Electronic prescription of Labile Blood Products: A cultural revolution by the APHM and EFS PACA-Corsica!

Abstract

The electronic prescription of Labile Blood Products was recommended in a 1997 directive, to ensure transfusion safety in healthcare services. Following multiple institutional reminders by the Haemovigilance Unit of the Marseille Public Hospitals (APHM), the board of directors decided to set up a project for electronic transfusion records. Here we present the issues arising from this computerisation and the impact of this change of practice on the APHM and the Etablissement Français du Sang PACA-Corse (EFS PACA-Corsica; French Blood Institute Provence-Alpes-Côte d'Azur-Corsica). Concerning the APHM, we were overly optimistic when designing the prescription of Labile Blood Products (LBP), thinking that prescribers would choose the correct product qualifications. Unfortunately, the choice of LBP qualifications was excessive, resulting in product reception being blocked for the medical units. Furthermore, we were also faced with a resistance to change from the older doctors, while the younger doctors and junior doctors at ease with computers rapidly adhered to the tool. Concerning the EFS PACA-Corsica, this change in practice disconnected the link between the software in charge of red cell immunohaematology and LBP delivery, requiring the development of a new tool to re-establish a link. The EFS demanded a remote print-out, as a back-up for the electronic delivery of the prescription. The issue around identity discordance reinforced the ties between the APHM Haemovigilance and Identity Vigilance Units and the EFS. The partnership between our two structures was beneficial for the implementation of electronic transfusion records. The APHM gained in safety, obliging prescribers to note the duration of transfusion, and in healthcare traceability (reception, transfusion, adverse event reporting etc.). For the EFS PACA-Corsica, despite the difficulties encountered with software when the tool was first implemented, electronic nominative prescription made tasks simpler, gave better access to transfusion data, and reduced the number of phone calls from medical units inquiring about patient immunohaematology results. The comprehension and attentiveness between our two entities enabled us to complete this project and to resolve the problems as they appeared.