1. No category

INFO SESSION BEQUINT
WORKING GROUP “ELECTRONIC
PRESCRIPTION”
CONTEXT ELECTRONIC PRESCRIPTION BLOOD
COMPONENTS (BC)
• Prevalence in Belgium: results of first national survey
o no electronic prescription in 81% of the hospitals,
13% in preparing the EP.
o In 98%: no direct link between BC prescription form and recent
hematologic values.
o no information about the indication of transfusion in 14% of the
hospitals and only in broad outlines in 78%
• Why an EP for BC ?
o large variation in transfusion practice: need for more
standardisation
o specific data collection for analysis of transfusion activity in
Belgium
ELECTRONIC PRESCRIPTION OF BC
= computerized physician order entry (CPOE)
= integrated into Electronic Medical Record
ELECTRONIC PRESCRIPTION OF BC: LITERATURE
• Transfusion 2013  Tavares et al.
• - recommendations to prescribing physician: pre-transfusion Hb >
9 g/dl (annulation ?); Hb between 8 – 9 g/dl  single unit ?
• - 33% decrease of RBC transfusions
• Transfusion 2013  Goodnough et al.
- real-time clinical decision support (CDS) ans best-practice alerts
(BPA) into physician order entry (POE) for BC in the electronic
medical record system.
- 24% decrease of RBC transfusions
- opportunity to use prescriber education and audits upon POE.
ELECTRONIC PRESCRIPTION OF BC: LITERATURE (2)
• Am J Clin Pathol 2014  Mc Williams et al.
• - adaptive alerts = alerts not only triggered by the pre-tranfusion Hb,
but also by the physician-selected indication for TF.
• - non-evidence-based trabsfusions persist but decreased over time
• - but: decline in RBC transfusions might have been caused by other
factors
• - but: a limitation of this alerts  based solely on laboratory
parameters
• - but: avoid “alert fatigue”  reduce the number of alerts by providing
prescriber with evidence-based and practical BC ordering options.
ELECTRONIC PRESCRIPTION OF BC: POSSIBLE
FUNCTIONS
1) ordering blood components for clinical use
2) ordering pretransfusion tests (cross-match, T & S, blood
group,…)
3) Clinical Decision Support System (CDSS)
4) systematic data collection with regard to prescription
behaviour (analysis of internal transfusion policy +
benchmarking with other hospitals)
AIMS OF THE WORKING GROUP
1) determine criteria to develop an electronic prescription of
BC
2) summarize these criteria in a reference document and
distribute this between Belgian hospitals and software
developers
3) Pilot project of CDSS / creating a protocol for analysis of
prescription behaviour based on data of EMR (DRG
codes…)
Final aim: to improve rational prescription behaviour
in a user-friendly way  customization!
SUMMARY OF IMPORTANT ELEMENTS OF
ELECTRONIC PRESCRIPTION BC
Method: comparison of existing
electronic prescriptions
• unambiguous patient selection
• few clicks to open the prescription form
• patient data automatically shown:
• Body weight, blood group
• Recent Hb, platelet count,…
• Informed consent (?)
• patient data to add:
• polytransfused patient
(pre-) medication
severe immunocompromised patient
COMMON ELEMENTS OF ELECTRONIC
PRESCRIPTION BC
• data prescriber
•
•
•
•
•
Login name (assistant/supervisor)
Requesting department (+ campus)
Phone number
RIZIV/INAMI number
data distribution of blood components
• Destination (department + phone number)
• Desired timing (date + hour)
•
urgent order
(protocol for urgent transfusion)
(protocol for massive transfusion)
COMMON ELEMENTS OF ELECTRONIC
PRESCRIPTION BC
• Type of blood components
• Erythrocyte concentrate (ECL), platelet concentrate
• Plasma (vs. SD plasma)
(+ combinations)
• Number of blood components
• No restriction versus restriction in certain cases
• Specific characteristics of blood components
• Irradiated
• CMV negative donor
• Intra-uterine transfusion,…
COMMON ELEMENTS OF ELECTRONIC
PRESCRIPTION BC
• Indications for ECL
• …
• Indications for platelet concentrate
• …
• Indications for plasma
• …
POSSIBLE TOOL FOR DATA-ANALYSIS
• no one of the actual EP systems, discussed in the WG, is really
suitable for data collection and for benchmarking of the use of
blood components.
• 2 possible strategies:
1 ) registration of sufficent data when developing the EP.
2) systematically link the EP with other parts / data of the
electronic medical record and combine with the data of
the EP (for example: ICD-9 CM codes)
 more user friendly
COMPOSITION OF THE WORKING GROUP
Name
Institution
Timothy Devos
Universitair Ziekenhuizen Leuven
Anneli Keereman
Rode Kruis-Vlaanderen: Dienst Voor het Bloed
Robert Larbuisson
Centre Hospitalier Universitaire de Liège
Ludo Marcelis
Heilig-Hartziekenhuis Roeselare-Menen
Ludo Muylle
Universitair Ziekenhuis Antwerpen, Federaal Agentschap voor Geneesmiddelen en
Gezondheids- producten (FAGG)
Luc Nicolas
FOD VVVL
Lucien Noens
Universitair Ziekenhuis Gent
Dominique Putzeys
Centre Hospitalier Régional de la Citadelle, Liège
Rik Schots
Universitair Ziekenhuis Brussel
Jamie Verelst
Universitair Ziekenhuis Brussel
DISCUSSION
• Your experience with developing electronic prescription?
• Your experience with data-analysis of transfusion activity?