Ordering irradiated blood correctly - attainable goal?

[Kathy]

We recently went up on CPOE (Cerner) and we have two red cell products available to order: RBCs and RBCs Leukoreduced/Irradiated. They can order special requirements (including irradiated) on either one. We recently decided that we should monitor orders that are not ordered as irradiated for patients who require irradiated blood products. Of course, we have alerts set up in our blood bank system for patients who require irradiated prodcuts, but the problem arises if people are not in the habit of ordering irradiated blood correctly and we don't have a record in the blood bank system. Non-irradiated blood could be transfused to a patient who requires it. So far it looks like we have a 77% compliance rate. We are aiming for near 100%, but I don't know how realisitic this is...I am still seeing at least one order per day coming across without the irradiated requirement for patients who require it. The blood bank has caught these and issued irradiated products.

Does anyone know of any way, besides education (which appears to be relatively ineffective so far) to get them to order the irradiated product? Any kinds of alerts that can be set up in Cerner?

[Mabel Adams]

Pretty sad when the transfusion associated GVHD death rate is something like 90%! We have them order wrong both ways. Several hospitalists think that irradiated blood will just cause fewer transfusion reactions so they order it when it isn't indicated. We are starting an education program for practitioners but I don't know if it will help.

[Deny Morlino]

Most education opportunities are best received by the target audience when the audience perceives the information as coming from at least a peer or better yet an expert. People tend to be more receptive when on of these is the source of information. Try approaching the education from that perspective and it might be better received.

[SMILLER]

I agree with Deny. Have a nurse or unit secretary or both do the education if at all possible. Do this after making sure that they have a policy that explains appropriately how they process orders for irradiated blood.

For your Quality Improvement project, you can show how much better htings are before and after the education.

Scott

[Barbarakym]

Actually, the education should come from the Pathologist or a Speciailist in Blood Bank. Medical Meetings are a good place to give handouts and a quick statment by the Pathologist. Mailings from the Pathologist through the Hospital Medical Office with the handout to all doctors on staff should help. We have had the same problem with hospitalists.