The Effects of a Computerized Transfusion Decision Support System on Physician Compliance and Its Appropriateness for Fresh Frozen Plasma Use in a Medical Center

Abstract

Fresh frozen plasma (FFP) transfusion remains a significant issue for blood banks because of a lack of consensus regarding its appropriate use. To study the factors influencing physician compliance, we evaluated FFP transfusion episodes in the year 2008, using a computerized transfusion decision support system. A total of 10,926 episodes were reviewed. The demographic data, physician compliance, and therapeutic efficacy were investigated. The physician noncompliance rate was 46.5%. The highest number was ordered by the hepatobiliary division, which might be due to the high incidence of liver cirrhosis and hepatoma in Taiwan. Excluding the cases for plasma exchange and emergency surgery, 31.2% of episodes had abnormal coagulation results before transfusions. The therapeutic efficacy is statistically significant in patients with abnormal pretransfusion coagulation tests (P < .001). Computerization may be a favorable trend in medical management systems, but it should be more functional to improve medical quality.

Inappropriateness of fresh frozen plasma for abnormal coagulation tests

“…A reluctance to adhere to the guidelines has also been identified as a contributing factor to the high number of inappropriate FFP transfusions, with over 46.5% of physicians being reported as non-compliant in one study. 21,22 One interventional study reported an 80% reduction in FFP usage and reduced inpatient mortality following physician training and enforcement of preexisting FFP guidelines. 23 Such measures could be of benefit in this centre.…”

Effectiveness of a real‐time clinical decision support system for computerized physician order entry of plasma orders

“…A complementary intervention to reduce non–evidence‐based plasma transfusions is to alert the prescriber at the time of ordering that the plasma appears unnecessary or is being ordered at an incorrect dose based on the recipient's INR and body weight. Also known as clinical decision support systems (CDSSs), alerts can be created within the computerized physician order entry (CPOE) interface that will appear on the screen if a physician attempts to order plasma outside of the guidelines set by the institution 14‐16. These alerts provide evidence‐based guidance on the appropriate use of plasma at the moment that a prescriber is considering ordering the product and thus serve as an educational opportunity in and of themselves and can complement the other transfusion medicine educational activities that might also be occurring at the institution.…”

The physician compliance of red blood cell transfusion by computerized transfusion decision support system

“…Physician incompliance of RBC transfusion in our study could be defined, as the physician chose the "no" indication when ordering transfusion, and there are 3467 (16.9%) episodes performed without choosing any indication from CTDSS, moreover, 557 episodes without pretransfusion hemoglobin data when ordering in our study. As we described in the study of platelet and fresh frozen plasma usage by CTDSS [8,9], a noncompliant transfusion order does not always mean an unnecessary usage. A noncompliant episode might be a necessary transfusion if the clinical status satisfies the blood component-usage criteria, but does not pick any indication by the physician from CTDSS, when ordering.…”