Improved traceability and transfusion safety with a new portable computerised system in a hospital with intermediate transfusion activity

Abstract

Background: A retrospective study carried out on medical records of transfused patients in our hospital in 2002 revealed that manual identification procedures were insufficient to offer satisfactory traceability. The aim of this study was to assess adequacy of transfusion traceability and compliance with proper identification procedures after introducing an electronic identification system (EIS) for transfusion safety.

Materials and methods: The chosen EIS (Gricode(®)) was set up. Traceability was calculated as the percentage of empty blood units used returned to the Transfusion Service, compared to the number of supplied units. Compliance in the Transfusion Service was calculated as the percentage of electronic controls from dispatch of blood components/transfusion request performed, compared to the total number of transfused units. Compliance in the ward was calculated as the percentage of electronic controls from sample collection/transfusion performed, compared to the total number of samples collected.

Results: This retrospective study showed that only 48.0% of the medical records were free of inaccuracies. After the implementation of the EIS (2005-2008), traceability was always above 99%. Percentage of monthly compliance from 2006 to 2008 was always above 93%, showing a significant trend to increase (p<0.05). The mean compliance in this period was higher in the Transfusion Service (97.8 ± 0.7 SD) than in the ward (94.9 ± 2.4 SD; p<0.001). Compliance in the ward was lowest when the system was first implemented (87.9% in April 2006) after which it progressively increased. No errors in ABO transfusions were registered.

Conclusion: After implementation of the EIS, traceability and compliance reached very high levels, linked to an improvement in transfusion safety.

Figure 1

Electronic identification with the Gricode^® system. The reader identifies the bar-coded bracelet fastened to the recipient. Labels are attached to the bracelet, blood sample for compatibility analyses and transfusion sheet, and encode a unique and never repeated transfusion safety number (TSN).

Figure 2

Flowchart of events when using the Gricode^® System: a patient’s sample is collected and the system reads the bar-coded labels with the transfusion safety number (TSN) on the recipient’s bracelet, blood sample and transfusion sheet (1). The sample and transfusion sheet arrive at the Transfusion Service (TS) for compatibility analyses and they are read again (2). The assigned compatible blood units to be transfused are checked before being dispatched from the TS (3). A bedside electronic cross-match test is carried out with the reader just before starting (4) and after finishing (5) the transfusion. Finally, totally or partially used bags are returned to the TS, where a final reading control is performed for traceability and compliance assessment purposes (6).

Figure 3

Average monthly percentages of transfusion traceability, since the electronic identification system was put in place, from January 2005 to November 2008.

Figure 4

Global percentage of compliance with controls carried out by both ward staff and Transfusion Service staff. Curve fit: r²= 0.17; Significance of the slope: F=0.6.1, p<0.05.

Figure 5

Annual compliance in percentages, comparing the Transfusion Service (TS) and ward staff. The 2006 values are the average from April to December; 2008 values are the average from January to November. In the whole period, average compliance in TS was 97.8±0.7 SD versus 94.9±2.4 SD in the ward (p<0.001).

Figure 6

Average monthly percentage of compliance, comparing Transfusion Service (TS) and ward staff from January 2006 (TS) or April 2006 (wards) to November 2008.