A review of electronic medical records and safe transfusion practice for guideline development

How to improve blood transfusion safety through information technology and practices

BACKGROUND/OBJECTIVES

The essence of safe blood transfusion is providing the right blood to the right patient at the right time. To improve transfusion safety, we implemented a suite of information technologies across the entire process to standardize clinical practices.

METHODS

Our approaches include automatic warnings in storage management, regulatory restrictions and adaptive alerts in transfusion request, cross-checking in blood issuance, barcode matching for patient identification, personal digital assistants tracking throughout transfusion processes, spontaneous reminders for adverse actions, information sharing for individualized transfusion, and system overrides for special situations. The system generated data were analyzed using Excel.

RESULTS

Data from 2019 to 2024 indicate a waste rate of 1.0 %. The average turnaround time for blood issuance ranged from 71.4 to 173.5 min. The percentage of transfusions starting beyond 30 min and completing beyond 4 h fluctuated over the six-year period. For red blood cells, these percentages gradually decreased to 2.8 % and 0.7 %, respectively. The overall transfusion reaction rate per 100,000 units was 746.9. A total of 1165 red cell requests exceeded the threshold, with 119 lacking reasonable justification. Additionally, two near-miss events are presented.

CONCLUSION

Integrating regulatory limitations and reminders into a transfusion knowledge base prevents knowledge errors. Technical identification and alert systems are effective in reducing slip errors. Information technology enhances transfusion safety by improving adherence to transfusion guidelines and minimizing avoidable operational errors.

Red Blood Cell Transfusion in Critically Ill Adults: An American College of Chest Physicians Clinical Practice Guideline

BACKGROUND

Blood products frequently are administered to critically ill patients. Considering recent trials and practice variability, a comprehensive review of current evidence was deemed essential to offer pertinent guidance to critical care practitioners. This American College of Chest Physicians (CHEST) guidelines panel examined the literature on RBC transfusions among critically ill patients overall and specific subgroups, including patients with gastrointestinal bleeding, acute coronary syndrome (ACS), cardiac surgery, isolated troponin elevation, and septic shock, to provide evidence-based recommendations.

STUDY DESIGN AND METHODS

A panel of experts developed six Population, Intervention, Comparator, and Outcome questions addressing RBC transfusions in critically ill patients and performed a comprehensive evidence review. The panel applied the Grading of Recommendations, Assessment, Development, and Evaluations approach to assess the certainty of evidence and to formulate and grade recommendations. A modified Delphi technique was used to reach consensus on the recommendations.

RESULTS

The initial search identified a total of 3,082 studies, and after the initial screening, 38 articles were reviewed. Among them, 23 studies met inclusion criteria, comprising 22 randomized controlled trials and one cohort study. Based on the analysis of these studies, the panel formulated two strong and four conditional recommendations. The overall quality of evidence for recommendations ranged from very low to moderate.

CONCLUSIONS

In most critically ill patients, a restrictive strategy was preferable to a permissive approach because it does not increase the risk of death or complications, but does decrease RBC use significantly. Data from critically ill subpopulations also supported a restrictive approach, except in patients with ACS, for whom favoring a restrictive approach could increase adverse outcomes.

Costs and consequences of over-investigation of minor transfusion reactions

BACKGROUND

Adverse transfusion events create a direct cost burden on the healthcare system through increased morbidity, mortality, extra investigations for diagnosis, patient treatment and increased use of hospital resources. Understanding the costs and impact minor transfusion reactions have on the healthcare system presents an opportunity for potential cost savings and improved clinical practice.

AIMS

To determine the cost associated with investigating minor transfusion reactions, to identify opportunities to improve the management of blood transfusion reactions and potential cost savings through the application of current national guidelines.

METHODS

A retrospective review of all suspected transfusion reactions reported to the laboratory over a 6-year period was performed. Reports were assessed for appropriateness of clinical management and associated investigations. Cost of inappropriate investigations and associated blood product discard was calculated using current national tariffs.

RESULTS

Of the 274 reports, febrile non-haemolytic transfusion reactions were the most common reactions, with 96 (35%) cases. One hundred forty-eight patients were unnecessarily investigated for suspected transfusion reactions totalling AU$ 32 427.00. The initial total value of partially discarded blood products was AU$ 55 656.00.

CONCLUSION

The study demonstrated that unnecessary investigation of minor transfusion reactions adds a significant financial burden to the healthcare system.