New technologies to enhance the safety of blood transfusion

New technologies to enhance the safety of blood transfusion

Transfusion safety mentioned, most people think of is to prevent the spread of various diseases due to blood transfusions. Blood transfusion safety is not just the safety of the past three decades, the main concern of the safety of blood products, the result is the risk of transfusion-transmitted diseases greatly reduced. Despite this achievement, but the overall transfusion safety (the entire process of blood transfusion safety) still depends on the transfusion of blood collected from many areas of cooperation and linkages. The risk of transfusion errors in the United States than the transfusion-transmitted hepatitis B, hepatitis C, HIV risk is three times higher. Error often caused by negligence transfusion errors and cognitive errors result. Gross errors often occur in the hectic and operator fatigue when duplicates operation, this deficiency can be overcome with the machine. Blood transfusion, blood transfusion before the final inspection and testing bedside sample labeling is easy to make mistakes on the key points, so that the new technology is also part of these error-prone. Existing technologies include: non-computer facilities, bedside bar code technology facilities, electronic identification technologies. Several commercial bar code technology has entered the stage of clinical application and continuous improvement. Radio-electronic systems will soon be used clinically. The third point is the error monitoring blood decided that it would be a challenging information technology field. In this paper, several new technologies currently in use to enhance transfusion safety for a comprehensive overview.

1. mis-transfusion: more common than we realize
 

World literature data indicates that the error severity and high incidence of transfusion has reached an unacceptable level. Transfusion errors in the United States has been reported to the FDA transfusion number one cause of death (owned since this report), Sazamn reported to the FDA from 1976 to 1985 feedback of transfusion-related deaths have been reported, the 256 deaths were reported in the (non-hepatitis, non-HIV-infected lethal factor), 51% is due to lose ABO incompatible blood products cause acute hemolytic reactions. Linden, etc. According to New York State received blood transfusion incident report data to calculate the risk of transfusion ABO error 1/140000U. Robillard and other reports from Quebec transfusion accident monitoring program data that the error is very common blood transfusion accident incidence rate of 1/12000 second blood transfusion. Andreu from the French blood transfusion accident monitoring program reported similar findings. Cognitive errors due to blood transfusion accident, true blood transfusion accident rate higher than reported. One of the most controversial of the three universities in Belgium hospitals, they come to the startling conclusion that the accident rate of transfusion 1/400U.
 

2. The introduction of New Technologies

Medical errors are usually broadly divided into fault errors and cognitive errors. Cognitive errors occurred in the medical workers lack adequate knowledge and erroneous application of knowledge. Negligent errors due to mental concentration, fatigue, negligence, making duplicates of operation errors. Such as blood sample labeling, patient bedside identity checks are repeat projects likely to commit negligent errors. If the patient's sample collection session wrong, the consequences are very serious. This error there are two types: one is the label error, one is installed the wrong blood tube. There are two aspects of the operation error causes the sample labeling link error occurs. First, as the patient is not the actual source of the data, the second is not generated at the bedside and immediately labeling, but the pre-printed labels. Blood samples were drawn after the medical staff, with the blood sample to the labeling zone, such as nurses stations, it is possible to extract a blood sample incorrectly placed another patient label affixed to the tube. Linden and other reports in the ABO blood transfusion records with such errors accounted for 40%. The current bedside examination of the patient's safety is not enough. American University published two pathological observations, these two sets of results are from the 1994 and 2000 experiments, analysis bedside check basic elements, including patient identification confirmation, wristbands logo and logo consistent with the blood of the patient identity and consistent demand for blood, confirm the validity of the information. 2000 review of more than 4000 blood transfusion cases, including 25% of cases did not do wristbands logo and logo consistent with blood, that is, many patients do not realize that to take protective measures to avoid serious blood transfusion errors. Therefore, it is necessary to collect the patient's blood before transfusion bedside labeling and inspection aspects of the introduction of new technologies in order to control the occurrence of errors. Computer systems using computer technology transfusion decisions help doctors make the right decision for transfusion, better to avoid the occurrence of transfusion errors, improve accuracy of transfusion therapy.

3. new technologies to enhance the safety of transfusion in clinical application

3.1 Non-computerized technology

BloodLoc system represents an example of non-computer technology aimed at reducing transfusion errors. BloodLoc system patient blood samples collected in order to avoid an error occurs while using a specially designed wristband, wristband embedded in a card, the card is preset with a set of numbers. The patient's blood samples collected, this card is removed from the wristband as bedside printer prints a label templates. Using this system, the driver that the system is running three letters numbers can only get from a patient's wristband, truly a sample at the bedside, at the bedside labeling. BloodLoc system in order to avoid pre-transfusion bedside check for errors while using a plastic combination lock, number lock a user must open this port to reach the blood bags. In blood banks, this number is allocated to the lock sealed plastic blood bags containing spare. Blood transfusion, the patient wristband with a three-letter numbers to open this lock. Wenz et al, 672 times in 312 patients with transfusion, this facility three times to prevent potential errors transfusion. Mericuriali other reports, the use of the system for the 3231 patients Bloodloc transfusion 10995U, detect and avoid potentially fatal four blood transfusions.

3.2 Application of bar code technology
Barcode technology is the medical workers in routine laboratory techniques used, blood bags once they leave the blood bank, medical personnel rely on the naked eye to interpret the bar code, it is necessary to use barcode technology extends outside the laboratory. First hospital patients should be aware of patient identification wristbands are a major source of information facilities should only be interpreted with the naked eye wristbands can also be modified to use the machine interpretation wristbands machine interpretation techniques for one-dimensional, two dimensional bar code or electronic identification technologies. Secondly, medical workers, especially nurses and anesthetists perform blood transfusions require training in order to be able to skillfully use bar code technology lines. To prevent erroneous transfusion, the patient barcode identification (the strap) and preparation of blood transfusion recipients barcode identification (in bags on) a machine interpretation techniques applied two preferred link. Applied when the patient sample collection barcode technology system usually consists of a bedside computer or a mobile handheld computer, a bar code reader and a bedside printer. Lattice produced Medicopia represents the most advanced barcode technology sample collection system. Pocket PC from the hospital information system and laboratory information systems to collect a series of patient information, such as laboratory test results, in vitro models and special instructions. This information is transmitted through a wireless network to a mobile handheld computer. In the blood, the user scans the bar code on the patient wristband, from a portable printer to print labels, blood samples were drawn from patients achieved immediately after the bedside generate labels and labeling purposes. Patientsafe Transfuse IDTM barcode technology system is a system for pre-transfusion bedside examination. It consists of a hand-held portable bar code reader and a portable printer components, users scan their own ID, scan the patient's wristband barcode, then scan the identification of blood products, if the data does not match, the machine will alarm sound. Transfusion process of recording can be printed and pasted into patient medical records. Bridge Medical, Care Fusion and Lattic three companies have similar barcode technology products. But barcode technology systems to reduce errors transfusion rate is still pending clinical observation.
3.3 Electronic identification mark
Electronic identity (Radiofrequency identification, RFID) and similar data exists barcodes with bar code, has the following advantages: electronic identity can store more data, and is easier to use. Two functions of RFID identification is to locate and identify. Positioning the electronic signals emitted FRID identifies the receiver can be received, the long-range identification signal emitted electrons is the "active logo", "active logo" radio waves are transmitted to the battery, expensive, as in an automotive lock is "active identity. " Identification mark not emit energy, no batteries, is the "passive identity", also called "smart tags." Than the "active logo" cheaper and can be applied to identify objects of various sizes, including bags identification and identification wristbands. "Passive ID" must be placed in the reader energy emission range, when the reader identifies the energy emission into the scope of the activation of the label identifies the small antenna on-chip data, the data can be received by the reader. Such as shopping malls for the theft and sale of clothes is not placed on the protection logo is the "passive identification." For medical workers, the main concern is blood transfusion, mainly for identification rather than positioning. Therefore, the use of the patient wristband "passive identity" can be the same as the bar code technology for identification of the patient. "Passive identification" can also be used to identify the bags. RFID wristbands no visible code, this code wristbands visible during surgery is often wet and lost, responsible for the implementation of the operating room nurses due to blood transfusions and had little contact with the patient, the patient did not know, only through name and a detailed description of the medical records to identify patients. In patients with loss of consciousness, can not say his name bedside examination in the case, in particular, is prone to error. And the operating room and emergency blood transfusion is often hectic circumstances, it is easy to commit before transfusion fault error checking in two key factors. Sazama FDA received reports of transfusion reported accident data, the error occurs most often in blood transfusion for surgical patients. Operating room environment is conducive to use technology to protect patient safety, human factors, and protect patient safety combined to ensure the safety of blood transfusion practice has long been applied in the treatment of patients with anemia. Operating room should be implemented to enhance patient safety technology transfusion ideal place. RFID is not routinely used in the collection of blood samples. U.S. Maxell companies are producing blood sample for RFID. Using a specially designed test tube rack 96, RFID encoding tubes can read the data and transfer to the laboratory computer system. This tube application in developing countries more expensive, with prices continuing FRID identification system, experts believe that such a marking is widely used in the future.
3.4 intelligent information storage and infusion systems
Alaris is an ongoing development of the use of bar code technology and RFID technology embedded pump system. Run this system, the user must first scans the patient's wristband and then scanning the coded blood products, software installations blood transfusion before starting the pump, check for the data match. This technology was originally designed for a large number of intravenous administration, transfusion therapy has been used in this facility. The system can improve patient safety of blood transfusion needs further study. A retrospective survey was found in the intensive care unit, the wise use of the pump did not reduce the incidence of drug infusion errors, mainly due to the medical staff can not properly use the system. This finding reveals the development of a widely available and easy to operate safety infusion systems challenges.

4. clinical transfusion decision technology

Current information technology in the health care decisions of the application is still in its infancy. The development of technology through three levels: Document retrieval, computer-aided medical decisions, the computer automatically medical decisions. Computerized clinical doctor (physician order entry, POE) has been implemented in many medical centers. Data show that this system is reduced by 50% of the serious medical errors, the overall error reduction of 80%. Computerized POE system allows more sophisticated and clear mission and traceable clinicians and pharmacists, blood banks, radiologists and other hospital departments information exchange. Computer-aided decision systems often linked with POE as a clinical decision two levels of computer technology. The system enables physicians easy access to the information needed to help doctors make the right decision. This information includes: drug allergy alert, drug recommended dose, range, antibiotic selection, and other information. Transfusion therapy, these reminders can be scheduled in the blood and blood transfusion indications to doctors provide valuable guidance. Three level of medical decision system determined automatically by a computer system. Although computer-aided decision system has achieved some success, but this technology is still in its infancy, even after a very long period of development. Studies have shown that computer-aided decision is unreasonable if the design will produce new medical errors. New technology to solve a problem at the same time created a new problem. More current lack of clinical experience, more research is needed to evaluate these new technologies guard against medical errors in the role. Nevertheless, in the 21st century information technology will be applied to large-scale control of blood transfusion safety.

5. Conclusion

Although information technology widely used in modern society, but in the field of health care applications is lagging behind. While strengthening security and the application of new technologies transfusion - non-computer facilities, bedside barcode technology facilities, electronic identification technology and technology and other aspects of clinical transfusion decisions made ​​some achievements, but also the need for more research to determine the What technology can improve the patient's transfusion safety. To reduce transfusion errors, improve patient safety of blood transfusion. Medical workers, hospital administrators need to work together to strengthen the safety of blood transfusion in application of new technologies to go.