Yerrabothala Swaroopa, Desrosiers Kevin P, Szczepiorkowski Zbigniew M, Dunbar Nancy M
Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
Transfusion. 2014 Oct;54(10 Pt 2):2640-5. doi: 10.1111/trf.12627. Epub 2014 Mar 27.
Our hospital transfusion policy was recently revised to recommend single-unit red blood cell transfusion (RBC TXN) for nonbleeding inpatients when the hemoglobin (Hb) level is not more than 7 g/dL. Our computerized provider order entry system was reconfigured to provide real-time decision support using prospective computerized order auditing based on the most recent Hb level and to remove the single-click ordering option for 2-unit RBC TXNs to enhance compliance. This study was undertaken to assess the impact of these changes on hospital transfusion practice.
This study analyzed the total number of transfusion events, proportion of single and 2-unit transfusions and the Hb transfusion trigger in the preimplementation period (October 2011-March 2012) compared to the postimplementation period (October 2012-March 2013).
In the postimplementation period the total number of RBC units transfused/1000 patient-days decreased from 60.8 to 44.2 (p < 0.0001). The proportion of 2-unit TXNs decreased from 47% to 15% (p < 0.0001). We also observed significant decreases in pretransfusion Hb triggers.
Implementation of restrictive transfusion policy supported by prospective computerized order auditing has resulted in significantly decreased RBC utilization at our institution.
我院输血政策最近进行了修订，建议对于非出血性住院患者，当血红蛋白（Hb）水平不超过7g/dL时采用单单位红细胞输注（RBC TXN）。我们重新配置了计算机化医嘱录入系统，以基于最新的Hb水平通过前瞻性计算机医嘱审核提供实时决策支持，并取消了2单位RBC TXN的一键下单选项，以提高依从性。本研究旨在评估这些变化对医院输血实践的影响。
本研究分析了实施前阶段（2011年10月至2012年3月）与实施后阶段（2012年10月至2013年3月）的输血事件总数、单单位和2单位输血的比例以及Hb输血触发点。
在实施后阶段，每1000患者日输注的RBC单位总数从60.8降至44.2（p＜0.0001）。2单位TXN的比例从47%降至15%（p＜0.0001）。我们还观察到输血前Hb触发点显著降低。
在前瞻性计算机医嘱审核支持下实施限制性输血政策，已使我院的RBC利用率显著降低。
