David Linnemeyer, BS, MT(ASCP)SBB), Manager, East Jefferson General Hospital Blood Bank
For Blood / Biologics
My own blood bank's ISBT implementation was not quick or easy. If I could do everything again, I would do things quite differently. Hopefully a review of my own mishaps will help you plan your own ISBT implementation more effectively.
First, I delayed my own implementation with the excuse that I did not believe that ISBT would give the department enough "bang for the buck." Higher expenses and increased complexity of workflow resulting from ISBT implementation at a time of reduced resources would far outweigh any benefits. I still believe that to be true post-implementation. But eventually, I realized I was using this opinion as an excuse not to begin implementation. In the end my opinion did not matter; ISBT was not going away and ISBT components would soon be in my inventory. Basically, I determined it would be much less stressful for all concerned to get on with it and finish the project!
"In the end my opinion did not matter, ISBT was not going away..."
Looking back, I now realize that three areas should have been better explored before I began the project. First, my learning curve was longer than anticipated. Second, I thought the ISBT capabilities of our computer system might be sufficient for the department's ISBT needs. I discovered that just because a system had ISBT capabilities does not necessarily mean these capabilities will be sufficient for the department's needs. Third, I should have analyzed the scope of the project to a greater extent. As an experienced blood banker, in the past when I have begun a project I usually had a fairly good idea as to its complexity and scope. In this case, even though I had attended numerous ISBT workshops over the years, I really did not understand what the implementation of the system would entail. I should have read information available from ICCBBA more thoroughly before going forward. As a result, my learning curve was of much greater length than anticipated, I belatedly realized my computer software could not fulfill the department's needs and additional printers and scanners had to be requested, and the project was much more complex than I had anticipated. As a result, ISBT implementation took much longer than I anticipated or than was necessary.
I did realize that it would be important to minimize the time frame when both Codabar and ISBT components would be used concurrently in the blood bank. I attempted to coordinate ISBT implementations of with my own transfusion service and donor room. Ultimately this was thwarted by "floating" implementation dates of outside blood sources and unexpected computer software limitations of our in-house donor computer. As a result, the blood bank has had to handle both Codabar and ISBT labeling for an extended period of time.
Most importantly for planning purposes, I needed to determine to what extent ISBT would impact my own hospital blood bank. A minimally impacted blood bank would have one outside blood source that doesn't import, transfusion of a limited variety of components, and component modifications performed outside of the blood bank. Additionally, a minimally impacted blood bank would either be non-computerized or have software without barcode capabilities and no in-house donation center. At the other end of the spectrum, an example of a greatly impacted blood bank would be one with multiple outside sources of blood that import with component modifications performed in-house. That blood bank would also receive both Codabar and ISBT components, would have an in-house donation center, and computer server software with barcode capabilities for on-demand printing. My own blood bank unfortunately perfectly fitted the "greatly impacted" scenario.
My first incorrect assumption: I thought I could gain knowledge of ISBT by devoting an hour here and half-an-hour there and that I could implement ISBT without reading all the basic information on the subject. Didn't work, never does--I never learn. Until I devoted an entire day, no interruptions, to ISBT research, I floundered (it's amazing what one can learn by reading!). Don't have time to do this? I bet you take vacation days and somehow the blood bank survives without you. After I devoted time to reading basic information, ISBT didn't seem half as complicated.
Second wrong assumption: I thought that since my current sun-setting computer software had ISBT tables, it could be utilized for ISBT. Wrong, never assume. The programmers who wrote the ISBT section for the software had next to no knowledge regarding how ISBT is used in the blood bank.
I could go on in this vein for some time, but I do have some pride. So this is what I would do if I could do it all over again...
- Implement a test plan that would evolve as the project progressed.
- Read the ICCBBA publications found at www.iccbba.org.
- From these publications I could then understand the structure of each major barcode type: DIN, product code, ABO&Rh, and expiration. This makes everything so much easier and saves time in the long run. I would also know "core conditions" and "attributes," all essential if one is required to build software tables from scratch (the software of my new system did require table builds from scratch).
- I would contact my outside blood sources to obtain: their implementation schedule; a list of ISBT product codes to be utilized; any client educational materials; their ISBT contact person; and check digit information relating to interfaces and DIN manual input.
- Determine how to handle pooling, splitting, and aliquot labeling.
- Allow sufficient time to validate all steps and the barcodes themselves.
- Determine if computer software is adequate, what table builds are required (time-consuming), and if the software can handle concurrently Codabar and ISBT.
- Evaluate scanners and printers: scanners should have both Codabar and ISBT capabilities. Are there a sufficient number of scanners and printers including backup? Is the printer model correct? (Not all printers have the capability to print the entire DIN)? Has that model been internally programmed for ISBT and has sufficient time been scheduled to validate all hardware?
- Labels: I would determine if it would be most cost effective to purchase labels or print in-house. If printed in-house, should a stand-alone system be utilized or the main computer, or both?
- I would plan how to handle both Codabar and ISBT concurrently. Will the computer on-demand labels be Codabar or ISBT? Should I then stock the type of label not being printed by my computer system? Example: If the majority of the components are to be ISBT, I would have the computer system on-demand labels be ISBT and print Codabar stock labels to be used as needed.
- I would realize aliquot and splits labels can be a challenge, and it may take time to resolve how these labels will be handled.
- I would determine if the computer software could bill both Codabar and ISBT product codes. Again, don't assume.
First, acquire your basic ISBT knowledge. This will save you much time in the long run. Second, an evolving test plan is essential in order to ensure that nothing slips through the cracks and causes a last minute delay in implementation. Third, network! Fourth, prepare your administration for potential additional costs (supplies and capital).
If you follow the steps outlined, there will be less chance your ISBT implementation will be delayed, while you complete overlooked items. Your project is more likely to be on time and hopefully less stressful.
Regardless, be wary of setting a concrete completion date with your manager!
David Linnemeyer has enjoyed 26 years' experience in blood banking and is the manager for the East Jefferson General Hospital Blood Bank in New Orleans. He has served as an AABB assessor for 20 years and lectures at meetings and conventions regionally and nationally. Linnemeyer also lectures in New Orleans' medical technologies and blood bank specialty schools. Contact him at firstname.lastname@example.org.
ISBT 128: More than Identification http://iccbba.org/
Roberts, Stanley C. Planning for Hospital Conversion to ISBT 128 Labeling for Blood Products
. American Red Cross, March 2006. January 13, 2009. http://www.bloodct.org/planning_for_hospital_conversion.pdf