(P-QU-7) Evaluating the Impact of Electronic Documentation Integration on Transfusion Documentation Compliance

Background/Case Studies: At our institution, paper transfusion tags (PTT) were used to document blood product transfusions. This dated process hindered workflow, duplicated documentation, and increased opportunities for human error. In an effort to enhance our transfusion workflow and mitigate these opportunities for error, an electronic documentation system (EDS) process was implemented to replace the previous, paper-based process.

Study

Design/Methods: This retrospective review analyzed data from a previous 12-month audit related to the completion of PTT. Completion was defined as providing information for all required items, including initials from the transfusionist and qualified second verifier (QSV) for the pre-transfusion verification, documentation of vital signs at the appropriate intervals (pre-transfusion, 15 minutes after initiation, and post-transfusion), administration site, and the transfusion completion details. The review consisted of selecting 30 random PTT weekly with a goal of 93% completion compliance. The 30 PTT included review of 20 PTT for red blood cells (RBC), 5 for platelets (plts), and 5 for plasma (FFP) transfusions. Once compliance of 93% was maintained for three weeks, audits were deescalated to monthly, and then quarterly based on continued compliance. Due to the number of required items, the risk for human error, and potential harm, the institution opted to explore and implement the use of an EDS to improve the process and decrease the opportunity for error. Once implemented, education was provided to the teams who transfuse products or serve as a QSV. After implementation, transfusion documentation was reviewed to ensure compliance with the required documentation.

Results/Findings: 1,140 PTT were audited (756 RBCs, 193 plts, and 191 FFP). 122 (11% overall; 75 RBCs, 20 plts, 28 FFP) PTT were found to be incomplete. After implementation of the EDS, audits were completed to ensure compliance. 600 transfusions using the EDS were audited (400 RBCs, 100 plts, and 100 FFP). 28 (5%) of electronically documented transfusions were incomplete. Following the implementation of the electronic documentation, incomplete transfusion documentation decreased by 60% and the information is readily available for the care team in the electronic medical record.

Conclusions: As a result, the auditing process for completion was deescalated based on maintaining the previously set goal. The implementation of the EDS improved transfusion workflow efficiency, strengthened regulatory documentation compliance, and most importantly, reduced the risk of patient harm from transfusion errors by introducing an additional layer of electronic verification to our already existing verification process.