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Introduction

Decision Support for Blood Transfusion Appropriate Blood Use Dr Richard Gregg & Prof. Mike Murphy Oxford University Hospitals and NHS Blood & Transplant. Introduction. Is blood transfusion an important issue? Is current transfusion practice adequate? How can decision support software help?

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Introduction

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Presentation Transcript

  1. Decision Support for Blood TransfusionAppropriate Blood Use Dr Richard Gregg & Prof. Mike Murphy Oxford University Hospitals and NHS Blood & Transplant

  2. Introduction • Is blood transfusion an important issue? • Is current transfusion practice adequate? • How can decision support software help? • Do the results support the concept? • Future prospects • Conclusions, questions and thoughts on supporting clinical teams during implementation

  3. Do Blood Components Matter? • Common • 1.8 million red cell units used in England each year • 250,000 platelet units used in England each year • Risky • 10 deaths per year in UK • 30-50% of deaths are due to human error

  4. Do Blood Components Matter? • Expensive • Highly refined and extensively tested • Over £260 million pounds per year in England • Limited resource • Less than 4% of UK population are donors • Shortages remain a real issue

  5. The consequence.... Transfusion is Politically Sensitive

  6. Transfusion Practice Two Decades Ago • SANGUIS 1993 ‘Large variation in prescribing practice’ • DOH ‘Better Blood Transfusion’ • Hospital transfusion teams and committees • Blood transfusion policies and procedures • Education, training & continuing professional development • Audit

  7. Where are we now? • National audits consistently show 20-30% inappropriate • Safety of hospital transfusion still an issue • Poor education and training • Limited use of IT for blood safety and informatics • Lack of patient involvement

  8. How Do We Move Forward..? Integrating available information and guidelines into patient blood management

  9. Integration – Simple? Lab Results? Allergies? Transfusion Indication? Weight? Transfusion ? Appropriate Age? Co-Morbidities? Special Requirements? Guidelines?

  10. Integration – Simpler Transfusion Indication? Age? Co-Morbidities? Appropriate Transfusion Weight? Integration and Decision Support Lab Results? Allergies? Special Requirements? Guidelines?

  11. How can electronic decision support help? • Prospectively • Improved clinician awareness • Integrate important data • Present data within a guidance framework • Alert user about errors • Retrospectively • Allow access to usage data • Individual • Departmental • Procedural

  12. ‘An elderly man with anaemia attended the outpatient department for monthly blood transfusion. His haemoglobin was eventually found to be dangerously high….. The consultant had signed a prescription on eight separate occasion without any blood tests’

  13. Improving awareness Inappropriate and Unnecessary Transfusion • Important results clearly displayed at the point of request • Alerts for absent results • Alerts for ‘out-dated’ results • Hb result belongs to another patient • Hb transcription error • Substitution of WCC for Hb

  14. ‘14.5% of patients could have been managed differently if advice had been sought from a haematologist’

  15. Guidance • Unnecessary transfusion • Over transfusion • Requesting supported with simple guidance • Hyperlinks • ‘Smart guidance’ with integration

  16. ‘A doctor went to the ward to see a new patient. He asked for the patient by name and was taken to the room of a patient with a similar first name. After seeing the patient he prescribed a unit of platelets to be given to the patient because he thought her platelet count was low….. Later they realised that the patient in the next room was the patient with a low platelet level.’

  17. Alerts • Non compliance with guidelines • Duplication • Dose • Specification • Duplicate prescription • Over transfusion • Incorrect patient • Incorrect results • Human error

  18. Evidence of Effect - RCC 10% Cancelled 90% Continued Red cell alert - Order cancelation Courtesy of Mark Yazer, UPMC Pittsburgh

  19. Evidence of Effect - FFP 20% Cancelled 80% Continued FFP alert - Order cancelation Courtesy of Mark Yazer, UPMC Pittsburgh

  20. Informatics - Changing Practice • Accurate data on blood use • Understanding practice • Targeted intervention Specialty A Specialty B Specialty C Specialty D Specialty E Specialty F Specialty G Specialty H Specialty I

  21. Where next? • Optimising safety – Enhanced integration • Facilitating data extraction – Uniform coding • Ensuring patient involvement • Clinician experience • End-to-end IT support

  22. True ‘End-to-End’ IT support

  23. Conclusions & Questions • Transfusion safety is a key priority • Current practice leaves significant room for improvement • Carefully designed decision support software can help clinicians choose the path of least resistance

  24. Hints to help clinicians! • Planning • Implementation • Testing • Development

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