John Radcliffe Hospital, Oxford

Reduced risk and cost with iSOFT labs solution

The risk of blood transfusion errors is reduced significantly at the John Radcliffe Hospital after investments in IT from iSOFT and Olympus.

Blood transfusion errors are a significant risk, with possible fatal consequences, which is greater in large hospitals like the John Radcliffe Hospital, part of the Oxford Radcliffe Hospitals NHS Trust, which gives 30,000 transfusions a year.

The Serious Hazards of Transfusion (SHOT) scheme in 2005 recommendations included more computerisation and barcode technology to ensure the right blood is always administered.

Other schemes have been tried including having specially trained nurses for all transfusion procedures. But, as well as being costly, they have been ineffective in preventing transfusion errors.

Added pressure for all NHS trusts stems from two European Blood Safety Directives that are now UK law. These set standards for quality and safety for the collection, testing, processing, storage and distribution of blood and blood components and apply to the UK Blood Services and hospital blood banks.

With an end-to-end IT solution, the risk of mistakes at the John Radcliffe is minimised and is in line with the National Programme’s principle of 'do once and share'. Central to this is iSOFT’s i.Laboratory TP (i.Lab TP) solution which acts as the main hub and interfaces to a range of other applications including the Olympus BloodTrack suite of applications.

The solution provides full traceability from when blood units enter the hospital to the time it is given to patients. “Traditionally, the NHS has done fantastically well in tracking blood into the fridge, but not so well in positively tracking units to patients,” says blood bank manager Julie Staves. “Now there is full traceability and full audit trail to track blood at every stage to ensure patients get the right blood every time.”

The whole system is designed so that users are compelled to adhere to certain actions such as checking a patient’s identification wristband.

The recent introduction of the electronic dispatch note (EDN) has had a marked impact, making the process of receiving blood units from the National Blood Service (NBS) into the hospital blood transfusion laboratory quicker and safer.

Previously, the process was largely manual, with staff having to scan five barcodes and enter six carriage returns. The risk of them getting distracted during the laborious process and inputting the wrong information was increased due to the busy laboratory and the tedious nature of the task.

Now, i.Lab TP is linked directly to the NBS Pulse system so that unit information is uploaded to a secure website and from there is downloaded to i.Lab TP. All that remains is for staff to check that the units dispatched by the NBS and those received in the blood bank correlate.

With this relatively simple process, the number of steps is reduced with just two barcode scans needed. There are other benefits including time savings. The time needed to book in a box of red cell units averaged 20 minutes; now that time has been halved.

The solution is also reducing the need to order additional or emergency blood stocks from the NBS. Staff are now able to check first whether units with the required antigen status are stored within the trust’s own stocks. Despite being on the same site as the trust’s blood bank, the local NBS charges the UK standard cost of £25 for each additional delivery and each unit of blood costs a standard £130. Locating and using existing stocks is saving money and also cutting wastage, as these stocks might otherwise sit in the fridge unused.

Another significant change is a vending machine to store blood at the point of use. Blood is no longer assigned to individual patients but stored by type in the vending machine. Again, this cuts wastage as units are taken as they are needed. And, in emergencies blood is available immediately, whereas before a porter might take 20 minutes to collect a unit from the blood bank.

The trust’s spending on blood and blood products is down 12% to £5 million. Julie Staves says these savings are mostly down to the IT developments and the associated training. “iSOFT and Olympus have worked with us to develop an end-to-end solution to improve safety by eliminating the risk of human error,” she said. “By also improving efficiency and reducing wastage we are making massive cost savings.

“The i.Laboratory TP solution is central to everything. It controls the whole process and movement of blood stocks around the hospital. Without it, nothing else would work.

“We work as a team with iSOFT and Olympus,” she added. As an example, the John Radcliffe has been instrumental in helping iSOFT develop and beta test the EDN functions that are available to all users in the next release of i.Laboratory TP.

“iSOFT is willing to listen to ideas and provide the support and know-how to make them a reality,” Staves said.

Download PDF