Implementation and Effectiveness of a Bar Code-Based Transfusion Management System for Transfusion Safety in a Tertiary Hospital: Retrospective Quality Improvement Study

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.

Adverse events associated with home blood transfusion: A retrospective cohort study

AIMS AND OBJECTIVES

To determine the rate of individual and system adverse events associated with blood transfusion at home.

BACKGROUND

Home or residential care facility based blood transfusion is beneficial for individuals requiring transfusion due to reduced disruption to daily life and the comfort of a familiar environment. However, blood transfusion may result in serious adverse events. There is a lack of research in this area, and there is a need to identify rates of adverse events and evaluate the system used for this service.

DESIGN

Retrospective cohort study.

METHODS

Existing data routinely collected for clinical care were used to determine client and system adverse events of medically stable adults with a chronic disease who underwent blood transfusion in a home setting provided by a nurse-led service. A STROBE EQUATOR checklist was used for this study (see Appendix S1).

RESULTS

There were 1790 episodes of care involving 533 participants, with 13 cases of transfusion reaction (incident rate [IR] 0.7%; 95% CI 0.43-1.25). Only five of these were severe, resulting in the cessation of the blood transfusion and further medical review or hospital admission (IR 0.28%; 95% CI 0.12-0.68). There were no cases of tampered blood packaging, expired or visually damaged blood products. There were 10 cases of incorrect paperwork (0.6%) and nine cases of incorrect temperature (0.5%). There were 153 cases of vascular access device adverse events (IR 8.5% 95% CI 7.3-9.9), most commonly, difficulty cannulating the individual (n = 82, 54%).

CONCLUSIONS

A nurse-led home blood transfusion service was associated with low rates of both individual and system adverse events. Further research is needed to explore the perception of those using this service and supports required to improve the experience.

RELEVANCE TO CLINICAL PRACTICE

Blood transfusions may be associated with increased risk of morbidity and mortality. This risk may be increased in a home setting due to the distance from an acute care facility. This study has demonstrated that a nurse-led home blood transfusion service is safe (<1% adverse event rate) for those with a medically stable, chronic condition. There were few failures in the system used to provide this service. Adverse events associated with the vascular access device were the most common complication and the reason for most blood product wastage. Mainly, this was due to difficulty inserting the short-term peripheral intravenous catheter (PIVC). RNs should consider ultrasound to aid PIVC insertion to facilitate treatment provision and enhance the experience of the individual.

Performance Evaluation of an Information Technology Intervention Regarding Charging for Inpatient Medical Materials at a Regional Teaching Hospital in Taiwan: Empirical Study

Background

The process of manually recording the consumption of medical materials can be time consuming and prone to omission owing to its detailed and complicated nature. Implementing an information system will better improve work performance.

Objective

The Information System Success Model was adopted as the theoretical foundation. The opinions of nursing staff were collected to verify the impact of the system intervention on their work performance.

Methods

This cross-sectional study was conducted at a regional teaching hospital. Nursing staff were invited to participate in the field survey. A total of 296 questionnaires were collected, and of these, 284 (95.9%) were valid and returned.

Results

The key findings showed that two critical factors (“subjective norm” and “system quality”) had significant positive effects (both P<.001) on user satisfaction (R²=0.709). The path of “service quality” to “user satisfaction” showed marginal significance (P=.08) under the 92% CI. Finally, the explanatory power of the model reached 68.9%.

Conclusions

Support from the top management, appointment of a nurse supervisor as the change agent, recruitment of seed members to establish a pioneer team, and promotion of the system through the influence of opinion leaders in small groups were critical success factors needed for implementing the system in the case hospital. The target system was proven to be able to improve work performance, and the time saved could be further used for patient care, thereby increasing the value of nursing work. The positive experiences gained from this study could lay the foundation for the further promotion of the new system, and this is for future studies to replicate. The example of the successful experience of the case hospital could also serve as a reference for other hospitals in developing countries like Taiwan with regard to the promotion of nursing informatization.