(P-TS-40) Electronic Monitoring and Real-Time Corrective Actions for Optimizing Transfusion Practices at an AABB-Accredited Hospital in a Low-Income Country

Ensuring adherence to transfusion protocols by the clinical teams after the blood unit is released from the blood bank is a universal challenge, which seems insurmountable in a sub-optimal human resource environment, in low and middle-income countries. Deviations from established guidelines can result in transfusion errors or adverse outcomes. Thus, finding cost-effective, innovative solutions is crucial to ensure the safety of blood transfusions.

Study

Design/Methods:

The study was conducted at the Indus Hospital and Health Network, Karachi, Pakistan, from January 19 to May 2, 2024. A bedside electronic transfusion software with real-time prompts was introduced and baseline data was audited to evaluate critical control points in the transfusion process from January 19 to February 2, including receipt of blood units in the wards within 15 minutes of issuance, initiation of transfusions within 30 minutes of issuance, completion of transfusions within 4 hours of initiation and transfusion to “wrong” patients.  To address non-compliances, real-time email alerts to all nursing and blood bank staff were programmed and deployed on March 3. There was no intervention in response to the email alerts from March 4 to 18. Weekly follow-ups were initiated between the upper management of the blood bank and nursing from March 19 to April 2. The frequency of these follow-ups was increased to daily random from April 3 to 17. The strategy was adjusted to real-time follow-ups between on-duty blood bank and nursing staff in the wards upon receiving email alerts from April 18 to May 2.

Results/Findings: As depicted in Figure A, the baseline audit identified several issues with 56% delays on receipt, 41% delays in initiation, 2% delays in completion, and 0.1% wrong transfusions. Subsequent phases involved varying levels of follow-up, leading to no change in key metrics. In the final intervention involving real-time follow-up by blood bank staff with ward nurses, delayed receiving dropped to 23%, delayed initiation to 25%, delayed completion to 4%, and wrong transfusions to 0.7%. As this intervention progressed, email alerts significantly dropped to 1%, with no delays in receiving, initiation, or completion, while wrong transfusions were 0.5%. The blood utilization review committee (BURC) meeting integrated the real-time follow-up responsibilities into the job description of blood bank for ongoing CAPA.

Conclusions: Information technology plays a key role in identifying human errors in real-time, enabling timely implementation of CAPA, which is most effective at the grassroots level; and facilitating the availability of data for clinical audits. BURC remains a pivotal entity in fostering systematic improvements. These elements form a comprehensive approach to enhancing transfusion safety.