Michael C McCrory1, John J Strouse, Clifford M Takemoto, R Blaine Easley. 1. *Departments of Anesthesiology and Pediatrics, Pediatric Critical Care, Baptist Hospital, School of Medicine, Wake Forest University, Winston-Salem, NC †Department of Pediatrics, Pediatric Hematology, Johns Hopkins University School of Medicine, Baltimore, MD ‡Departments of Pediatrics and Anesthesiology, Cardiovascular Anesthesiology and Critical Care, Texas Children's Hospital/Baylor College of Medicine, Houston, TX.
Abstract
AIM: To evaluate the use of a computerized physician order entry (CPOE) protocol on manual red blood cell (RBC) exchange transfusion in critically ill children with sickle cell disease. METHODS: We conducted a retrospective study of children with sickle cell disease who received a manual RBC exchange transfusion before (2001 to 2008, n=22) and after (2008 to 2009, n=11) implementation of a CPOE protocol. Outcomes included compliance with protocol, percentage reduction in sickle hemoglobin, and peak hemoglobin during exchange. RESULTS: Compliance with the manual exchange protocol improved after introduction of CPOE (pre-CPOE: 20 protocol violations vs. post-CPOE: 3 violations, P=0.02). Percentage reduction in sickle hemoglobin also improved (pre-CPOE: 55% vs. post-CPOE: 70%, P=0.04), whereas peak hemoglobin during RBC exchange was similar (pre-CPOE: 12.0 g/dL vs. post-CPOE: 11.5 g/dL, P=0.25). However, hemoglobin levels after the mean of 7 hours of exchange were significantly higher pre-CPOE (pre-CPOE: 11.5 g/dL vs. post-CPOE: 10.5 g/dL, P=0.006). CONCLUSIONS: Use of CPOE for manual RBC exchange transfusion in children is associated with improved protocol compliance, improved reduction of sickle hemoglobin, and better maintenance of hemoglobin levels in a goal range during prolonged exchanges.
AIM: To evaluate the use of a computerized physician order entry (CPOE) protocol on manual red blood cell (RBC) exchange transfusion in critically ill children with sickle cell disease. METHODS: We conducted a retrospective study of children with sickle cell disease who received a manual RBC exchange transfusion before (2001 to 2008, n=22) and after (2008 to 2009, n=11) implementation of a CPOE protocol. Outcomes included compliance with protocol, percentage reduction in sickle hemoglobin, and peak hemoglobin during exchange. RESULTS: Compliance with the manual exchange protocol improved after introduction of CPOE (pre-CPOE: 20 protocol violations vs. post-CPOE: 3 violations, P=0.02). Percentage reduction in sickle hemoglobin also improved (pre-CPOE: 55% vs. post-CPOE: 70%, P=0.04), whereas peak hemoglobin during RBC exchange was similar (pre-CPOE: 12.0 g/dL vs. post-CPOE: 11.5 g/dL, P=0.25). However, hemoglobin levels after the mean of 7 hours of exchange were significantly higher pre-CPOE (pre-CPOE: 11.5 g/dL vs. post-CPOE: 10.5 g/dL, P=0.006). CONCLUSIONS: Use of CPOE for manual RBC exchange transfusion in children is associated with improved protocol compliance, improved reduction of sickle hemoglobin, and better maintenance of hemoglobin levels in a goal range during prolonged exchanges.
Authors: Sheila A Fisher; Annemarie B Docherty; Carolyn Doree; Stephen P Hibbs; Michael F Murphy; Lise J Estcourt Journal: Cochrane Database Syst Rev Date: 2017-02
Authors: Lesley J J Soril; Thomas W Noseworthy; Laura E Dowsett; Katherine Memedovich; Hannah M Holitzki; Diane L Lorenzetti; Henry Thomas Stelfox; David A Zygun; Fiona M Clement Journal: BMJ Open Date: 2018-05-18 Impact factor: 2.692