Barcoding in transfusion medicine
Barcode technology can improve the safety of blood product administration throughout the hospital and in obtaining the sample for crossmatch to administering blood products. Barcode technology helps ensure that the patient is correctly identified during these processes. Adding this technology to the transfusion workflow can prevent errors with substantial consequences for the patient including death.
According to an analysis of transfusion related errors occurring in New York over 10 years, 659 out of 9,000,000 transfusions involved an error for a frequency of 1 in 14,000 transfusions. Five patients died from these errors, a frequency of 1 in 1,800,000. Administration of ABO incompatible blood is one of the most serious errors that can occur, although half of impacted patients did not have any signs or symptoms after this event. The majority of errors occurred at the bedside, and the most common mistake was giving a blood product to the wrong patient, followed by mistakes in drawing the initial sample including incorrectly labeled samples.
Typically the workflow for transfusion using barcode technology is as follows:
1) The patient is issued and fitted with an identification wrist band with a barcode containing patient information
2) Blood is ordered and a blood sample is drawn for crossmatch. The barcode on the patient wrist band is scanned and used to generate the correct patient label to be placed on the blood tube
3) The sample is sent to the blood bank for crossmatch and a label is applied to the blood unit allocated containing medical record number and the unit identification number.
4) Before the blood is administered, the clinician scans the patient wrist band and scans the barcodes on the blood unit to verify that this it is the correct, compatible, unexpired unit.
At the University of Iowa Hospitals and clinics, barcode technology was implemented in 2005 and the effect on patient safety was analyzed. They tacked the number of incident reports filed related to transfusions and this number went down by 83% after implementation. Only 0.17% of samples were rejected by the blood bank, from 1.82% prior to implementation which were often due to handwriting or transcription issues.
Presumably for these reasons, the most recent AABB standards released April 1, 2018 require that each patient have their ABO blood type tested on a live sample and then confirmed by a second method. The second method can be looking at a previous sample drawn at a different time or sending a second blood sample from the patient via a second blood draw. However, if barcode scanning was used to confirm the patient identification when the first sample was drawn, that first sample can simply be tested again. With this new standard, it will be much more labor intensive and time consuming to order blood for transfusion without using barcode technology and its inclusion in blood bank standards suggests that it will soon be the standard of care.
1. Linden, J. V., Wagner, K. , Voytovich, A. E. and Sheehan, J. (2000), Transfusion errors in New York State: an analysis of 10 years' experience. Transfusion, 40: 1207-1213. doi:10.1046/j.1537-29 95.2000.40101207.x
2. Turner, C. , Casbard, A. and Murphy, M. (2003), Barcode technology: its role in increasing the safety of blood transfusion. Transfusion, 43: 1200-1209. doi:10.1046/j.1537 -2995.2003.00428.x
3. Askeland, R. , McGrane, S. , Levitt, J. , Dane, S. , Greene, D. , VandeBerg, J. , Walker, K. , Porcella, A. , Herwaldt, L. , Carmen, L. and Kemp, J. (2008), Improving transfusion safety: implementation of a comprehensive computerized bar code–based tracking system for detecting and preventing errors. Transfusion, 48: 1308-1317. doi:10.1111/j.1537 -2995.2008.01668.x
4. Standards for Blood Banks and Transfusion Services. 31st ed. Bethesda, MD: AABB, 2018.
Submitted by Caroline Wright