Background/Case Studies: Minimizing blood product wastage is critical in caring for patients requiring blood transfusion. Electronic medical records (EMR), with transfusion guidelines and indications, have been associated with improvements in transfusion practice. This study investigates whether an association exists between the method of ordering blood products (electronic or verbal) and blood product wastage.
Study
Design/Methods: This retrospective, cross-sectional study evaluated blood transfusion and wastage reports from general workload data of 3 sites in a large hospital system, generated during normal Transfusion Service operations between September 01, 2022, and February 28, 2023. All clinical sites use the same hospital-wide EMR and transfusion service LIS. Two sites allow both electronic and verbal blood product orders, while one site only allows electronic orders for non-emergent transfusion orders. A sample size of 3000 transfusion orders (electronic and verbal orders) was reviewed. Data were analyzed using SPSS Statistics version 28.
Results/Findings: Analysis of Transfusion Summary and Wastage data showed statistical differences in the mean percent transfused (%T) and percent discarded (%D) between the electronic and verbal order groups for the RBC, platelet, and combined sample orders. See Table 1. The ordering method showed a moderate to large effect on the transfusion and wastage outcomes. Wastage data analysis exhibited a large effect size for platelet orders (Cohen’s d Point Estimate -1.300) and a moderate effect size for RBC (Cohen’s d -0.451) and the combined orders (Cohen’s d -0.518), with a greater proportion of wasted blood products arising from verbal orders.Of note, all wasted platelets were verbally ordered. For this study, the mean %T and %D were different for verbal and electronic orders (p< .001), with electronic orders associated with less wastage and higher usage rates compared with the verbal ordering method. Conclusions: Transfusion indications guide provider’s ordering practices through the EMR. This study showed a significant difference in the percent of blood products transfused and percent of blood products discarded between electronic and verbal orders. Electronic ordering methods were associated with decreased wastage and better utilization compared to verbal orders. Lack of EMR guidance at the point of order could lead to excessive blood orders which may translate to blood product wastage.
