Ian Jenkins, MD, SFHM, Jay J

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Transfusing Wisely: Clinical Decision Support Improves Blood Transfusion Practices Ian Jenkins, MD, SFHM, Jay J. Doucet, MD, Brian Clay, MD, Patricia Kopko, MD, Donald Fipps, MS, MT (ASCP), DBB, Eema Hemmen, MPH, Debra Paulson, MS Joint Commission Journal on Quality and Patient Safety Volume 43, Issue 8, Pages 389-395 (August 2017) DOI: 10.1016/j.jcjq.2017.04.003 Copyright © 2017 The Joint Commission Terms and Conditions

Figure 1 The BPA, adapted from the best practice alert developed by Goodnough et al. (Improved blood utilization using real-time clinical decision support. Transfusion. 2014;54:1358–1365), was designed to appear when the patient's last known Hb value exceeded 7 g/dL. It advises providers that they are ordering blood for a patient whose most recent Hb value is >7 g/dL and requires them to remove the orders or specify a valid reason for deviating from the 7 g/dL transfusion threshold. HGB [Hb], hemoglobin; PRBC, packed red blood cells; UCSD, University of California San Diego. Joint Commission Journal on Quality and Patient Safety 2017 43, 389-395DOI: (10.1016/j.jcjq.2017.04.003) Copyright © 2017 The Joint Commission Terms and Conditions

Figure 2 As shown in Figure 2a, the interventions were associated with reductions in multiunit transfusions by 67.1%—from 59.9% at baseline (January 1, 2014–September 30, 2014) to 41.7% during the intervention period (October 1, 2014–April 30, 2015) and 19.7% during the postintervention period (May 1, 2015–September 30, 2016) (p < 0.0001). As shown in Figure 2b, transfusions for Hb values ≥ 7 g/dL decreased by 47.4%—from 72.3% at baseline to 57.8% during the intervention period and 38.0% during the postintervention period (p < 0.0001). Hb, hemoglobin; LCL, lower control limit; UCL, upper control limit; Q, quarter. Joint Commission Journal on Quality and Patient Safety 2017 43, 389-395DOI: (10.1016/j.jcjq.2017.04.003) Copyright © 2017 The Joint Commission Terms and Conditions

Figure 3 Monthly data points are graphed, with the percentage of transfusions for Hb ≥ 7 g/dL on the x-axis and the percentage of multiunit (≥ 2 units) transfusions on the y-axis. Dramatic improvement, as evident by the shift to the left and down (arrow) from the baseline (January 1, 2014–September 30, 2014), intervention (October 1, 2014–April 30, 2015), and postintervention periods (May 1, 2015–September 30, 2016), is shown. Hb, hemoglobin. Joint Commission Journal on Quality and Patient Safety 2017 43, 389-395DOI: (10.1016/j.jcjq.2017.04.003) Copyright © 2017 The Joint Commission Terms and Conditions