(P-TS-42) Enhancing Pediatric Blood Transfusion Safety Through Weight-Based Ordering: A Comprehensive EMR Approach

In September 2023, we optimized the EMR by implementing weight-based dosing for all blood products within a comprehensive blood product order set, simplifying the process compared to the previous method of ordering blood products from separate order sets. Blood product orders for patients < 20 kg were defaulted within the order set directing providers to order via weight-based dosing (ml/kg) with the option to select from 5,10 or 15 ml/kg or customize the ml/kg dosage.  Blood product orders for patients ≥ 20 kg defaulted to unit-based blood orders. Based on clinical discretion providers were able to manually select the alternate order panel, weight-based versus unit-based as clinically indicated. We studied blood volume transfused six months pre and post intervention.  Blood transfusion volumes >20ml/kg were classified as over the recommended volume. We assessed the number of red blood cell (RBC), platelet and fresh frozen plasma (FFP) transfusions > 20ml/kg. Emergency and surgical blood orders were excluded from analysis.

Results/Findings: There were 5,084 blood product orders pre intervention and 3,955 blood product orders post intervention. For patients < 20 kg, 85.9% % of RBC, 86.3% of platelet and 54.6% of FFP orders utilized a weight based (ml/kg) order set. After the implementation of weight-based orders, there was a significant decrease in the amount of > 20ml/kg RBC transfusions (4.7% vs 2.3%, p=0.012) and platelet transfusions (23.6% vs 6.4%, p< 0.001).  An increase in FFP transfusions > 20 ml/kg post intervention was not statistically significant (6.6% vs 18.1%, p=0.134). Over half (58.2%) of transfusions >20ml/kg were ≤ 5 ml/kg over 20ml/kg. Additional analysis by patient location demonstrated that 3 inpatient floors (corresponding primarily to hematology/oncology, pediatric ICU and cardiac ICU) and 1 outpatient infusion center accounted for 82.3% of the >20 ml/kg blood orders.

Conclusions: Approximately 20% of platelet transfusions in pediatric patients weighing less than 20 kg were for > 20 ml/kg pre intervention. Implementation of a ml/kg weight-based blood order set significantly decreased the amount of >20ml/kg RBC and platelet transfusions in patients less than 20 kg. Further research and collaboration between transfusion medicine and clinical teams may elucidate factors that contribute to variability in pediatric transfusion volumes.