Real-Time Clinical Decision Support Decreases Inappropriate Plasma Transfusion.

Abstract:

Objectives:To curtail inappropriate plasma transfusions, we instituted clinical decision support as an alert upon order entry if the patient's recent international normalized ratio (INR) was 1.7 or less. Methods:The alert was suppressed for massive transfusion and within operative or apheresis settings. The plasma order was automatically removed upon alert acceptance while clinical exception reasons allowed for continued transfusion. Alert impact was studied comparing a 7-month control period with a 4-month intervention period. Results:Monthly plasma utilization decreased 17.4%, from a mean ± SD of 3.40 ± 0.48 to 2.82 ± 0.6 plasma units per hundred patient days (95% confidence interval [CI] of difference, -0.1 to 1.3). Plasma transfused below an INR of 1.7 or less decreased from 47.6% to 41.6% (P = .0002; odds ratio, 0.78; 95% CI, 0.69-0.89). The alert recommendation was accepted 33% of the time while clinical exceptions were chosen in the remaining cases (active bleeding, 31%; other clinical indication, 33%; and apheresis, 2%). Alert acceptance rate varied significantly among different provider specialties. Conclusions:Clinical decision support can help curtail inappropriate plasma use but needs to be part of a comprehensive strategy including audit and feedback for comprehensive, long-term changes.

journal_name

Am J Clin Pathol

authors

Shah N,Baker SA,Spain D,Shieh L,Shepard J,Hadhazy E,Maggio P,Goodnough LT

doi

10.1093/ajcp/aqx061

subject

Has Abstract

pub_date

2017-08-01 00:00:00

pages

154-160

issue

2

eissn

0002-9173

issn

1943-7722

pii

3976049

journal_volume

148

pub_type

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