Implementation of electronic crossmatch in a multisite facility

1
THE IMPLEMENTATION OF ELECTRONIC CROSSMATCH IN A
MULTI-SITE FACILITY Lester C. , Boychuk D.,
Kokoski M., MacDonald A., Evanovitch D.,
Gagliardi K., Hamilton Regional Laboratory
Medicine Program (HRLMP), Hamilton Health
Sciences and St. Josephs Healthcare Hamilton, ON

• BACKGROUND
• The Hamilton Regional Laboratory Medicine Program
  (HRLMP) is a jointly owned and operated clinical
  service program of Hamilton Health Sciences (HHS)
  and St. Joseph Healthcare.
• HRLMP operates four Transfusion Medicine (TM)
  laboratories located in each of the acute care
  sites across the two institutions under a single
  management structure.
• A common Lab Information System (LIS), Meditech
  Magic, is in use at three of the four sites.
  These three site moved to the introduction of
  EXM.
• The implementation of the Electronic Crossmatch
  (EXM) has long been identified as an enabler to
  the consolidation of Transfusion Medicine service.

• RESULTS
• LIS team
• Developed and tested rules as indicated by the
  validation study to ensure functionality for
  ultimate patient safety
• Process team
• Process changes identified during training were
  considered and implemented if needed
• Training team
• Provided initial EXM training and a follow-up
  refresher session for all staff prior to the go
  live date
• Risk analysis/ Hazard analysis
• Analysis identified that additional risk was not
  introduced with the move to EXM
• A phased in approach for the introduction of EXM
  was suggested and endorsed by the TM Operations
  team
• Phase 1
• Implementation of Patient testing for EXM
• Phase 2
• Implementation of unit blood group confirmation
• Phase 3 (final phase)
• Full implementation of Electronic Crossmatch

• PROCESS
• The LIS Technical Specialist investigated,
  created and validated the necessary rules for EXM
• Other facilities were contacted to determine best
  practices
• The Transfusion Medicine Operations Team met to
  make decisions on options for sample requirement,
  testing to be performed and to discuss best
  practices
• The regulatory requirements for utilization of
  EXM were identified
• A project plan was developed to set timelines
• Development of teams were organized
• These teams consisted of LIS staff, management
  staff and front-line members and were to focus
  on
• Validation- develop and test scripts to challenge
  the LIS build ensuring that all warning flags,
  computer blocks and rules operate as designed
• Process and workflow- review and identify
  workflow changes. Develop standard operating
  procedures (SOP)
• Training-develop educational material and train
  staff for EXM implementation
• Risk Analysis-ensure that a safe product is
  provided to patients

• CONCLUSION
• EXM was successfully implemented at all 3 sites
  on January 31, 2006
• Time lines were met due to the commitment of all
  staff involved
• Transfusion Medicine service and patients have
  benefited from the introduction of EXM which
  allows for the timely provision of large
  quantities of red cells in a trauma situation
• Communication is essential with the introduction
  of any major project
• Valuable information was provided by open
  communication encouraged and supported by the
  team members.
• Staff were encouraged to voice all suggestions
  during the process change to allow for
  understanding and acceptance of the changes
• Meetings held immediately after the
  implementation not only provided a venue for
  constructive feedback, but also provided an
  opportunity for the team members to learn how
  best to approach future initiatives
• Many concerns outside of our immediate control
  exist with the provision of a safe product for
  our patients. Introduction of EXM has helped to
  increase patient safety.

Figure 1. The decision making framework for the
implementation of Electronic Crossmatch

• REFERENCES
• American Association of Blood Banks, Technical
  Manual, 14th edition.
• Canadian Society for Transfusion Medicine,
  Standards for Hospital Transfusion Services,
  version 1, September 2004.
• Canadian Standards Association, Blood and Blood
  Components, Z902.

ACKNOWLEDGEMENTS A special thanks to Mary
Kokoski if not for her dedication and three year
commitment to the project, EXM would not have
been possible. The authors would also like to
acknowledge the team members and the entire
Transfusion Medicine staff without whom the
success of the implementation would not have been
realized.