title: Computerized physician order entry improves compliance with a manual exchange transfusion protocol in the pediatric intensive care unit.
abstract: OBJECTIVE
  To evaluate the use of a computerized physician order entry (CPOE) protocol on manual red blood cell (RBC) exchange transfusion in critically ill children with sickle cell disease.
  
  
  METHODS
  We conducted a retrospective study of children with sickle cell disease who received a manual RBC exchange transfusion before (2001 to 2008, n=22) and after (2008 to 2009, n=11) implementation of a CPOE protocol. Outcomes included compliance with protocol, percentage reduction in sickle hemoglobin, and peak hemoglobin during exchange.
  
  
  RESULTS
  Compliance with the manual exchange protocol improved after introduction of CPOE (pre-CPOE: 20 protocol violations vs. post-CPOE: 3 violations, P=0.02). Percentage reduction in sickle hemoglobin also improved (pre-CPOE: 55% vs. post-CPOE: 70%, P=0.04), whereas peak hemoglobin during RBC exchange was similar (pre-CPOE: 12.0 g/dL vs. post-CPOE: 11.5 g/dL, P=0.25). However, hemoglobin levels after the mean of 7 hours of exchange were significantly higher pre-CPOE (pre-CPOE: 11.5 g/dL vs. post-CPOE: 10.5 g/dL, P=0.006).
  
  
  CONCLUSIONS
  Use of CPOE for manual RBC exchange transfusion in children is associated with improved protocol compliance, improved reduction of sickle hemoglobin, and better maintenance of hemoglobin levels in a goal range during prolonged exchanges.
authors.affiliation: *Departments of Anesthesiology and Pediatrics, Pediatric Critical Care, Baptist Hospital, School of Medicine, Wake Forest University, Winston-Salem, NC †Department of Pediatrics, Pediatric Hematology, Johns Hopkins University School of Medicine, Baltimore, MD ‡Departments of Pediatrics and Anesthesiology, Cardiovascular Anesthesiology and Critical Care, Texas Children's Hospital/Baylor College of Medicine, Houston, TX.
authors.forename: Michael C
authors.initials: MC
authors.lastname: McCrory
authors.forename: John J
authors.initials: JJ
authors.lastname: Strouse
authors.forename: Clifford M
authors.initials: CM
authors.lastname: Takemoto
authors.forename: R Blaine
authors.initials: RB
authors.lastname: Easley
mesh_terms: D000293:Adolescent; D000755:Anemia, Sickle Cell / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D017707:Erythrocyte Transfusion; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D008297:Male; D050316:Medical Order Entry Systems; D012189:Retrospective Studies