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Comparison of CPOE-specific prepopulated transfusion indications to use of ‘other’

Computerized physician order-entry systems ensure proper blood utilization and reinforce evidence-based practices for blood product ordering. Implementation of CPOE ranges from having providers select a prepopulated indication for ordering a blood product to providing immediate feedback with computer-generated best practice alerts. The authors conducted a study, after a new CPOE system was installed at their institution, to evaluate the use of “other” as an indication in blood product ordering and to examine the reasons for transfusion that are listed as free text in lieu of prepopulated indications. When the new CPOE system was introduced, a comprehensive change flier that detailed ordering practices for packed red blood cells, platelets, fresh frozen plasma (FFP), and cryoprecipitate was sent to all sites that were affected by the change. The authors analyzed how frequently health care providers selected “other” when placing orders for RBCs, platelets, and FFPs and assessed the reasons, expressed in free text, for the orders. The study was conducted at the Long Island Jewish Hospital blood bank. Transfusion order records for RBCs, platelets, and FFPs were obtained using a health care analytics program for Allscripts’ Sunrise Clinical Manager. The records were collected from April 2021, when the CPOE system was implemented, to November 2021. The transfusion orders were obtained from the emergency department and intensive care unit for adult patients and the Cohen’s Children’s Medical Center emergency department, ICU, and Med4, which is a unit for pediatric hematology and oncology, for pediatric patients. The percentage of “other” orders and reasons for “other” orders were reviewed. The results showed that 9.7 percent of RBC orders, 1.9 percent of platelet orders, and 18.2 percent of FFP orders were placed using the indication of “other.” Although the reasons for “other” varied, the most common reasons were bleeding (15.7 percent for pediatric RBC orders) and hold for the operating room (14.3 percent of pediatric and 15.8 percent of adult RBC orders). Among a few unique indications was FFP for ACE-inhibitor-associated angioedema (84.6 percent of adult “other” FFP orders). Because some of the “other” orders are recurring indications for transfusion, the authors may consider expanding their institutional list of prepopulated transfusion indications to include some of the more common free-text entries. The authors noted that the “other” orders revealed trends that could inform future educational initiatives and CPOE design to improve blood product utilization and patient outcomes.

Tong N, King J, Fomani K. Comparison of computerized provider order entry specific transfusion indications versus the use of “other.” Transfusion. 2023;63:737–744.

Correspondence: Dr. Nicholas Tong at ntong@northwell.edu