NYC H+H/Bellevue & NYU Grossman School of Medicine New York, New York, United States
Background/Case Studies: Compliance with timely and complete documentation (D) even using an electronic medical record (EMR) is challenging.Reliance on paper transfusion (TX) administration D continued. Despite implementing Epic BPAM and OpTime as the primary methods of TX D, our hospital system struggled with entry of baseline vital signs (BVS), 15-minute vital signs (15VS), end vital signs (EndVS), TX reaction (TXRN), volume, and end time.At EMR go-live, reports were built to track D compliance and to enable real time corrective action to be taken by entering the missing information. Users were given +/-5 minutes grace period on the vital sign entry timing. Entries >+/-5 minutes were considered noncompliant. In an effort to improve compliance we developed a comprehensive transfusion administration guideline outlining all the entire process including EMR screen shots upon which facility SOP were to be modeled, created online D training modules, built EMR reminder tasks to nursing worklists, and assembled a dashboard tracking progress.Our goal was to achieve a high level of compliance with EMR D enabling paper to be discontinued. We sought to assess the effectiveness of our interventions.
Study
Design/Methods: We compared electronic TX D compliance rates from July to December 2021 (pre-intervention) to those in September 2023 to February 2024 (post-intervention). Statistical analysis was performed using the Student’s T-test.
Results/Findings: From 7/21 to 12/21 21443 RBCs, 5014 plasmas, 2776 single donor platelets (SDPs), and 659 pools of CRYO were transfused, and EMR D was attempted for 20138 units. From 9/23 to 2/24 21527 RBCs, 4646 plasmas, 3083 SDPs, and 491 pools of CRYO were transfused and EMR D was attempted for 21462 units. Compliance with all elements improved from 24.2% in the pre-intervention period to 64.5% post-intervention (p-value < 0.0000025). Table 1 shows the compliance percentages for specifically required TX D. Post-intervention compliance with individual elements now ranges from 81% for TXRN to 98.7% for BVS. Conclusions: Although the EMR, as built, cannot require the user to enter all required fields, high rates of compliance with necessary documentation can be achieved via 1) training to a well written policy, 2) building of EMR reminder tasks to prompt entry of required D, and 3) accountability for assuring D is entered timely.Paper TX administration records need only be completed when it is not possible to document a transfusion using the EMR.
