Automation: patient bedside procedures

1
Automationpatient bedside procedures

• Paul Ashford

2
Safe Blood?

• Ensuring the provision of safe blood is a high
  priority
• Donor selection
• Testing
• Processing
• Quality assurance
• But...

3
Safe Blood?

• Ensuring the provision of safe blood is a high
  priority
• Donor selection
• Testing
• Processing
• Quality assurance
• But...
• Safe blood given to the wrong recipient can cause
  death or serious injury

4
Is there a problem?

• You wont find a problem if you dont look for it
• Haemovigilance systems consistently show that the
  most frequent errors are Incorrect blood
  component transfused

5
UK SHOT Report 2011
6
Identification is the key

• At each step of the transfusion process, and
  every other intervention in medicine,
  identification of the right patient is an
  absolute essential.
• SHOT Report 2011

7
Bedside Information Cycle
8
Bedside Information Cycle
Sample from wrong patient
9
Bedside Information Cycle
Results reported against wrong patient identifier
Sample from wrong patient
10
Bedside Information Cycle
Results reported against wrong patient identifier
Sample from wrong patient
Patient incorrectly identified
11
Bedside Information Cycle
Results reported against wrong patient identifier
Sample from wrong patient
Patient incorrectly identified
Request carries wrong patient identifier
12
Bedside Information Cycle
Results reported against wrong patient identifier
Sample from wrong patient
Patient incorrectly identified
Request carries wrong patient identifier
Sample from wrong patient
13
Bedside Information Cycle
Results reported against wrong patient identifier
Sample from wrong patient
Patient incorrectly identified
Request carries wrong patient identifier
Sample from wrong patient
Samples incorrectly identified
14
Bedside Information Cycle
Results reported against wrong patient identifier
Sample from wrong patient
Patient incorrectly identified
Request carries wrong patient identifier
Patient incorrectly matched to products
Sample from wrong patient
Samples incorrectly identified
15
Types of Error

• Transcription errors
• 569237 becomes 569327
• Inconsistent or missing identifiers
• Hospital number family name forename DoB
• Confusion of identifiers
• Penny Alison or Alison Penny? (The strange case
  of Penny Allison)
• Wrong source of information
• Inadequate checking

16
Manual Interventions

• Consistent policies and procedures
• Adequate training and refreshers
• Patient wristbands
• Sufficient identifiers (with redundancy)
• Double checking
• Appropriate working conditions
• Policies for handling errors

17
Automation enhances good practice

• It should not be used to correct bad practice

18
Automation Interventions

• Bar coding of blood products
• Electronically readable patient wristbands
• Control software

19
Bar coding of blood products

• Both machine readable and clear text
• Standard design
• Use of ISBT 128 international standard
• Linked automated data capture and effective blood
  management systems

20
Patient Wristbands

• Electronic identification of the patient
• Electronic and human readable
• Reduces likelihood of identification error
• ISBT 128 data structures

21
Patient Wristbands

• Reduces likelihood of identification error
  provided it is attached to the correct patient!!!

22
Wristband controls

• Wristband only to be assigned by specified well
  trained staff
• Thorough patient identification procedure prior
  to printing and affixing wristband
• Written procedures regarding removal and re-issue
  of wristbands
• Patient education regarding importance of
  wristband

23
Scanners and control systems

• Bedside scanning systems to capture electronic
  information
• Control software linking all phases of the
  information cycle

24
Norwegian ISBT 128 System

• Based on ISBT 128 Technical Bulletin 8
• Patient has bar coded wristband
• Blood unit is ISBT 128 labelled
• Patient wristband scanned at sample collection
  tube label generated
• Blood bank selects compatible blood and generates
  two part match with unit label, confirming
  correct unit
• At bedside match with unit label scanned and
  patient wristband

25
Patient and Blood bar coded
26
Patient and Blood bar coded
27
Patient and Blood bar coded
28
Patient and Blood bar coded
29
Match with Unit
30
Oxford Hospital System

• Similar approach to Norwegian system
• Has additional security of controlled
  refrigerator access
• Suitable for remote issue situations
• Staves et al. Transfusion 200848415-424

31

End-to-end electronic transfusion Bar-coded
patient ID on the wristband is used to label the
sample and blood bagDavies et al. Transfusion
2006 46 352-364
slide courtesy of Prof Mike Murphy
32
Bedside Information Cycle
33
Control Systems
Scanned patient ID
Patient ID automatically associated with request
at bedside
Scanned patient ID Confirmed match with blood and
reports
Scanned patient ID Correct patient confirmed
Patient ID transferred automatically to
crossmatch report and blood unit label
Samples automatically labelled with bar codes at
point of collection
34
Control Systems
???
Scanned patient ID
???
Patient ID automatically associated with request
at bedside
Scanned patient ID Confirmed match with blood and
reports
Scanned patient ID Correct patient confirmed
Patient ID transferred automatically to
crossmatch report and blood unit label
Samples automatically labelled with bar codes at
point of collection
35
(No Transcript)