Great Ideas

Shanaz Sohal and Jo Murfett

The latest feature from NHS Connecting for Health looks at the Automatic Identification and Data Capture programme, and, in particular, at Mayday Healthcare NHS Trust’s blood tracking pilot. Shanaz Sohal, the pilot’s project manager, and blood transfusion nurse specialist Jo Murfett outline its progress.

One hundred and thirty hospitals are now signed up to the Automatic Identification and Data Capture programme that is being run by NHS Connecting for Health – and 175 will have joined by the end of the year.

The programme which is being run in conjunction with the standards organisation GS1, the National Patient Safety Agency and the NHS Purchasing and Supply Agency, is encouraging the NHS to adopt auto-identification technologies to improve patient safety and cut costs.

It follows the Department of Health report, Coding for Success, which advocated the use of smart wristbands – equipped with barcodes or radio frequency identification tags and using GS1’s global numbering system – to identify patients and products in healthcare settings.

AIDC technologies can help to accurately identify patients, match them to the right blood, drugs and other treatments and track medicines, instruments and other assets from purchase to use – cutting errors and avoiding losses and waste.

Right patient, right blood

Mayday Healthcare NHS Trust has been working within the programme on a blood safety tracking pilot. It is testing the Electronic Clinical Transfusion Management System IT specification, developed by the NPSA, the National Blood Transfusion Service, and Serious Hazards of Transfusion.

Research by SHOT found that between 1996 and 2004, five patients died as a direct result of being given incompatible blood. ABO incompatibility contributed to the deaths of another nine patients and caused major illness in a further 54.

ECTMS provides guidance that is intended to prevent such deaths and injuries by making sure that patients receive blood that is cross-matched for them. At the Mayday, blood bags are being tracked using active RFID technology, and patients have been issued with wristbands holding passive RFID chips that can be read by staff using hand-held readers.

The readers complement other checks and make sure that the right patient gets the right blood. They can also generate printed labels with patient details on them for blood sample tubes, which reduces the risk of these being incorrectly labeled.

The Mayday pilot has received £350,000 worth of funding from CfH. It is being run principally in the Jubilee and London Wing wards and the main theatres. Blood transfusion nurse specialist Jo Murfett was involved in preparation work, while project manager Shanaz Sohal joined a month after the formal start in July 2007.

Mayday: challenges and progress

Sohal explains how both old and new technology have to work together in the pilot. “The trust already had a partial wireless network in place, and aims to expand on this,” he says. “Wireless technology is costly and the trust is investigating the potential for multiple applications, for example improving patient and staff security.

“The trust is using its existing order communications system to request blood and blood products. But the pilot will explore the potential of decision support and electronic prescribing. Active RFID technology is being used to track the journey of the blood bags. Passive RFID technology is being used in the patient wristbands.”

She adds that other challenges have included: addressing existing patient identification issues, implementing major changes to existing processes and staff practices, introducing new and unfamiliar technology and training.

“Ward staff will need to use the electronic blood tracking system [and] some are wary of the new technology to be used for patient identification, blood sampling and for the setting up of blood transfusions,” she says, pointing out that some nurses are unlikely to use computers on a daily basis.

However, Murfett says: “We anticipate that it will be relatively straightforward for the nursing staff. There will be lots of ‘prompts’ as they learn and they appreciate that it is all about creating a safer clinical environment for patients and greatly reducing the risks to staff of making any mistakes.”

She still spends one day a week in the Haematology day unit, carrying out blood transfusions and other therapies. “I find this gives me an opportunity to find out for myself what the nurses are finding challenging or helpful about the systems being used – or, indeed, about anything else we plan to bring in,” she says.

Murfett is particularly interested in the blood bag tracking: “We clearly need to find any bags that may not have been accounted for and we need to know the destination of every single blood product issued,” she says. “A lot of blood is needed in emergency or trauma cases and we need to be able to account for every drop in a situation that is high pressure and fast-moving.

“Active RFID tags ensure that we find every individual bag, used or unused, after the event. We will be using this in intensive care, the high dependency unit, haematology day care, main theatres, coronary care, and Queens Wards 1 and 2 which treat patients who need orthopaedic surgery. ”

Other areas of work

CfH is planning to disseminate lessons learned from Mayday to the NHS. Meanwhile, the AIDC programme is focusing on three areas of working: patient identification, pharmaceuticals and decontamination.

Hospitals are using standardised, technology-supported wristbands to match patients to medications and surgery sites as well as blood products; and RFID tags are being attached to pharmaceuticals to consistently identify drugs and dosages. RFID tags are also being embedded in instruments to check they have been decontaminated before use.

The agencies involved say: “the ultimate vision is to enable the deployment of RFID or bar-coding systems across all hospitals, pharmacies, clinics and healthcare centres. Although it may be a major investment for some, it is a way of making the NHS experience cleaner, safer and more effective and of enabling long-term cost savings.”

Link

NHS Connecting for Health’s Auto Identification and Data Capture programme