Transforming transfusion safety: Insights from implementing bedside electronic checks at a large UK NHS Trust 

Transforming transfusion safety: Insights from implementing bedside electronic checks at a large UK NHS Trust  

Use of bedside electronic transfusion checks (BETC) can reduce error and improve transfusion safety. Despite national recommendations in the UK supporting introduction of these systems, uptake has been limited.     

A recent study by Oyekan and colleagues reported on the implementation of BETC at a large UK National Health Service (NHS) trust with four hospitals, investigating successes and challenges encountered across stakeholder engagement, technical (digital and organisational) and staff training. These insights aim to guide future adopters in navigating the complexities and maximising the patient safety benefits.  

A phased implementation strategy (pre-pilot, pilot, main implementation) was undertaken over three years (April 2022 - March 2025) covering all inpatient areas and haematology day units. This was supported by a dedicated specialist project team including a project manager, two transfusion practitioners (one with a nursing background and one with transfusion science background) and an IT specialist. A separate governance structure was developed for project oversight.   

An electronic medical record (EMR) and electronic prescribing of blood components was in use at the Trust. The BETC system deployed used personal digital assistant devices (PDAs) which enabled users to scan their own ID, the patient’s ID band and the blood compatibility label. In addition, mobile Zebra printers generated labels for group and screen (G&S) samples.  

To evaluate the uptake of the BETC system, an anonymous survey directed at nurses, doctors and relevant healthcare support staff was developed to assess training satisfaction.   

A total of 404 PDA devices were rolled out across the Trust with 5,079 staff trained, delivered mainly by the project transfusion practitioners (TPs), supported by the hospital-based TPs. Training included competency assessments, with refresher training offered to staff needing an update. Upon completion of each training period, it was evident that training 60% of staff was inadequate for optimal BETC use and increasing to 80% staff coverage improved adoption.   

There was an initial preference by staff to use BTEC for blood administration. As the uptake of BETC devices for G&S sample labelling increased, the rate of sample rejection markedly decreased, an effect observed amongst all participating sites. Training feedback was positive and 89% of staff indicated that they required no further training.   

Early and continual stakeholder engagement (including at a very senior level), thorough training (by experienced TPs) and adaptive project management (to address unforeseen challenges) were identified as important for project success. Early adopters played a key role in championing the system and facilitating uptake. Later adopters required more engagement and extended support.   

The authors provide an excellent overview of the key challenges and facilitators to implementation of BETC that they encountered (table 1) and list of their prerequisites completed in the pre-pilot stage to allow for end-to-end usability of the new system (table 2). The limitations and the generalisability to other settings are highlighted in the discussion. The importance of integration with EMR to reduce workflow duplication and access to simulation-based training were highlighted.  

Reference:  

Oyekan F et al. Transforming transfusion safety: Insights from implementing bedside electronic checks at a large UK National Health Service trust. Vox Sanguinis; early view article. https://onlinelibrary.wiley.com/doi/10.1111/vox.70189