Baylor College of Medicine/Harris Health System Houston, Texas, United States
Background/Case Studies: When transfusion is indicated for patients with sickle cell disease, the standard of care demands ordering RBCs that have been tested and deemed negative for sickle hemoglobin. By lowering the concentration of sickle hemoglobin, transfusing sickle-negative RBCs helps to prevent ischemic and vaso-occlusive crises. Given the crucial nature of placing sickle-negative orders for patients with sickle cell disease, our team sought 1) to determine the number of RBC ordering events where sickle-negative was not requested by the ordering provider as well as 2) leverage technology to assist the ordering physician at the point of order entry to ensure that all patients with sickle cell disease would have sickle-negative RBCs ordered.
Study
Design/Methods: We created an Epic enhancement to assist providers at the point of order entry for red blood cells. Transfusion Medicine and Hematology/Oncology physicians agreed upon a list of diagnostic (SNOMED) codes that require sickle-negative RBCs when transfusing. When RBCs are ordered in an electronic medical record containing one of these codes, a banner announcing the patient’s diagnosis of sickle cell disease automatically populates and the “sickle cell negative” requirement is selected by default when the order window opens. The Quality team reviewed the orders placed over the course of 12 months, including before and after the intervention, for all patients with the aforementioned diagnostic codes in order to determine effectiveness.
Results/Findings: See Figure 1. Incorrect RBC Transfusion Orders for Patients with Sickle Cell Disease Conclusions: While transfusions in patients with sickle cell disease are a low frequency event, in comparison to the total volume of RBC transfusions performed, they represent a high risk scenario. By leveraging technology to assist providers in the blood ordering process we have seen a sustained reduction in the number of incorrectly placed orders. Feedback gathered from physicians after the initial order enhancement has created opportunity for additional modification to the order design. Through continued collaborative effort and end-user engagement we endeavor to make the incorrect ordering of RBCs in patients with sickle cell disease a never event.
Importance of research: Point-of-order-entry is a crucial engagement step for physicians for both education and quality programs in patient care. By leveraging technology, physicians at all stages and specialties can receive specialized knowledge and guidance on topics that may be infrequently visited. Ordering sickle negative RBCs by physician trainees who have not previously treated patients with sickle cell disease is a great example of a high stakes event where the goal is zero errors.
