Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States of America.
Division of Hospital Medicine, Children's Healthcare of Atlanta, Atlanta, GA, United States of America.
Blood Transfus. 2023 Jan;21(1):3-12. doi: 10.2450/2022.0309-21. Epub 2022 May 10.
Children are at increased risk from transfusion-related medical errors. Clinical decision support (CDS) can enhance pediatric providers' decision-making regarding transfusion practices including indications, volume, rate, and special processing instructions. Our objective was to use CDS in a pediatric health system to reduce:blood product-related safety events from ordering errors;special processing ordering errors for patients with T-cell dysfunction, sickle cell disease (SCD), or thalassemia;transfusions administered faster than 5 mL/kg/h.
In this single-center before and after quality improvement study, we evaluated how user-centered design of pediatric blood product orders influenced pediatric transfusion practices and outcomes. Safety events were identified through active and passive surveillance. Other clinically relevant outcomes were identified through electronic health record queries.
Blood product-related safety events from ordering errors did not change significantly from the baseline period (6 events, 0.4 per month, from 1/1/2018-3/27/2019) to the intervention period (1 event, 0.1 per month, from 3/28/2019-12/31/2019; rate ratio: 0.27 [0.01-2.25]). Packed red blood cell (PRBC) and platelet orders for patients with T-cell dysfunction that did not specify irradiation decreased significantly from 488/12,359 (3.9%) to 204/6,711 (3.0%, risk ratio: 0.77 [0.66-0.90]). PRBC orders for patients with SCD or thalassemia that did not specify phenotypically similar units fell from 386/2,876 (13.4%) to 57/1,755 (3.2%, risk ratio: 0.24 [0.18-0.32]). Transfusions administered faster than 5 mL/kg/h decreased from 4,112/14,641 (28.1%) to 2,125/9,263 (22.9%, risk ratio: 0.82 [0.78-0.85]).
User-centered design of CDS for pediatric blood product orders significantly reduced special processing ordering errors and inappropriate transfusion rates. Larger studies are needed to evaluate the impact on safety events.
儿童在输血相关医疗错误方面的风险增加。临床决策支持（CDS）可以增强儿科医务人员在输血实践方面的决策能力，包括适应证、容量、速度和特殊处理说明。我们的目标是在儿科医疗系统中使用 CDS 减少：因医嘱错误导致的与血液制品相关的安全事件；T 细胞功能障碍、镰状细胞病（SCD）或地中海贫血患者的特殊处理医嘱错误；输血速度超过 5mL/kg/h。
在这项单中心的前后质量改进研究中，我们评估了以患儿为中心的血液制品医嘱设计如何影响儿科输血实践和结果。通过主动和被动监测来识别安全事件。通过电子健康记录查询来识别其他临床相关结果。
从医嘱错误引起的与血液制品相关的安全事件在基线期（6 起事件，0.4 起/月，1/1/2018-3/27/2019）和干预期（1 起事件，0.1 起/月，3/28/2019-12/31/2019）均无显著变化；速率比为 0.27（0.01-2.25）。T 细胞功能障碍患儿的浓缩红细胞（PRBC）和血小板医嘱未注明照射的比例从 488/12359（3.9%）显著下降至 204/6711（3.0%），风险比为 0.77（0.66-0.90）。SCD 或地中海贫血患儿的 PRBC 医嘱未注明表型相似单位的比例从 386/2876（13.4%）下降至 57/1755（3.2%），风险比为 0.24（0.18-0.32）。输血速度超过 5mL/kg/h 的比例从 4112/14641（28.1%）下降至 2125/9263（22.9%），风险比为 0.82（0.78-0.85）。
以患儿为中心的 CDS 设计用于儿科血液制品医嘱显著减少了特殊处理医嘱错误和不适当的输血率。需要更大规模的研究来评估对安全事件的影响。
