title: Implementation of a simple electronic transfusion alert system decreases inappropriate ordering of packed red blood cells and plasma in a multi-hospital health care system.
abstract: OBJECTIVE
  Prescriber adherence to institutional blood component ordering guidelines can be low. The goal of this study was to decrease red blood cell (RBC) and plasma orders that did not meet institutional transfusion guidelines by using data within the laboratory information system to trigger alerts in the computerized order entry (CPOE) system at the time of order entry.
  
  
  METHODS
  At 10 hospitals within a regional health care system, discernment rules were created for RBC and plasma orders utilizing transfusion triggers of hemoglobin <8 gm/dl and INR >1.6, respectively, with subsequent alert generation that appears within the CPOE system when a prescriber attempts to order RBCs or plasma on a patient whose antecedent laboratory values do not suggest that a transfusion is indicated. Orders and subsequent alerts were tracked for RBCs and plasma over evaluation periods of 15 and 10 months, respectively, along with the hospital credentials of the ordering health care providers (physician or nurse).
  
  
  RESULTS
  Alerts triggered which were heeded remained steady and averaged 11.3% for RBCs and 19.6% for plasma over the evaluation periods. Overall, nurses and physicians canceled statistically identical percentages of alerted RBC (10.9% vs. 11.5%; p = 0.78) and plasma (21.3% vs. 18.7%; p = 0.22) orders.
  
  
  CONCLUSIONS
  Implementing a simple evidence-based transfusion alert system at the time of order entry decreased non-evidence based transfusion orders by both nurse and physician providers.
authors.affiliation: Department of Pathology, University of Pittsburgh, Pittsburgh, PA, United States.
authors.forename: Matthew
authors.initials: M
authors.lastname: Smith
authors.affiliation: Department of Pathology, University of Pittsburgh, Pittsburgh, PA, United States; The Institute for Transfusion Medicine, Pittsburgh, PA, United States.
authors.forename: Darrell J
authors.initials: DJ
authors.lastname: Triulzi
authors.affiliation: Department of Pathology, University of Pittsburgh, Pittsburgh, PA, United States; The Institute for Transfusion Medicine, Pittsburgh, PA, United States.
authors.forename: Mark H
authors.initials: MH
authors.lastname: Yazer
authors.affiliation: Department of Pathology, University of Pittsburgh, Pittsburgh, PA, United States.
authors.forename: Marian A
authors.initials: MA
authors.lastname: Rollins-Raval
authors.affiliation: Department of Anesthesiology, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA, United States; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States; McGowan Institute for Regenerative Medicine, Pittsburgh, PA, United States.
authors.forename: Jonathan H
authors.initials: JH
authors.lastname: Waters
authors.affiliation: Department of Pathology, University of Pittsburgh, Pittsburgh, PA, United States; The Institute for Transfusion Medicine, Pittsburgh, PA, United States. Electronic address: jay_raval@med.unc.edu.
authors.forename: Jay S
authors.initials: JS
authors.lastname: Raval
mesh_terms: D002984:Clinical Laboratory Information Systems; D057286:Electronic Health Records; D017707:Erythrocyte Transfusion; D005260:Female; D006801:Humans; D008297:Male; D050316:Medical Order Entry Systems; D010949:Plasma; D017410:Practice Guidelines as Topic
keywords: CPOE; Computerized physician order entry; Electronic transfusion management; FFP; Plasma; RBC; Red blood cells