The University of Iowa Hospitals and Clinics administers over 33,000 units of blood components annually. The process is complex because of its multiple steps and involvement of many different staff and departments. Although institutional error rates for blood component administration are historically very low, UI Hospitals and Clinic's culture of excellence in patient care plus an emphasis on increased patient safety dictate an exploration of this opportunity to reduce rates even further.

As a first step, a Department of Nursing team trialed multiple patient identification (PID) bands, looking for a band that supported bar code, was comfortable, latex free, and impermeable to fluids. The house-wide roll out of this new band supported the 2005 JCAHO patient Safety Goal Improve the accuracy of patient identification. This initiative also set the stage for the new blood products process.

An interdepartmental team from nursing, pathology, information technology, blood bank, and physicians collaborated to create and test the new programming for blood products processes. The system was piloted on the Clinical Cancer Center, 4JPE Hematology and Oncology unit, 3JCE/W Pediatrics, MICU, and 7RCW Bone Marrow Transplant units. These nursing, pathology and blood bank staff members gave valuable insight and feedback, bringing to light problems and issues which were solved prior to full house implementation. The interdepartmental team analyzed data, modified programming, wrote policies and procedures, purchased and installed equipment, educated staff, and rolled the process out house-wide.

Following correct identification of the patient, the new process requires bar code scanning at each of the major hand-offs: Sample Collection, Sample Arrival in Blood Bank, Product Dispense from Blood Bank, and Product Transfusion. Using a mobile wireless computer, the PID is scanned first, and the sample or product is matched to the patient. The computer alerts users to a match, or an error. Scanning errors initiate a bright red color on the screen, and must be corrected before proceeding. Nurses historically used a colleague as a 'second checker' for sample collection and blood administration. The computer itself now serves this purpose, increasing clinical efficiencies.

The program keeps track of every transaction, allowing scrutiny of the data for quality improvement purposes. Data show that the new bar code process captures potential errors at an earlier step in the process, allowing clinicians to self-correct in a timely manner. The new bar code process is safer for patients and more efficient for nurses!

Members of the Interdepartmental Team

• Loreen A. Herwaldt, MD, Professor of Medicine and Associate Professor of Epidemiology
• Lee Carmen, Chief Information Office and Director, Health Care Information Systems
• Romy Bolton, Coordinator, Quality Management, Health Care Information Systems
• Linda Chase, RN, Senior Assistant Director, Department of Nursing Services and Patient Care
• Lynn Comried, RN, Advanced Practice Nurse, Research, Quality and Outcomes Management, Department of Nursing Services and Patient care
• Sue Dane, Applications Development Manager, Administration, Department of Pathology
• Deborah Greene, Program Associate II, Administration, Department of Pathology
• Barbara J Hannon, RN, Advanced Practice Nurse, Central Nursing, Department of Nursing Services and Patient Care
• Charles Helms, MD, PhD, Chief of Staff, University of Iowa Hospitals and Clinics
• John Kemp, MD, Professor, Department of Pathology
• Judy Levitt, Clinical Laboratory Manager, Department of Pathology
• Steve McGrane, Applications Development Manager, Health Care Information Systems
• Aleta Porcella, RN, Advanced Practice Nurse, Nursing Informatics, Department of Nursing Services and Patient Care
• Sheri Swartzendruber, RN, Coordinator, Quality Management, Clinical Outcomes and Resource Management
• Marita Titler, RN, Senior Associate Director, Nursing Services; Director, Research, Quality and Outcomes Management, Department of Nursing Services and Patient care
• Jeff Vande Berg, Program Associate I, Clinical Outcomes and Resource Management
• Kristy Walker, Information Technology Management V, Health Care Information Systems