Where do you record important BT messages on Winpath system?

[tangx]

Does your lab use Winpath. If you do, where do you record BT messages?

For the last decades, our BT lab use Notepad to record important BT messages, such as: BMT donor recipient blood group and special requirement; shared care info; Neonates and maternal info, reasons for special requirements, JW patient requirements. All these information can be carried through patients' demography and worked perfectly until last year.

More and more labs in the department started to put all kinds of messages on notepad and now OCS form numbers are automatically updated there as well.
I believe this is potential risk for BT lab because the BT messages might be missed among other messages.

I am wondering how other BT Winpath users record their messages?

[Barbara]

We have the same problem of "too many messages" feeding in to the Notepad, however we still continue to use it to record important information. To alert the BMS that a BT relevant message is available in the Notepad we have a flag called "NOTE" that asks the BMS to check for messages. In addition we increase font size, make the text bold or change the colour so it stands out among all the EPR type feeds. This tends to work quite well, and our pre-XM check list also prompts you to check the notepad for messages.

[Rashmi]

If you are going to change the info style- this would have to be for all previous records too, and will be a lot of work,otherwise there is potential for staff to miss this important information and release unsuitable units.

[sjb]

We don't use notepad for important info for all the reasons stated, although we too use the 'NOTE' flag, but for some Pts the signal to noise ratio is too high.

Better to use a mix of rules and spec reqs.

[tangx]

We don't use notepad for important info for all the reasons stated, although we too use the 'NOTE' flag, but for some Pts the signal to noise ratio is too high.

Better to use a mix of rules and spec reqs.

Yes, we use spec reqs too and flags but some messages need free text like BMT or mixed field caused by previous transfusion history in other hopsitals, drop down list is not enough.

[tangx]

Thanks Barbara, we are doing the same at the moment- flag to remind, changing colour. However it is not ideal for reasons mentioned in Rashmi's post.

[tangx]

If you are going to change the info style- this would have to be for all previous records too, and will be a lot of work,otherwise there is potential for staff to miss this important information and release unsuitable units.

IT IS a lot of work to change colour for all previous records and I don't think it is possible too. I did try and realise all previous records cannot be edited unless delete and re-type.

[Rashmi]

Hi Tangx,
Really good the consideration you have given to this and actions taken so far , now you need to escalate things outside your control:

1.Pathology / Quality managers together with your input need to assess the risk to all the patients for the period prior to your changing the font colour (probably whole of your database!).
2. If another department now adds Notes to a patient record containing transfusion details- this will still be a problem. Is the transfusion dept alerted by users who are adding new notes? if not- there are still risks because you will not have awareness to change font colours.
3. How was this change allowed to happen without consultation with Blood bank? ( yes, these things are sent to try us regularly- but unacceptable !!)
4. Is there a risk that another user can delete transfusion notes accidentally?
5. If unsuitable blood is released because staff didn’t notice the buried Notes- the RCA must mention this as possible contributory factor.
6. The Pathology risk assessment is key, and this should be on the trust risk register. Remember this is a risk to both the patient and your staff.

bw

[tangx]

Hi Tangx,
Really good the consideration you have given to this and actions taken so far , now you need to escalate things outside your control:

1.Pathology / Quality managers together with your input need to assess the risk to all the patients for the period prior to your changing the font colour (probably whole of your database!).
2. If another department now adds Notes to a patient record containing transfusion details- this will still be a problem. Is the transfusion dept alerted by users who are adding new notes? if not- there are still risks because you will not have awareness to change font colours.
3. How was this change allowed to happen without consultation with Blood bank? ( yes, these things are sent to try us regularly- but unacceptable !!)
4. Is there a risk that another user can delete transfusion notes accidentally?
5. If unsuitable blood is released because staff didn’t notice the buried Notes- the RCA must mention this as possible contributory factor.
6. The Pathology risk assessment is key, and this should be on the trust risk register. Remember this is a risk to both the patient and your staff.

bw

Many thanks for your advice Rashimi. I will escalate it to Path GM.

[yassnikb]

thanks very useful