Follow these steps to create a workflow for blood product administration by EMS and fire units.
This article explains how to use AngelTrack's vial-tracking system to create a workflow for blood product administration (transfusions) in the field.
Step 1, Configure the Medication List
Each distinct blood product must have a record in your AngelTrack server's medication list.
If you stock more than one dosage of a product, then create a separate record for each dose, with all records linking to the same RxNorm code. Or you could use a more-specific RxNorm for the different dose levels or delivery systems.
The NEMSIS standard also provides eight SNOMED codes specifically for transfusions. These SNOMEDs are permitted in lieu of an RxNorm code; in other words, normally every medication must have its RxNorm code on file, but for blood products you can use one of these SNOMED codes instead:
- 116762002 "Administration of blood product"
- 116795008 "Transfusion of cryoprecipitate"
- 116861002 "Transfusion of fresh frozen plasma"
- 116865006 "Administration of albumin"
- 180208003 "Transfusion of platelets"
- 33389009 "Transfusion of whole blood"
- 71493000 "Transfusion of packed red blood cells"
That said, it is up to your state health department to allow the necessary SNOMED or RxNorm codes for EMS administration. These allowances are promulgated in your state's StateDataSet, which AngelTrack already imported for you when your server was first deployed, and which you can reimport again whenever you like.
To learn more, please visit the Medication List Guide.
Step 2, Configure the Vial Tracker
AngelTrack's vial-tracking system will track the units of blood and/or doses of blood products.
The vial tracker assumes that each station has a drug safe. In the case of blood products, this would be the refrigeration unit where the products are stored.
The vial tracker follows each dosage across its entire lifetime at your agency. It uses lot numbers and dose numbers for this purpose. Depending on how the blood products are labelled, you might benefit from adding a USB barcode scanner gun to the workstation where arriving blood products are scanned into the system.
If any blood products do not have unique serial numbers already on them, then you must purchase a roll of barcoded serial-number stickers, and apply a sticker to each arriving unit.
To learn more, please read the Vial Tracking Guide.
Step 3, Configure the Drug Boxes
AngelTrack's vial tracking system uses the concept of a "drug box" to represent a portable or non-portable drug storage box or safe that travels with the crew in their vehicle.
Your blood products go into a cooler or mini-fridge instead, but AngelTrack considers that to be a drug box.
Thus, you must visit your Devices and Equipment List, and add a drug box record for each cooler or mini-fridge that holds blood products. If a cooler / mini-fridge always stays with a specific vehicle, then assign the device record to its owning vehicle.
To learn more, please read the Devices and Equipment Tracking Guide.
Step 4, Establish a "Perpetual Inventory" Process
When new blood products arrive at a station, you must have a process for logging them into AngelTrack.
You already set up all the components of the system in steps 1, 2, and 3, so now your station chiefs or their assistants must conscientiously utilize the system, carefully logging each arriving blood product into AngelTrack's perpetual inventory of the station's drug fridge. They likewise must log each expired item as it is removed and discarded.
This can go quickly, especially if you have a USB barcode scanner gun and your blood products have barcodes, or if you buy a roll of barcode stickers that can be quickly placed onto arriving items.
When the perpetual inventory is accurate, then crews coming on-shift can easily complete their check-out process, described in the next step.
Step 5, Add a Custom PCR Signature for Blood Product Consent
Your medical director or legal counsel may require you to collect a custom signature form for blood product consent. You can create a new signature form for that and add it to the PCR, once you receive the necessary legal verbiage from your legal team.
To learn more, please visit the Custom PCR Signatures Guide.
Step 6, Train Crews on the Check-Out / Check-In Process
When your ALS crews check-out blood products from the refrigerator at the start of a shift, and place them into their vehicle's cooler or mini-fridge, they will now use AngelTrack's drug-box system. You learned about about drug boxes in step 3.
At the start of any ALS shift, the crew will see UI on their Crew Home Page to check-out, update, or check-in a drug box. AngelTrack collects electronic signatures from them during check-out and check-in. The crew can then move blood products between the fridge and the vehicle's cooler by clicking items in AngelTrack's drug-box contents editor.
AngelTrack knows what items are in the fridge because you earlier logged them into inventory, in the process you established in step 4, so it's a one-click process to mark an item as moved from the station's fridge to the vehicle's cooler, or vice versa.
Step 7, Train Crews on PCR Documentation
Blood product administration is to be documented using the PCR-Medications tab, not the PCR-Procedures tab.
The PCR-Medications tab collects all the necessary data, and you can add additional custom fields for things like:
- Patient blood type / Rh
- Blood type compatibility test result
To learn more, please visit the Custom EMS PCR Fields Guide.
If your crew uses the drug box system correctly, then the PCR-Medications tab will offer them a picklist of the various blood product units in their vehicle's cooler, so that they can point-click select the one they used, which automatically updates the perpetual inventory.
When AngelTrack later emits a NEMSIS XML for the trip, it will automatically insert a matching PCR-Procedures record for the blood product administration. You crews only need to fill out the PCR-Medications tab.
Step 8, Add a "Fridge Temp" Item to the 24-Hour ALS Checkoff
Probably you have a work-item where every day someone must verify the temperature in the station's blood products refrigerator. To cover that, and ensure it gets done, amend the checklist you use for your 24-Hour ALS unit(s), and add the temperature-check item to the bottom.
The crew can perform that check at whatever time of day is best, and then notate it in their checklist at any point in time, since they'll have access to the checklist for their entire shift.
If the crew must perform multiple checks throughout the day, then you can put multiple items in the checklist, like this:
- Blood products fridge temp - 08:00
- Blood products fridge temp - 16:00
- Blood products fridge temp - Midnight
To learn more, please visit the Checklists Guide.
Step 9, Configure Billing
If you levy a line-item charge for blood products administered where not covered by insurance, AngelTrack can automatically assess the charge for you, so that it appears in the patient's invoice.
To set that up, read the Service Charges Guide and then add the proper dollar amounts to the records in your Medication List.
Step 10, Resupply and Reordering
Because your blood products are inventoried alongside your other supplies at each station, you can use AngelTrack's resupply+reorder system.
To configure that, you must specify the minimum quantity of each product to be kept on-hand at each station, as well as the reorder-to quantity... then let AngelTrack prompt you when it's time to reorder. It can even fill out your purchase orders for you, for each supplier.
To learn more, please visit the Supply Room Guide.