John Radcliffe develops e-prescribing for blood

John Radcliffe Hospital, part of the Oxford Radcliffe Hospitals NHS Trust, is developing a new electronic prescribing system for blood products to support its transfusion processes. The aim is to improve patient safety and cut inappropriate blood prescribing.

The initiative is the latest step in the development of its electronic blood transfusion system, which uses bar codes, hand-held PCs with built-in bar code readers to improve the blood transfusion safety. The John Radcliffe is one of the first hospitals in the country to introduce an integrated blood prescribing system.

Over the past three and a half years the trust has developed the electronic blood transfusion system in partnership with Olympus osYris, a provider of medical barcode technology, to reduce errors in the blood transfusion process at the trust. The system, called BloodTrack, is now in use in the haematology department, day care unit and cardiac surgery unit, and just about to be introduced into intensive care.

The process starts when a sample of the patient’s blood is taken for cross-matching and barcodes are issued using a hand-held computer to uniquely identify the blood sample to the patient. Barcodes are then repeatedly used in a series of checks ensure to the right blood is transfused to the right patient.

Introducing the system has required a complete review of all the processes involved in blood transfusion, which involves multiple checks. Professor of blood transfusion medicine at Oxford Radcliffe hospitals, Mike Murphy, said: "We’ve looked very carefully at the hospital’s transfusion process, which is very complex and involves many staff. We’ve broken this down into a series of simpler steps and designed the software around them."

The new system which runs on a hand-held computer now means that one nurse is prompted to carry out 14 checks, where it previously required two nurses following 27 stages making paper records. "It’s safer, it’s less time consuming and we know that staff prefer it," said Prof Murphy.

As well as guiding and prompting staff through the transfusion process the BloodTrack system also generates an electronic record of all the data collected throughout the transfusion process, including how long it took, all monitoring and staff observations recorded. "Temperature, pulse and blood pressure are taken before, during and after the transfusion, and there is an option for adverse events recording," explained Professor Murphy.

Although an electronic transfusion record is generated this is not yet integrated with the hospital’s main electronic patient record system. Professor Murphy said that he hoped this would come with the development of integrated care records.

Audits carried out before and after the introduction of the new system show that it is also helping staff to deliver safer care by more closely following the complex procedures involved in transfusion. "Compliance with the correct procedures was very poor before, but since the introduction of the new system it’s been 100%," said Professor Murphy.

He added that the value of the system is that it helps eliminate the errors that the complex process of blood transfusion is prone to. Data collected by the national Serious Hazards of Transfusion (SHOT) scheme show the problems involved, such as patients getting the wrong blood. "We know that errors occur at every stage of the process," said Professor Murphy.

The next step in the development of the system will be the introduction of decision support to guide the appropriate prescribing of blood products. "We are now developing an algorithm for appropriate transfusion, this will help prescribers know when transfusion is appropriate or not," explained Professor Murphy.

"I hope we will see benefits similar to those we have already seen on patient safety in reducing inappropriate prescribing of blood, which should result in big cost savings."