Feature Story

Need for software savvy in push for patient safety

October 2002
Suzanne Butch, CLDir(NCA)

Patient safety is at the forefront of information systems issues for the transfusion service.

Identifying a patient from specimencollection to transfusion of a blood component is of utmost import. Several of the systems in this month’s blood bank software survey can track specimens from collection through testing and reidentification of the patient and blood component at the time of transfusion.

The same patient-identification system ideally should be used throughout the hospital for all patient care, not just for laboratory specimens and transfusion. Many hospitals, however, continue to use technology developed in the 1960s to label specimens. The "credit card," or like imprinting device with standard identification wristbands, is still common. Although specimens can be collected using labels generated by the laboratory information system, many specimens continue to be identified with labels created using the "credit card." When a specimen arrives in a computerized laboratory without a computer identification, the lab adds a label containing the specimen identification. When a specimen is sent to another lab for testing, yet another layer of specimen identification is added to the tube.

The NCCLS and the International Council for Commonality in Blood Banking Automation are developing a standard means of identifying a specimen so it can retain its original computer-generated specimen identification even if it is referred to a reference lab. Such a standard would require computer vendors to move to a common format for identifying specimens. There is no telling how long such a transition would take.

Only 61.5 percent of participants in the CAP’s 2001 J-C Transfusion Medicine Proficiency Testing Survey1 indicated their transfusion service was computerized. And among this group, installation and operation of the same system can vary considerably. Some institutions set up their systems to detect and prevent errors. In others, the computer is just one more step in an already complicated manual system.

Some transfusion services appear to be unaware of the error-detection and prevention capabilities of their software. Transfusion service personnel and blood bank vendors can share the blame for this. Transfusion service personnel often fail to read the documentation supplied by the vendor, and they depend on the vendor to lead them through system setup. On the flipside, not all employees assigned by vendors to help set up optional settings are equally skilled, and some may install only the basics of a system.

The error-detection and -prevention capabilities of the software should be integrated with the facility’s standard operating procedures. Purchasers of transfusion service systems need to shop around for software with error-prevention and detection capabilities that meet their facilities’ requirements. How well a computer performs can depend on the original system setup. In some cases, it will be necessary to change the facility’s SOPs to streamline processes and use the error-detection capabilities.

A simple error-prevention and -detection method is to use the bar codes on blood labels for every step in the receipt, processing, crossmatching, and dispensing of components. Some facilities use bar coding to the fullest, while others use a single bar-code reader, if any, when entering inventory. Furthermore, paper records continue to be used with computer systems. Transfusion service personnel indicate they record testing reactions, conclusions, and unit transactions in the computer at a "more convenient time."

The computer obviously won’t be of value in preventing errors if the transactions are not recorded as the activity is occurring. Those transfusion services that fail to take full advantage of the bar-coding and error-detection capabilities of their systems lose out on the more sophisticated error-prevention capabilities of ISBT 128.

In the first implementation of ISBT 128 in North America, the Armed Services Blood Program has begun using ISBT 128 labeling of blood components in San Antonio and intends to complete installation at its other centers by year end. At least one hospital donor center is now using ISBT 128 for the units it collects.

It remains to be seen if the July 26 meeting of the FDA to solicit comments for developing a regulation concerning bar-code labeling of drugs, including biologicals, will result in a U.S. federal mandate to use ISBT 128 or any other standard. The current U.S. guideline for labeling blood components, "United States industry consensus standard for the uniform labeling of blood and blood components using ISBT 128," allows for alternatives to bar-code labeling. But even if the government mandated that donor centers label blood components using ISBT 128 or another bar-code standard, it is likely that not all transfusion services would use the bar codes in their processes.

Appearing on pages 58 through 64 are 16 blood bank information systems. The vendors in this year’s lineup offer a variety of bar-coding capabilities, and many claim to support ISBT 128 unit labeling, among numerous other features. It is also worth noting that in anticipation of the Health Insurance Portability and Accountability Act guidelines issued Aug. 14² some of the vendors have added audit trails to their systems to track those who had access to patient information.

The profiles presented in the following survey were generated from a questionnaire completed by the vendors. Please verify the accuracy of vendors’ claims before making a purchase.

References

1. CAP Transfusion Medicine Resource Committee. Transfusion medicine (comprehensive) and educational challenge participant summary report. Survey J-C 2001. Northfield, Ill.: College of American Pathologists; 2001.

2. Standards for privacy of individually identifiable health information (Privacy Rule). Federal Register. Aug. 14, 2002; 67:157. Suzanne Butch is chief technologist of the blood bank and transfusion service, University of Michigan Health System, Ann Arbor. She is responsible for validating and implementing blood bank software.

Suzanne Butch is chief technologist of the blood bank and transfusion service, University of Michigan Health System, Ann Arbor. She is responsible for validating and implementing blood bank software.