Lay the groundwork for computerized records
Lay the groundwork for computerized records
Team approach used to set criteria
Development of electronic communication channels proved indispensable for Salt Lake City-based LDS Hospital's success with its computerized blood ordering program. But development of human communication channels was just as important to the effort, says Reed Gardner, PhD, professor of informatics at the University of Utah and co-director of medical computing at LDS Hospital.
Before the electronic system could go on line, criteria for using it had to be developed by a cross-section of staff, including the Hospital Transfusion Committee, the blood bank director, the quality assurance department, the medical staff, and the medical informatics department. The staff reviewed the literature and developed stricter criteria than were in place.
They then approached the hospital's Medical Executive Committee for its support.
"This was a sensitive enough issue that we went directly to our Medical Executive Committee, which consists of the medical directors of the clinical staff of the hospital," Gardner says. "We said, 'These are the new criteria we are using. They are based on these scientific results and recommendations. We need to take a stand on it. We think we need that stand should come from the Medical Executive Committee.' They were willing to jump in and do it."
Starting in December 1994, the blood products ordering criteria became effective. (See criteria, p. 112)
Gardner admits there were detractors inside and outside the hospital, but he points out that backers of the criteria are open to hearing new data and research. Also, any blood orderer can override the criteria when the computer prompt suggests a blood order for a certain case.
Most caregivers have embraced, or at least accepted, the criteria, Gardner says. "We've moved the mean hematocrit for when blood is given for anemia from up in the 30s down to around 26," he says. This indicates that caregivers are buying into the guidelines, which call for transfusions only when the hematocrit, or concentration of red blood cells, falls to 24. *
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