on MW (My Worklog) when the RE screen is closed. To resolve an INV (Invalid):

a. Keep the RE screen open, or reopen the RE screen if closed.

b. Add a replacement test for the test that was Invalid (see how to add a test below).

c. Result the added replacement test.

d. Continue tabbing between fields until all tests are resulted and interpreted.

J. If a portion of a test is completed, and the result screen is closed, the remainder of the testing no longer appears on the main Pending Worklog. The unfinished testing appears on MW (My Worklog).
Note: MW is always specific to the user signed on at the time.

K. UCL requires a few add-on tests to be performed in specific circumstances such as:

a. Antibody ID for a positive Antibody Screen.

b. Antigen Typing the Patient with a newly found antibody.

c. Any additional testing required as per Blood Bank procedures.
Note: If the testing performed is unusual, and is important information for future testing on this particular patient, be sure to edit the Patient Comments. (See “Patient Demographics and Orders (Electronic and Manual), Patient / Order Module”.) The Comments section is free text and it is possible to enter a lot of information regarding special handling of specimens and testing. This information is then be available on the PAAG bar (e.g.: Warm Autoantibody – recommend using Saline Technique).

L. To add tests do not “Save” the current work. While still on RE:

a. Go to Results (Menu Bar); Add Test:

b. The “Add Test” window opens and the cursor is in the Test Battery ID field.

c. Click Find to choose the test needed.

1. Select (highlight) the desired test.

2. Click OK.

d. The “Add Test” Window reopens with the test listed in the test battery field. Click OK.

1. Single tests: the test name is the test that is added to RE:

2. Test Batteries (ABO Discrepancy; Patient Antigen Typing; Retest) - the test name chosen has multiple tests available, so no one test populates the RE screen immediately:

With the focus on the test battery row go to “Find”, the Binoculars icon:

Select (highlight) the desired test and click OK. The selected test now opens on RE and is ready for resulting:

Warning: All antigen typing tests are based on their respective package insert procedures. If the result screen that opens on RE does not match the package insert procedure, check the test selected and reagent manufacturer. Any test code followed by an (M) is an Immucor reagent. All other test codes are Ortho reagents:

If the selected test and manufacturer are correct, the package insert may have changed. Contact a SafeTrace administrator immediately and use the backup log to record test results.

To select additional tests from a Test Battery go to Results (Menu Bar); Add Test from Test Battery.

M. Add Optional Subtest Option:
Certain tests allow for the addition of an optional subtest. When in a result field, and an additional result may be helpful, go to Results (Menu Bar) and see if “Add Optional Subtest” is active. If the option is active, there is a subtest available for the selected test. Follow the written testing protocol.

A variety of tests include an optional subtest such as adding an Auto Control to a Peg Antibody Screen, or adding A1 and/or B cells to an eluate antibody screen.

N. Complete the testing and record the interpretations. (Use Find, the Binoculars icon).

O. Click on the disk icon to Save.

P. Certain add on tests (Antibody ID; Antigen Typing; Antibody Titer) reflex back to the LIS. The LIS orders the test and this order is treated as an LIS downtime order. Give the requisition to the clerical staff to order in the HIS. The test must be entered in the HIS with the same desired date and time entered in the LIS (± 30 minutes). The order connects to the existing test in the LIS and the results cross from the LIS to the HIS.

2. Product Selection and Crossmatching – RBCs:
Warning: Do not product select and crossmatch a unit before the Antibody Screen is completed. The result of the Antibody Screen determines the type of crossmatch procedure to use.

A. In the Patient/Order module, click on PW (Toolbar) to open the Pending Worklog.

B. Click on the Red Question Mark (Query) next to PW to bring up all pending work.

C. Highlight the Item row with the appropriate product (RBCs).

D. Click on PS (Toolbar) to open the Product Selection window:

E. Bar code (or manually enter) the Product code and unit # from the unit label. SafeTrace Tx uses these two criteria to find the unit in Inventory and populate the other fields. (No other criteria are accepted by SafeTrace Tx for use in its search of the Inventory.)

F. Click Accept.
Warning: If the patient has an Auto unit in inventory, and that unit was not selected, a warning message displays:

Cancel this message and clear the unit information. Find and product select the appropriate autologous unit.
Warning: Some Auto units are delivered with a Biohazard notation attached to the unit and identified in the bar code. This information is automatically entered into SafeTrace and is part of the product profile. This initiates the need to override in product delivery, product selection and product issue.

G. When all products have been selected, click OK.

H. The PW reopens.

I. Select (highlight) the crossmatch (XM) order for the patient.

J. Click on RE (Toolbar) to open Result Entry:

K. The cursor appears to be in the XM selection field, but the Specimen ID MUST be entered by the operator and verified by SafeTrace before recording test results. Barcode (or manually enter) the Specimen ID # found on the specimen tube. The cursor automatically moves to the XM selection field when barcoding the Specimen ID; when manually entering the Specimen ID, tab to move the cursor from the Specimen ID field to the XM selection field.

L. The Crossmatch Test consists of a battery of crossmatch techniques. With the focus (cursor) on the Crossmatch line, click Find, the Binoculars icon, to choose the type of crossmatch to perform:

a. For a patient with a negative antibody screen select the XM Is (Immediate Spin crossmatch procedure). Selecting any other crossmatch for this type of patient elicits a warning message:

b. For a patient with a positive antibody screen, or a history of an antibody, select a crossmatch that includes the antiglobulin phase (XM gel). Selecting a crossmatch without an antiglobulin phase for this type of patient is against UCL protocol and brings up the same warning as above with a prohibiting factor on the unit tag and requires overrides to issue.

c. Double click on the chosen crossmatch to add the appropriate result fields to RE (Result Entry).

d. To select an additional crossmatch from the Crossmatch Test Battery, go to Results (Menu Bar); Add Test from Test Battery.

M. Complete all testing and record the results and interpretations. Use “Find”, the Binoculars icon.
Note: Minimize the screen instead of closing it; each time an RE screen is opened, the specimen ID step is required before advancing to the result field. When testing more than one patient on the same RE screen, each patient’s specimen ID must be verified before advancing to that patient’s result field(s).

N. Click on the disk icon to Save.

O. Close

P. Product ID tag(s) and Product ID Labels print automatically when each crossmatch result is saved.

Q. Attach the Product ID Tag(s) to the appropriate unit(s) using a rubber band. Place the Product ID Label on the back of the component bag. Place the tagged units in the appropriate place in the refrigerator.

R. The units are now available for issue.

3. Search for Special Products (antigen negative, CMV negative):
Special products are located in SafeTrace by performing a search of the inventory using specific criteria. The search can be limited to a specific UCL site, or the search can include all UCL sites.

A. In the Inventory module, go to Utility (Menu Bar); Search Component:

B The “Component Search” window opens (see below).

C. Type in the Product ID and any other limiting factor necessary (ABO, Rh, Reserved). Use Find if necessary.

D. Click Extended. The Extended Search Parameters window opens.

E. The left-hand side has two grids, Antigens Negative and Modifications. Highlight the appropriate item(s) and move them to the right-hand side grid(s) by using the arrow [>] button:

F. When all the necessary search parameters have been chosen, click OK.

G. The Component Search window reopens with the Phenotype Search Criteria and/or the Modification Search Criteria filled in. Click Query.

H. The components matching the selected criteria display in the Component Detail grid on the lower half of the window:

I. Use this information to select a unit(s) for testing. Print the screen for reference.

4. Antigen Typing RBCs:
When the results of an Antibody ID indicate the need to antigen type units before they are crossmatched on a patient, the unit antigen typing must be manually ordered in SafeTrace. To order antigen typing on units:

A. Go to File; New; Product Test Batch:

B. A small “New Product Test Batch” window opens with the Batch # filled in:

C. Click OK.

D. The “Product Test Batch” window opens:

E. Check ( √ ) the box for “Select and Go to Result Entry”.

F. Highlight the Test ID field and click Find. Double click on the desired test. The test populates the Test ID field on the upper grid. (If more than one antigen is involved, click the Add button and repeat.)

G. Move the cursor to the Bar Code field. Barcode, or manually enter, the Product code and unit # from the label of any unit to include in the test batch.

H. Click Accept.

I. When all products have been selected, print the screen for patient billing, then click OK.

J. The Results Entry screen opens. (If the “Select and Go to Result Entry” box was not checked, the product test batch appears on the PW (Pending Worklog) and must be selected to go to RE (Results Entry).

K. Click on the disk icon to Save. The component information automatically updates.

M. Close.

5. Search for Patient’s Available Components:
To view the units available in SafeTrace Tx for a given patient:

A. In the Patient/Order module, go to Product (Menu Bar); Patient Order Inquiry:

B. The “Patient Order Inquiry” window opens.

C. Enter the Patient ID # or the MR #; click Query. The patient information displays with the “Ready to Issue” radio button selected in the “Order Component Status” field. Only components that are “Ready to Issue” are listed:

D. To view components with a status other than “Ready to Issue”, change the radio button in the “Order Component Status” field and click Query.

E. Components with the desired status fill the grid.

6. Search for Patient’s Transfusion History:
When a new antibody is found or a Transfusion Reaction is reported, the first part of the investigation should be the recent transfusion history:

A. In the Patient/Order module; go to Product (Menu Bar); Patient Order Inquiry:

B. The “Patient Order Inquiry” window opens.

C. Enter the Patient ID # or the MR #; click Query. The patient information displays with the “Ready to Issue” radio button selected in the “Order Component Status” field.

D. Change the radio button to “Issued”; click Query.

E. All issued components display in the Components grid with the Product Code identifying the type of component:

7. Sending Patient Work to the Reference Lab:
Testing sent to the reference lab for antibody identification requires deselecting the original antibody ID and any corollary testing from MW (My Worklog - Toolbar), and returning them to PW (Pending Worklog - Toolbar). See the SafeTrace “Start-up, Log On, and Log Off” procedure.
The test remains on the PW until the report is returned from the reference lab.

8. Reporting Reference Lab Results:

A. In the Patient/Order module, go to PW (Pending Worklog - Toolbar). Click on the Red Question Mark (Query).

B. Select the appropriate antibody ID test (and any corollary tests) for the patient. Go to RE (Results Entry – Toolbar).

C. Enter the reference lab report in the Interpretation section of the test grid.

D. Use the comments section to state that the testing was completed at the Reference Lab. If more space is needed for result entry or future testing suggestions, open the patient profile and Edit Patient Comments. (See “Patient Demographics and Orders, Electronic and Manual; Patient/Order Module: SafeTrace”) The PAAG bar is updated for comments to review.

E. Click on the disk icon to Save.

F. Close.