B lood Bank Managem Management Syste Sys tem m - A Monitoring Monitori ng Tool For Blood Bl ood Ban B ank k Sta S tanda ndards rds Amarjeet Singh Cheema, Hruday Kishora Meher, Rajiv Yadav
Abstract: Blood cannot be created by any means, it can only be collected from the Humans i.e. donors. Recruitment of safe donors and monitoring the standards is a challenging task. No Blood Bank, Hospital or Government can sustain health care without adequate blood. The major concern of Blood Bank is to maintain the Quality of Blood as well as to identify the Professional Donors. NACO (National AIDS Control Organization) and NABH (National Accreditation Board for hospitals and Healthcare Providers) provides standards to ensure the quality of Blood and identify the Professional Donors. But monitoring the standards and identifing the Professional donors manually is a challenging job. The software available in market is useful to cater the day to day functioning of Blood Bank but cannot enforce the standards. Bio Metric devices are also available to detect the professional donors but not available in an integrated form with application. Quality Checks are available but these checks are not conducted on routine basis and also not on all bags. To overcome these issues we designed and implemented standard enforcing mechanism in each process of Blood Bank Management System and also integrated Bio Metrics with Donor Registration Process to identify the Professional Donors. This not only covers the day to day working in blood Bank but also ensures implementation of the Blood Bank Standards. I ndex ndex Terms — Hospital ospital Mana M anage gement I nformation nformation Syste System (HMI (HM I S), Monitoring Too T ool, l, Professiona rofessionall Donor
1. Introduction Blood sustains life. A deficiency in the quality of blood will impair the quality of life and even compromise life itself.Blood Bank is a vital part of the health care service. Increasing advancement advancement in the field of Transfusion Transfusion Medicine and Technology Technology has necessitated necessitated enforcing measures to ensure quality of Blood and its products. The blood transfusion system has made significant advancement in areas of donor management, storage of blood, grouping and cross matching, testing for transmissible diseases, rationale use of blood and distribution etc. In order to improve the standards of Blood Banks and the Blood Transfusion services in our country, National AIDS Control Organization(NACO) through Technical Resource Group on Blood Safety has formulated comprehensive standards to ensure better quality control system on collection, storage, testing and distribution of blood and its components. A well-organized Blood Transfusion Service (BTS), with quality systems in all areas, is a pre-requisite for the safe and effective use of blood and blood products. This is a vital component of any health care delivery system. The main issue, which plagues blood banking system in the country, is enforcing the standards & identifies the Professional Donors. A donor donates blood in exchange of money or other form of payment. The professional Blood donation is banned in our country w.e.f.1st January 1998[1]. The NACO Standard is followed manually in all blood banks. For measuring the quality of Blood, Quality check is performed on selected bags but not on all blood bags. As mentioned above that the main issue is still a need to be addressed i.e. Monitoring of Standards & Professio nal Donors. For identifying the Professional donor we implemented Biometric in SMS Blood Bank, Jaipur. At the time of Donor Registration, Biometrics checks the finger impression of donor in repository. If donor is already gave donation within 3 months as per donation type then system will not allow to stamp the visit of such donors. On the other hand to make the Blood Bank system as monitoring tool, we design Blood Bank Management system in such a way that standards will be checked forcefully. To enforce these standards we wrap the Blood Bank Monitoring system in monitoring tool which ensures that the standards will be followed. This monitoring tool is in form of rules which can be configured as per the state wise NACO guidelines. guidelines. This paper presents various aspects of Blood Bank Management System which has been implemented in PGIMER. Paper is divided into following sections. Section 3 elaborates major issues in the Blood Banks. Section 4 describes Blood Bank Management System as a Monitoring Tool for Blood Bank Standards. Section 5 discusses the salient features of the Blood Bank Management System.
2. Overview of Blood Bank Management System Blood Bank is one of the important departments. It plays an important role with blood collection and issue of blood/components. Its activities include blood donations, blood grouping, antibody screening, antibody identification, cross matching, blood infectious tests, component preparation, preparation, issuing compatible blood blood and Blood components components etc. Blood Bank Bank Module provides provides up-to-date information information about total daily blood blood / component stock, total daily blood requisitions and information regarding donor. Blood bank module constitutes of, registering the donor at the hospital premises or at the camps arranged by the Blood Bank itself. Every Donor undergoes a physical examination test and the donor examination results are entered into the system. Depending on the examination result the donor’s blood can be accepted or rejected. If a Donor is accepted his/her blood is collected and is put in a bag and that bag is given a unique number by the system itself. This bag number is the same unique number given to identify that donor also. After the blood is collected, it undergoes certain tests. Initially the blood has to undergo serology tests tests the results of which are entered into the system through through the result entry screen. After the result entry process an authorized authorized person validates validates the result on the system. After serology test, blood grouping is done on the blood and results of the same are entered entered into the system. A senior person again validates this Blood group detail on the system. After all the tests are performed on the blood, the various blood components are separated. The components are added to the existing stock and are now ready for cross match & issue. The requisition of blood component will come from Hospitals. For every requisition, Blood is issued depending on the availability of blood in the stock.
Proceedings of ASCNT-2011, CDAC, Noida, India, pp
Amarjeet Singh Cheema, Hruday Kishora Meher, Rajiv Yadav Blood Bank is an integral part of HMIS. Hospital Management Information System manages the information of Hospital section wise. Blood Bank Module mainly interacts with In-patient management (IPD), Operation Theatre (OT), EMR, Emergency, Patient Billing and Stores as shown in Fig. 1.
Fig. 1: Blood Bank Work Flow
It also interacts with the Bio Medical Waste management for Bio safety and waste disposal. Blood Bank Management system is a loosely coupled module of Hospital Management Information System (HMIS). Blood Bank Module can be installed as separate module in case of independent Blood Banks and in case of Hospital it is integrated with Clinical modules. In all cases the billing and Store Management is coupled with blood Bank Management System. The Blood Bank module wise functionality is shown in Table 1.
Sub Module Donor & Donation Management
Bag Management
Investigation
Requisition & issue
Billing
Quality Control
Blood Bank Functionalities Functionalities Automatic Generation of Unique Donor Number Integration with HMIS Ability to view all the details of the Registered donor Identification of professional donor using bio metric Provision to Print the Bar-Coded Labels & Donation Cards Facility to Print the Letters to Voluntary Donors Dynamic examination & questionnaire tile as per NACO guidelines based on donor type, donation type and donor gender Configurable blocking Days according to gender, last donation type and donation component consent utility to map dynamic consent based on donor type or donation type Online camp management Handling of the Inventory through barcode Provision for inventory management of the Blood / components by specifying the type of blood, blood component and their physical locations Functionality to generate alerts well in advance of the expiry date of blood and blood components Ability to restrict transaction against expired blood / blood components and directed donations (To handle reserved donations) Blood Stock can be viewed by Blood Bank User as per the role and blood bank policy Configurable For Different Labs Interface With Medical Equipments Bar Coded Sample No Generation Template Based Reports Generation Confidential Report Generation Automatic alert for exceptional test result by comparing with base line values Test results can be entered either in batch mode and / or individual case wise Priority Wise Color Coding of Requisition i.e. (Urgent/Routine) Stock Availability at the Time of Requisition Provision to Capture detail of the Patient Blood Sample Provision to Print the Cross Match Report Automatic Confirmation of Replacement Donation Different configurations possible-Online/Offline Billing Role Based/Tariff Based Cash Collection Authorized Waive Off Blood Component Reagent Quality Control Equipment Quality Control Table 1: Blood Bank Functionalities
Blood Bank Management System - A Monitoring Tool For Blood Bank Standards
3. Monitoring Tool Architecture The architecture of BBMS is shown in Fig. 2. The enforcing mechanism is a set of rules which are entered in the form of masters. On every process we call these rules through wrapper class methods. Whenever data is saved through BBMS process, it passes from wrapper class which checks the rules according to the process. Data will be saved only in case of true flag returned by the wrapper class. A wrapper class is a java file which has the process wise methods for checking the rules from database. In database, these rules are maintained in the form of masters.
Fig. 2: BBMS Architecture
To identify the professional donors, Biometric device is integrated with Donor registration process. We include the Biometric SDK libraries in donor registration process. Whenever we open the donor registration process, system first opens the biometric finger impression window. After capturing the thumb impression system checks the existence of donor in blood bank repository. We can check subsequently for other fingers as per the finger capturing policy set by Blood Bank. If donor is already registered system return the information as shown in Fig. system automatically calculate the locking periods of donation as per the last donation type and date and suggests for donor visit. If donor is already donated in the limit duration then system will not allow further processing. The system has second level of check to identify the professional donor. If Biometric fails to identify any professional donor then this level is activated. In this level the system will check the donor details provided at the time of donor registration with the database and return the list of donor matching the criteria set by the Blood Bank.
4. Implementation of Monitoring Tool As the standards are in the master form (Fig. 3) then the question arises how the system will ensure that these guidelines will be followed. For this we create the dependencies between processes through enforcing mechanism which don’t allow user to go further without fulfilling the process.
Fig. 3: Standards Master
Amarjeet Singh Cheema, Hruday Kishora Meher, Rajiv Yadav Some of the enforcement examples are mentioned below Restrict the permanent unfit donor for further donation and restrict the temporary donor for a specified duration of time shown in Fig. 4.
Fig. 4: Restrict the Donor for Donation
Bag labels can only be generated if Donor is fit and Bag is in Stock. Donation can be possible after generation of bag label shown in Fig. 5.
Fig. 5: Label Generation before Donation
Donor card can only be printed if Donor is fit and Donation is Successful. Physical examination details are cross checked from previous visit summary and patient EPR. In case of any discrepancies, donor is made forcefully unfit temporarily. Transfer of stock from across fridge depends on bag status. Expired bag can not be issued. Cross matching without availability of bag in stock is not possible. Billing is possible only if the Bag is cross matched. Bag can be issued after completion of Cross match. Bag is updated in the stock only after the TTI screening of bag is found non-reactive. The work flow to identify professional donor with Biometrics is mentioned below. After clicking the Donor Registration Process, a screen will popup to capture donor finger impression shown in Fig. 6
Fig. 6: Popup to Capture Donor Finger Impression
Blood Bank Management System - A Monitoring Tool For Blood Bank Standards
As per the Blood Bank rules, donor will ask to put the finger on Biometric device shown in Fig. 7
Fig. 7: Capturing Donor Finger Impression
System will search the finger impression in database If impression found then system returns the donor information with last visit details Donor donation eligibility will be checked by system according to donor last donation date and donation type If donor eligible then only system will allow to stamp donor visit If biometrics fail to find the donor information then we can check for other fingers as per blood bank rules If no information found then we also have the second level check i.e. system check the existing donor in database on the basis of information keyed such as donor name, age, father name, address etc If donor is not an existing donor then in that case system will treat the donor as new donor and save the information and finger impression into database shown in Fig. 8.
Fig. 8: Registering & Saving Donor Finger Impression
5. Implementation of NACO rules in BBMS Blood Bank Management System not only covers the Blood Bank working but also ensures the enforcement of standards. Some of the major NACO standards and how it covers in Blood Bank Management System are mentioned in Table 2 NACO Standards in BBMS Point No A- 6.0
B-1.2
B-3
NACO [2] NACO Standard The blood banks and transfusion services should aim to accept blood from only voluntary nonremunerated safe blood donors and to do away with the high risk donors and blood sellers. They should gradually phase out replacement donors. (N.B.: Blood sellers have been banned as per Supreme Court directive). Efforts should be directed towards encouraging and retaining adequate numbers of repeat donors. Donors should be appropriately recognized and felicitated for their contribution Following guidelines should be observed in order to determine that the blood donation will not be detrimental to the donors/recipients.
BBMS Identification of professional donor using bio metric Automatic identification of already registered donor and getting the clinical information from EPR
Auto generation of mail as per the schedule
Dynamic examination & questionnaire tile as per NACO guidelines based on donor type, donation type and donor gender Configurable blocking Days according to
Amarjeet Singh Cheema, Hruday Kishora Meher, Rajiv Yadav
C-6.0
C-7.0
D-5.0
F-1.0
F-2.1
H-3.0
The blood samples in the pilot tubes (clotted and anticoagulated) should be collected at the time of collection of blood by the same person who collects blood. They should be marked before collection to be identified with the unit of blood… The blood samples in the pilot tubes (clotted and anticoagulated) should be collected at the time of collection of blood by the same person who collects blood. They should be marked before collection to be identified with the unit of blood. The integral donor tubing of plastic bag should be filled with anticoagulated blood and sealed in such a manner that it will be available with segment numbers for traceability for subsequent compatibility tests. All mandatory tests should be carried out on blood samples in pilot tubes taken at the time of collection. The whole blood or components from any unit that tests positive should be discarded. A system should be in place to ensure that final container is labeled only after all mandatory testing is completed as per pharmacopoeal requirements. The numeric and alphanumeric identification on label should be provided by the collecting facility to each unit of blood/its components. This number should be documented for traceability. Any advanced technology for identification such as barcode system is preferable. STORAGE AND EXPIRATION
L-1.0
SELECTION OF BLOOD AND COMPONENTS FOR TRANSFUSION Blood should be issued from the blood bank along with the blood cross matching report form. A portion of the integral tube with at least one numbered segment should remain attached with the blood bag being issued. It is recommended that blood once issued should not be taken back by the Blood Bank, especially if the cold chain is broken. INFORMED CONSENT
Q
Bio safety and Waste Disposal
I-4.0 K-1.0
K-4.1
gender, last donation type and donation component In case if donor is also a patient in hospital then system will automatically check clinical guidelines from EPR. In case if doctor fail to identify any reason to unfit then system will automatically guide the doctor Donation can only captured after the generation of bag labels and mapping of bag tubing no.
Without capturing this information system can not allow further processing Tubing No is captured through barcode gun to avoid manual errors Once captured the information is released from stock to avoid the duplicate number
After performing TTI Screening and if report is reactive then the blood cannot be used and is stored in a different storage for discard Final label is printed only after the grouping, separation of components and completion of all the mandatory tests. Bag label, sample label are generated using a Barcode printer.
The expiry of blood component is automatically calculated by the system depending on the closed/open system. System automatically shows the blood bags that are compatible with the patient sample. At the time of issue of blood the system will generate a cross match report and that report is attached with the issued bag.
Any blood bag returned by the patient is kept in a different storage area for discard. System generated consent is taken from the patient. Dynamic guidelines and checklist for disposal of waste.
Table 2: NACO Standards in BBMS
6. Conclusion Blood Bank Management System ensures strict adherence to NACO Standards and also prevent the professional donors in the Blood Bank. It ensures that, as far as possible staff adheres to the guidelines for doing their routine activities. The major advantages of BBMS are: 1. Adherence to NACO guidelines 2. Identification of Professional donors 3. Maintaining the quality of blood 4. Integration with EPR for clinical details of the patients for physical examinations 5. Integration with Clinical Templates 6. Effective camp management
Blood Bank Management System - A Monitoring Tool For Blood Bank Standards Acknowledgment We are thankful to Dr. Neelam Marwaha, HOD, Dr. R. R. Sharma, Dr. Ashish Jain, Dr. Suchet Sachdev & Dr. Hari of Blood Bank, PGIMER Chandigarh and Dr. Gururaja, HOD & Mrs. Lata, Sr. Technician Blood Bank, GB Pant, Delhi for helping us understand the complete domain of Blood Bank. We also thankful to the staff of blood Bank, SMS Jaipur for their support in the implementation of Biometric solution
References [1] Voluntary Blood Donation Programme, Produced and Published by NACO, 2007 [2] Standards for Blood banks & Blood Transfusion Services, Produced and published by NACO, May 2007
Hruday Kishora Meher (Engineer (IT)-IV) received Bachelor of Engineering from Sambalpur University, Orissa. He has joined C-DAC Noida in the year 2007. Presently he is working as a Module Lead in Health Informatics Group, CDAC Noida for the design and development of Advanced Hospital Information Management System. He has worked on various technologies Java-J2EE (Struts Framework), Jasper Report, Oracle. E-mail:
[email protected] Amarjeet Singh Cheema(Project Manager) received Post Graduation Diploma in Advanced Software Design & Development from Electronics Research & Development Centre, Noida and B.E. (Electrical & Electronics) from the University of Gulbarga, Karnataka in the year 2001 and 2000 respectively. He is pursuing M-Tech in Information Technology from IP University. He started his career with C-DAC Noida in the year 2001. He has extensive experience in Requirement Analysis, Business Process Reengineering & Designing. He has expertise himself as a functional analyst in health domain and has done a number of successful implementations in the same area. Presently he is working as a Team Lead in Health Informatics Group, CDAC Noida for the design and development of Advanced Hospital Information Management System. He has designed & developed various advance utilities which make the Hospital Information Management System robust & user friendly. He has worked on various technologies C/C++, Pro C, Power Builder, Java-J2EE (Struts Framework), Visual Basic, Oracle, and UML. E-mail:
[email protected]
Rajiv Yadav has graduated in Computer Science & Engineering from Marathwada University Aurangabad (Maharashtra) in 1995. He has also completed his Diploma in Advanced Computing from CDAC. Since 1999 he has been associated with Centre for Development of Advanced computing. In his career span of more than a decade he has had the opportunity to serve in various group of CDAC, Presently he is associated with the Health informatics group of CDAC & Managing the Health Informatics Project in Government & Public Hospitals. E-mail:
[email protected]
