 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

 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

 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

 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

 National audits consistently show % 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

Integrating available information and guidelines into patient blood management

Lab Results? Allergies? Age? Weight? Special Requirements? Guidelines? Co-Morbidities? Transfusion Indication? Transfusion ? Appropriate

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

 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

‘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’

 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

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

 Unnecessary transfusion  Over transfusion  Requesting supported with simple guidance  Hyperlinks  ‘Smart guidance’ with integration

‘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.’

 Non compliance with guidelines  Duplication  Dose  Specification  Duplicate prescription  Over transfusion  Incorrect patient  Incorrect results  Human error

Red cell alert - Order cancelation Courtesy of Mark Yazer, UPMC Pittsburgh 10% Cancelled 90% Continued

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

Specialty A Specialty B Specialty C Specialty D Specialty E Specialty F Specialty G Specialty H Specialty I  Accurate data on blood use  Understanding practice  Targeted intervention

 Optimising safety – Enhanced integration  Facilitating data extraction – Uniform coding  Ensuring patient involvement  Clinician experience  End-to-end IT support

Robust Patient Identification Safe Blood Issue Enhanced Bedside Checking Relevant & Digestible Informatics Decision Support

 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

 Planning  Implementation  Testing  Development