JMIR Publications

ABSTRACT

Background:

Repeated blood product ordering is associated with order entry errors and potential patient harm. Traditional electronic health record (EHR) order sets require repeated re-entry for recurrent transfusions, creating inefficiencies, opportunities for error and contribute to physician burn out. We have historically used order sets to order blood products, which must be re-entered each time a transfusion is needed. Reusable transfusion therapy plans may address these challenges by standardizing and streamlining transfusion workflows. We conducted a pre/post study at a single pediatric academic center evaluating the implementation of reusable transfusion therapy plans for packed red blood cells (pRBCs) and platelets in oncology and hematopoietic stem cell transplant patients.

Objective:

The primary outcome was to evaluate the proportion of transfusions originating from the transfusion therapy plans during the post-implementation period. Secondary outcomes included evaluating (1) the proportion of eligible patients with applied transfusion therapy plans, (2) changes in transfusion efficiency (time from laboratory result to transfusion release and administration, pre-medication timing, and estimated overnight pages), and (3) impact on safety (guideline-concordant dosing, irradiated product ordering, and transfusion thresholds). We also assessed healthcare practitioner experience using an adaptation of the Technology Acceptance Model (TAM) survey.

Methods:

The pre-study period consisted of the 1 year pre-implementation, and the post-period consisted of the 1 year post implementation. We used our institutions enterprise data warehouse (SEDAR) to obtain demographic and transfusion details for all eligible patients. The adapted TAM survey was administered to eligible oncology clinicians.

Results:

The pre-implementation cohort had 558 unique patients who received a total of 2678 transfusions. The post-implementation cohort had 521 unique patients who received 2777 transfusions. During the post-implementation period, 59% of transfusion orders originated from a therapy plan, increasing to 71% in the final month. Compared with order sets, therapy plan–derived transfusions were released and administered significantly faster following laboratory results (p<.001). Guideline-concordant transfusion volumes increased significantly post-implementation for both packed red blood cells and platelets (p<.0001), as did ordering of irradiated blood products (p<.001). No differences were observed in pre-transfusion hemoglobin or platelet thresholds between study periods. Use of therapy plans was associated with an average avoidance of four overnight blood product entries per night. Survey responses from nurses and providers demonstrated high perceived usefulness and ease of use, with 95% endorsing continued use.

Conclusions:

Reusable transfusion therapy plans improved efficiency, standardized safe ordering practices, and were highly acceptable to clinicians. This longitudinal, non-interruptive EHR intervention represents a scalable approach to supporting high-risk transfusion workflows in pediatric oncology.