Nadia Hensley: Blood Administration in the OR

Background: Manual visual and verbal pre-transfusion checks of patient identification and blood product match are vulnerable to human error. Moreover, the dynamic and complex perioperative environment is fraught with patient safety risks. Subtle breakdowns in process owing to provider multitasking, patient acuity, and more can go unnoticed and result in patient harm. An ABO-incompatible blood transfusion at our institution launched an intraoperative initiative to leverage technology to improve patient safety.

Methods: A multidisciplinary team led a four-phase implementation of bedside barcode transfusion verification (BBTV) for intraoperative blood product administration. Manual random sample audits of blood component transfusions were used to examine accuracy of documentation from July 2014 until June 2016. After we transitioned to the Epic anesthesia information management system (AIMS) in July 2016, automated Epic reports were generated to provide population-level audits.

Results: After initiation of BBTV and the addition of Epic AIMS, we improved to >96% compliance with obtaining three metrics on documentation of patient identification: two electronic signatures, start and stop times of transfusion, and blood volume transfused. Pre-Epic audits had shown a mean compliance of only 87%, mainly owing to a lack of paper blood component requisitions. Only by creating a novel process within the Epic AIMS were we able to sustain success with these metrics at >96%.

Conclusion: By implementing BBTV and using a novel intraoperative documentation process within the Epic AIMS, we were able to initiate a safer process of blood transfusion in the operating rooms and improve documentation.