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" .
The authors of this article understand the major role that 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 was used during the time when the order entry is being written. This article focuses on the effects of CPOE in reducing Red Blood Cells (RBC) and plasma orders that did not meet the criteria for institutional transfusion.
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 RBCtransfusion and an international normalized ratio / (INR) greater than or equal to 1.6 in 24 hours before the order is written. While writing for the 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 RBC orders and a 10 month period for the plasma orders.
The study was able to establish that alerts from 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 RBC orders and 19.6% of plasma orders after an alert was triggered.
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.
- 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.