View source for Implementation of a simple electronic transfusion alert system decreases inappropriate ordering of packed red blood cells and plasma in a multi-hospital care system

The following is a review of the article, “Implementation of a simple electronic transfusion alert system decreases inappropriate ordering of packed red blood cells and plasma in a multi-hospital care system" <ref name="Smith"> Smith, M., Triulzi, D. J., Yazer, M. H., Rollins-Raval, M. A., Waters, J. H., & Raval, J. S. 
(2014).  Implementation of a simple electronic transfusion alert system decreases 
inappropriate ordering of packed red blood cells and plasma in a multi-hospital care 
system.  Transfusion and Apheresis Science, 51(3):53-58. DOI: http://dx.doi.org/10.1016/j.transci.2014.10.022. Retrieved from  http://www.ncbi.nlm.nih.gov/pubmed/25458903. 
 </ref>.


== Abstract ==
The authors of this article understand the major role that [[CPOE|Computerized Physician order Entry (CPOE)]] may have in preventing physicians and nurses from ordering blood transfusions when the patient did not meet the institutional transfusion criteria.  There are many supporting articles that have shown a decrease in ordering lab activities when a [[CPOE| CPOE]] was used during the time when the order entry is being written. This article focuses on the effects of [[CPOE| CPOE]] in reducing [http://learn.fi.edu/learn/heart/blood/red.html-RBC/ Red Blood Cells (RBC)] and plasma orders that did not meet the criteria for institutional transfusion.

==Methods==
Ten hospitals in a regional healthcare system used institutional transfusion guidelines that required the patient’s hemoglobin to be less than or equal to 8gm/dl in order to qualify for [http://learn.fi.edu/learn/heart/blood/red.html-RBC/ RBC]transfusion and an international normalized ratio [http://www.nlm.nih.gov/medlineplus/ency/article/003652.htm / (INR)] greater than or equal to 1.6 in 24 hours before the order is written.  While writing for the [http://learn.fi.edu/learn/heart/blood/red.html-RBC/ RBC] order or the plasma order, an alert would be triggered for the physician or nurse if the patient did not meet the institutional transfusion guideline.  Data was collected over a 15 month period for the [http://learn.fi.edu/learn/heart/blood/red.html-RBC/ RBC] orders and a 10 month period for the plasma orders.

== Results ==
The study was able to establish that alerts from [[CPOE|CPOE]] was able to reduce transfusion orders that were not evidence based and did not meet the institutional transfusion criteria.  Physicians and nurses cancelled 11.3% of [http://learn.fi.edu/learn/heart/blood/red.html-RBC/ RBC] orders and 19.6% of plasma orders after an alert was triggered.

== Comments ==
This article served as a good reminder that orders are sometimes written that are not evidence based.  This leads to poor quality of care for patients, wastes necessary medical resources, and create unnecessary expenses.  I think alerts that occur simultaneously when orders are written are a good thing but there needs to be a balance to the alerts because too many alerts are overwhelming and frustrating and too little alerts allow for errors to occur.

Related Read: [[Factors contributing to an increase in duplicate medication order errors after CPOE implementation |Factors contributing to an increase in duplicate medication order errors after CPOE implementation ]]

== References ==
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[[Category: Reviews]]
[[Category: CPOE]]
[[Category: nurse, physician]]