Need for software savvy in push for patient safety
Suzanne Butch, CLDir(NCA)
Patient safety is at the forefront of information systems issues for the transfusion
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
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
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.
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
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.