Watson Paul, Watson Denise, Dhesi Amanpreet, New Helen V, Davidson Anne, Armstrong Richard, Birchall Janet
Department of Anaesthesia, Southmead Hospital, North Bristol NHS Trust, Bristol, UK.
Education Team, NHS Blood and Transplant, Bristol, UK.
Transfus Med. 2020 Dec;30(6):485-491. doi: 10.1111/tme.12736. Epub 2020 Nov 12.
To assess the effect of an app providing national blood transfusion guidelines on prescribing decisions.
National, regional and local audits in England consistently show inappropriate use of all blood components; around 15%-20% of red blood cells (RBC) and 20%-30% of platelets and fresh frozen plasma (FFP). Hospital transfusion guidelines may be difficult to locate and not agree with national guidelines. We developed and tested a dedicated app providing national evidence-based guidelines for use at the point of care to help clinicians make better decisions when authorising blood.
METHODS/MATERIALS: We identified areas of blood authorisation with high frequency of component use and evidence of widespread unnecessary authorisation. We developed seven representative clinical scenarios where the transfusion of blood components may or may not benefit the adult patient. Responding doctors were invited to select their authorisation choice via an online questionnaire, initially without and then with access to the app. Adherence to guidelines was assessed with and without aid of the app.
Using the app, doctors were much more likely to select the correct decision, in accordance with national guidance. Compared with baseline measurements, decisions improved by 67% for RBC, 58% for platelets and 73% for FFP. These improvements were statistically significant.
Apps such as "Blood Components" can help doctors do "the right thing rather than the wrong thing". Further studies are required to assess the impact of using the app in clinical practice and the effect on blood component management and financial savings.
评估一款提供国家输血指南的应用程序对处方决策的影响。
英格兰的国家、地区和地方审计一直显示，所有血液成分都存在使用不当的情况；约15%-20%的红细胞（RBC）以及20%-30%的血小板和新鲜冰冻血浆（FFP）。医院输血指南可能难以查找且与国家指南不一致。我们开发并测试了一款专门的应用程序，该程序提供基于国家证据的指南，以便在护理点使用，帮助临床医生在授权输血时做出更好的决策。
方法/材料：我们确定了血液授权中成分使用频率高且存在广泛不必要授权证据的领域。我们制定了七个具有代表性的临床场景，在这些场景中，输血成分可能对成年患者有益，也可能无益。受邀回复的医生通过在线问卷选择他们的授权选择，最初不使用应用程序，然后可以使用该应用程序。在有或没有应用程序帮助的情况下评估对指南的遵守情况。
使用该应用程序时，医生更有可能根据国家指南做出正确的决策。与基线测量相比，红细胞的决策改善了67%，血小板的决策改善了58%，新鲜冰冻血浆的决策改善了73%。这些改善具有统计学意义。
诸如“血液成分”之类的应用程序可以帮助医生“做正确的事而非错误的事”。需要进一步研究来评估在临床实践中使用该应用程序的影响以及对血液成分管理和节省资金的效果。
