West Suffolk Hospital (WSH) NHS Trust based in Bury St Edmunds is a busy District General Hospital that covers 600 square miles and serves a population of 275,000 offering 460 beds to patients across the East of England. With departments including Day Surgery, Macmillan cancer unit, Critical Care and Accident & Emergency, WSH strives continually to offer patients the highest levels of care and patient safety so that they return to full health as quickly as possible.
WSH Trust prides itself on its ‘Patients First’ standards developed to ensure that patients always feel safe, cared for and fully confident of their treatment at the hospital. Patient safety is top of the WSH’s list and with a nationwide rise in the incidence of incorrect blood components transfused (across the UK there were 47 reports of ward based blood administration errors in 2008*), the staff remain constantly aware that accidents could occur if processes were breached. Such was the seriousness of the situation, hospitals nationwide started consideration of the NPSA National Patient Safety Agency's ( NPSA) framework for reporting and learning from serious incidents, which recommended better identification procedures for blood transfusions.
‘Right Patient, Right Blood’ process comes into practice:
The National Haemo Vigilance Scheme identified one of the main areas of risk of blood transfusion errors as being ‘from the point of collection from the storage fridge; to the site of transfusion; to the right patient’.
As such, WSH decided to maximise transfusion safety through the use of an electronic system that prints labels for blood transfusion samples, releases blood products from storage by matching product barcodes with patient identification barcodes and enables confirmation that the product is intended for the patient by matching the product barcode with the electronically generated bar coded patient wristband via the blood tracking software. Ashley Lewis, IT Project Coordinator, takes up the story:
“In the past, we used to rely on staff diligence and a system of manual checks and cross checks. It was always a concern though with over 350 staff requiring access to the blood bank that room for human error was always there. We wanted a watertight system that not only tracked that the correct blood was collected for the correct patient, but also that it was given to the correct patient and that it would alert the nurse if the recommended time out of controlled temperature storage was exceeded.”
Ashley approached mobile data specialists, Fordman Systems Ltd, to find out more about their Portable Blood Audit Release System (PBARS) software. Fordman, experts in the provision of healthcare software, have since 1999 been working with healthcare professionals to make transfusion errors a thing of the past. To run the software, Fordman recommend the use of mobile handheld devices. Having experienced problems with other handheld machines during the initial project implementation phase at WSH, Fordman recommended the Casio IT-800 which features an integrated C-MOS imager for logging 1D and 2D barcodes. When run together, the resultant Portable Blood Audit and Release system (PBARS) is simple to use and understand and is based on a series of barcode scans to access information or match and secure the correct blood product barcodes.
A mobile system required:
Selection of the Casio IT-800 wasn’t just based on the integrated barcode technology. Gilda Bass, a Blood Transfusion Specialist at the WSH is one of the key users of the system and elaborates further: - “We had a number of key criteria that we worked closely with IT on when commissioning the handheld PDAs. Reliability and robustness were obvious essentials working in this high pressure environment. Plus with the units being spread across several high blood use wards, we were looking for a truly mobile system that allowed seamless Wi-Fi connection.”
Hence the team were pleased to enable the integrated wireless feature within the Casio IT-800 that allowed them to transmit data from the bedside, general wards, operating theatres or wherever, automatically connecting to the Trust’s secure wireless network in order to send and receive data from the Blood Audit Release system.
Multiple users with a long working day
Administering blood at WSH is a 24 hour a day operation spread across multiple wards, therefore it was critical that the accompanying handhelds were not only easy to use, but that they were lightweight, slim and portable and could endure the rigors of shifts that span across 12 hours between recharge. Ergonomics testing in the Fordman/WSH review and acceptance meetings proved the Casio IT-800 to be easy to hold, easy to use and backed by a battery life of 12 hours for ultimate longevity.
The trial begins:
Pleased with the findings and advice from the reviews with Fordman, in the spring of 2010, WSH’s IT department and fifty users began an extensive six week trial of the Portable BARS system. Ashley reflects on the results. “Firstly, it’s really important with so many users that we received positive feedback about how easy the device was to use. Training was conducted easily and users quickly learned that just by pointing and clicking, the IT-800 efficiently picked up barcodes whilst also allowing manual keyboard input. Of equal importance was also the fact that we had no returns or glitches of the units within the six week trial.”
PBARS rollout begins:
With the trial successfully concluded, in September 2010 the WSH rolled out a suite of PBARS units across 5 high blood use departments.
Out on the wards, the system captures all relevant information including the unique identifier of the staff, patient details, ward, compatibility, times, dates and actions performed, providing a complete audit trail for compliance whilst ensuring the patient identification information is the same as the original patient identification wristband. The WSH uses the Casio IT-800s to obtain full reports on any of the activities that have taken place; either with patient or blood product. Hence at a click, patients’ medical records can be updated to reflect staff ID, donor numbers, blood groups, time blood is collected from fridge, time transfused and time blood pack is returned if unused. (This is a valuable feature when you consider the depletion of blood stocks across the UK).
Communications occur in real time across the secure Wi-Fi connection allowing true portability across the hospital and inter-departmental data sharing.
For the future, Ashley notes. “Now we have proven that the PBARS system is running effectively, we can envisage further applications for the Casio IT-800. Secure drug dispensing is one such area; as is tracking of total patient care plans from time of admittance to discharge from our care.”