End‐to‐end electronic transfusion management in hospital practice

Abstract

Background Errors occur at all stages of the hospital transfusion process and the resulting morbidity and mortality are well documented. Recent initiatives in the UK and elsewhere to reduce transfusion errors have focussed on implementing recommended manual procedures for good practice, but have only been partially effective.Aims Our approach was to ‘re‐engineer’ bedside and laboratory transfusion procedures.Materials and Methods We implemented barcode patient identification, bedside handheld computers and electronically controlled blood fridges to simplify transfusion procedures and improve practice.Results There was an improvement from 11.8% to 100% of staff following the process for correct pre‐transfusion bedside patient identification; no ABO incompatible red cell transfusions in 5 years; a reduction in wrong blood component transfused events from 1 in 27,523 to 1 in 67,935; reduced nursing (one nurse rather than 2 and half the time to administer blood) and laboratory workload; and more rapid delivery of urgently required red cell units to patients (from a median of 18 minutes to 45 seconds). The electronic system provided a simple mechanism for compliance with UK/EU regulatory requirements for the traceability of blood, and the documentation of transfusion and training. Feedback from both staff and patients was positive.Discussion The project was taken through pilot stages between 2001 and 2006 through to its full implementation across the acute hospitals in Oxfordshire in 2006/07. Our group wrote a national specification for the electronic transfusion process, but the implementation elsewhere in the UK has been slow. There is the potential to introduce an additional module into the electronic transfusion process to provide ‘decision support’ for doctors ordering blood to minimise inappropriate use of blood as part of a patient blood management programme, and use the same ‘end‐to‐end electronic’ approach for other clinical procedures such as drug administration.Conclusion The implementation of a hospital electronic transfusion management system was shown to provide improvement in transfusion practice and in the efficiency of the service.