There are several different types of comments in HIIG:
Physicians may enter any of these comment types. Comments may be entered before or after a test is authorized/verified. If entered after authorization, the test must be modified to accept the comment. Only result comments are visible in the patient’s medical record.
Physicians should use comments in the following situations:
Interpretations of DAT, antibody identification, ABO discrepancies
Instructions for the selection of specific and/or modified blood components
Donor eligibility issues (e.g. donor marker testing abnormalities and disposition)
Telephone call documentation
Donor counseling documentation
Any special instructions to staff
Any other situation where the transfusion physician determines it is desirable to enter a comment
Copy all result-comments and also enter then as global comments against the patient or donor record as applicable.
Procedure—Patient Result Comments After Results are Authorized/Verified:
Sign into HIIG and select Patient module, Patient Consultation, and enter the patient hospital HC number.
This post is the policy for using comments in Medinfo software. A subsequent post will show the process of entering comments.
There are several different types of comments in HIIG:
Global Comments appear on the first main screen of either the donor or patient record. The presence of comments is indicated by a bar at the bottom of the screen (in yellow or blue saying Presence of Comments. Double-clicking opens the list of entered comments.
Examination/Results Comments appear only when you open the result to which it is attached. You must know in advance to which result they are linked to find them.
Contraindication Comments appear when entering a donor deferral code
At HMC, we will enter examination/results comments again as global comments (donor or patient) so it is easy for staff to retrieve them and see them with all other comments. You can do this by cut and paste.
Physicians may enter any of these comment types. Comments may be entered before or after a test is authorized/verified. If entered after authorization, the test must be modified to accept the comment and require a special password (not the user sign-into HIIG). Only results/examination comments are visible in the patient’s medical record. Global, analysis, and contraindication comments are visible only in HIIG! Donor comments are only visible in HIIG.
The presence of comments documents physician review of abnormal results as required by the various accreditation standards.
Only designated staff may enter comments.
Comments entered after authorization/verification of results will modify the donor/patient record and require a special, high-level password distinctly different from the normal user password.
International accreditation standards require physician review of certain abnormal results such as transfusion reaction and antibody workups. This post describes how such review is documented in Medinfo Hematos IIG dedicated blood bank software.
In general there are three main ways to do this:
User ID associated with each transaction
Comments against results, analysis, or globally
Physician direct entry of results (e.g. transfusion reactions)
This applies to all modules of Medinfo, including donor and patient.
The system records the User ID of the staff member who performed an action—this includes the authorized transfusion physicians This covers everything in the system, donor or patient. However, it may require a specific query by user ID to list all of that person’s transactions. This is not easy to show an external assessor/inspector unless the query is performed in advance.
For those cases requiring review, comments can be placed with the results, which will be visible to anyone viewing that record. Additionally, internal comments can be added to the analysis and globally within the record.
Direct Physician Entry of Results and Interpretations:
For transfusion reaction workups, physicians may directly enter their interpretations and results in the system.
Subsequent posts will show how comments and direct physician entry of results are performed in the system.
In my time at the Saudi National Guard Health Affairs and at HMC Qatar, I offered the pediatric fellows a series of lectures of 1-2 hours duration. The following list has been updated to cover current topics of interest, including COVID-19 convalescent plasma.
Transfusing blood components for physicians—what do you need to know
Recognizing and treating adverse effects of transfusion
Blood components and derivatives—what you need to know
Blood filters, irradiation, aliquoting, and washing blood components
Pathogen inactivation and platelet additive solutions
COVID-19 and the blood supply, COVID-19 convalescent plasma
Indications for blood components and monitoring efficacy
Patient blood management: minimizing transfusions
Blood group serology and compatibility—what you need to know
Adult vs. pediatric transfusion medicine: special considerations for the pediatrics
This is a competency assessment for non-physician, non-nursing staff to transport blood from the hospital transfusion services/blood bank to the emergency department and operating rooms. This was designed by my Quality Manager, Ms. Edith Durante.
Below is a sample document specification for a document control process. It was originally designed but never implemented due to changes in the administrative structure in that organization. I want to thank Ms. Editha Durante, Quality Manager for preparing this.
As part of good manufacturing process, we must trace everything in Transfusion Medicine, from registration through release of components. The adoption of the Medinfo Hematos IIG computer system allows us to document anyone and everyone who “touches” the blood components and all processes.
Each staff member must use his/her personal log-in to sign into Medinfo Hematos IIG HIIG). Each transaction is recorded with the User ID.
Through the Medinfo Hematos IIG computer system, we can trace:
Each staff member who handled every step of every process.
Which equipment was used in processing
Which materials were used, including serial number of blood bags and selected reagents
For each component, the donor is identified, including review of all test results, physical examinations, and questionnaire
For each patient, all components received (from which each donor can be traced) and all testing results including transfusion reactions and any applicable protocols
For each reagent lot numbers, expiration dates
For each blood component, test results, serial numbers of blood, transfer, and pathogen-inactivation bags, dates and types of all modifications, including any changes in component outdates, disposition of unit (transfused, discarded, quarantined, etc.)
Units can be quarantined based on each of the above parameters to block release to and/or usage at all blood transfusion services/hospital blood banks.
Upon request of the Division Head, Transfusion Medicine/LIS, designated Transfusion Medicine and HIIG staff have access to trace any of the above.
All traceability incidents will be reported as variances and documented according to standard procedures.
Workflow processes for Medinfo HIIG, Current Versions
Standards for Blood Banks and Transfusion Services, Current Edition, AABB, Bethesda, MD, USA