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

Abstract

Background and Objectives: Electronic medical records (EMRs) are often composed of multiple interlinking systems, each serving a particular task, including transfusion ordering and administration. Transfusion may not be prioritized when developing or implementing electronic platforms. Uniform guidelines may assist information technology (IT) developers, institutions and healthcare workforces to progress with shared goals. Materials and Methods:A narrative review of current clinical guidance, benefits and risks of electronic systems for clinical transfusion practice was combined with feedback from experienced transfusion practitioners.Results: There is opportunity to improve the safety, quality and efficiency of transfusion practice, particularly through decision support and better identification procedures, by incorporating transfusion practice into EMRs. However, these benefits should not be assumed, as poorly designed processes within the electronic systems and the critically important electronic-human process interfaces may increase risk while creating the impression of safety. Conclusion:Guidelines should enable healthcare and IT industries to work constructively together so that each implementation provides assurance of safe practice.

Costs and consequences of over‐investigation of minor transfusion reactions

“…Transfusion medicine consultation should be encouraged. Decision support at the point of care may improve the appropriateness of investigations and management of adverse transfusion reactions 11 and is to be trialled within our recently installed electronic medical record system, for example, on when to target culturing of units. Finally, when considering how best to provide guidance on events during transfusion, this study highlights the need to consider a spectrum of signs and symptoms and not just those covered by current haemovigilance definitions.…”

Guidelines for the specification, implementation and management of IT systems in hospital transfusion laboratories: A British Society for Haematology Guideline

“…In all cases, the processes and controls must be clearly specified and interfaces between the electronic request system, LIMS and man- requirements are required such as irradiation. 17 Following the introduction of CDS, reports of an improvement in orders being made that follow agreed policies have been observed with continued improvement demonstrated up to 4 years from implementation. 15 There are a number of different features which should be considered when implementing an Order Comms system depending on the intended use of the system.…”

“…19 The use of electronic identification, for example patient barcoded wristbands can reduce the risk of patient identification errors however, there remain manual steps in the process and the IT system must not be used to replace existing positive patient ID verification steps. 17,18 Each sample must be uniquely identified preferably including a unique barcoded sample identification number that can be used throughout the laboratory process thus eliminating the need for any re-labelling (so-called 'run-through labelling'). If sample labels are printed by the electronic request management system, the following must apply:…”

“…CDS is an electronic solution designed to aid clinical staff when undertaking ordering. It is intended to ensure that the orders being made are appropriate for the clinical circumstances and the patient usually by comparing the haemoglobin concentration with accepted transfusion guidelines 17 . CDS can potentially improve patient safety and be used to indicate to clinical staff when special requirements are required such as irradiation 17 .…”

“…It is intended to ensure that the orders being made are appropriate for the clinical circumstances and the patient usually by comparing the haemoglobin concentration with accepted transfusion guidelines 17 . CDS can potentially improve patient safety and be used to indicate to clinical staff when special requirements are required such as irradiation 17 . Following the introduction of CDS, reports of an improvement in orders being made that follow agreed policies have been observed with continued improvement demonstrated up to 4 years from implementation 15 …”