Influence of user-centered clinical decision support on pediatric blood product ordering errors

• Type of Material: Article
• Authors: Evan Orenstein, Emory University; Margo Rollins, Emory University; Jennifer Jones, Children’s Healthcare of Atlanta; Swaminathan Kandaswamy, Emory University; Jeanne Boudreaux, Emory University; Alexis Carter, Emory University; Cassandra Josephson, Emory University
• Language: English
• Date: 2023-01-01
• Publisher: Blood Transfusion (BT)
• Publication Version: Final Published Version
• Copyright Statement: © SIMTI Servizi Srl
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.2450/2022.0309-21
• Title of Journal or Parent Work: Blood transfusion = Trasfusione del sangue
• Volume: 21
• Issue: 1
• Start Page: 3
• End Page: 12
• Grant/Funding Information: EWO and SK’s participation in this work was supported in part by the National Blood Foundation Early Career Investigator Award (NBF 20-15).
• Keywords: Thalassemia; Decision Support Systems, Clinical; Blood Platelets; Blood Transfusion; Anemia, Sickle Cell; Child; Humans
• Research Categories: Health Sciences, Oncology; Health Sciences, Pathology

Abstract

BACKGROUND: Children are at increased risk from transfusion-related medical errors. Clinical decision support (CDS) can enhance pediatric providers' decision-making regarding transfusion practices including indications, volume, rate, and special processing instructions. Our objective was to use CDS in a pediatric health system to reduce:blood product-related safety events from ordering errors;special processing ordering errors for patients with T-cell dysfunction, sickle cell disease (SCD), or thalassemia;transfusions administered faster than 5 mL/kg/h. MATERIALS AND METHODS: In this single-center before and after quality improvement study, we evaluated how user-centered design of pediatric blood product orders influenced pediatric transfusion practices and outcomes. Safety events were identified through active and passive surveillance. Other clinically relevant outcomes were identified through electronic health record queries. RESULTS: Blood product-related safety events from ordering errors did not change significantly from the baseline period (6 events, 0.4 per month, from 1/1/2018-3/27/2019) to the intervention period (1 event, 0.1 per month, from 3/28/2019-12/31/2019; rate ratio: 0.27 [0.01-2.25]). Packed red blood cell (PRBC) and platelet orders for patients with T-cell dysfunction that did not specify irradiation decreased significantly from 488/12,359 (3.9%) to 204/6,711 (3.0%, risk ratio: 0.77 [0.66-0.90]). PRBC orders for patients with SCD or thalassemia that did not specify phenotypically similar units fell from 386/2,876 (13.4%) to 57/1,755 (3.2%, risk ratio: 0.24 [0.18-0.32]). Transfusions administered faster than 5 mL/kg/h decreased from 4,112/14,641 (28.1%) to 2,125/9,263 (22.9%, risk ratio: 0.82 [0.78-0.85]). DISCUSSION: User-centered design of CDS for pediatric blood product orders significantly reduced special processing ordering errors and inappropriate transfusion rates. Larger studies are needed to evaluate the impact on safety events.