Safety and Efficiency Considerations for the Introduction of Electronic Ordering in a Blood Bank by ProQuest


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									Safety and Efficiency Considerations for the Introduction
         of Electronic Ordering in a Blood Bank
                 Andrew Georgiou, MSc; Tony Greenfield, MHA; Joanne Callen, PhD; Johanna I. Westbrook, PhD

● The introduction of computerized provider order entry                      The implementation of computerized provider order en-
(CPOE) systems is associated with major changes in work                   try (CPOE) systems provides a possible foundation for en-
processes. Implementation strategies need to consider how                 hancing the role of pathology services in the patient care
the technology will affect and be affected by the organi-                 process.4 These systems enable doctors, and other autho-
zation in which it is being installed. The aim of this study              rized clinicians to issue orders electronically, leading to
was to examine the potential effect of the introduction of                efficient order communication and decision support at the
a CPOE system on key work processes in a hospital blood                   point of ordering. However, CPOE introduction can also
bank by using qualitative data from focus groups, inter-                  be associated with important and disruptive changes to
views, and participant observation and quantitative data of               laboratory and clinical professionals’ work practices and
telephone communication. We found that work practices                     processes.5 The planning and implementation of these sys-
in the blood bank are made up of a mosaic of collaborative                tems requires consideration of how the technology will
processes underpinned by communication channels to fa-                    both affect and be affected by the organization in which
cilitate safe and efficient work practices. The introduction               it is being installed.6 This is of particular importance for
of CPOE systems requires consideration of these channels                  pathology departments, which consist of a diverse range
and of the ways that CPOE may disrupt existing commu-                     of services, each with its own unique tasks and require-
nication processes. There needs to be high levels of staff                ments.2
preparedness to minimize patient risk and optimize per-                      Pathology services have received limited attention in the
formance.                                                                 research literature on CPOE,7 with even less consideration
   (Arch Pathol Lab Med. 2009;133:933–937)                                of specific pathology departments and their particular or-
                                                                          ganizational and technical features. The blood bank was
                                                                          chosen for study because of the critical role it has in the
P   athology services have been described as the ‘‘hidden
      science that saves lives.’’ 1 They make an essential con-
tribution to the effective prevention, detection, and man-
                                                                          safety and quality of patient care. Our aim was to describe
                                                                          key work processes of laboratory professionals within a
                                                                          hospital blood bank and examine the potential effect of
agement of disease but are still widely perceived as a                    the introduction of CPOE systems by using qualitative
backroom function,2 with many people unaware of their                     data from focus groups, interviews, and participant ob-
vital, ongoing importance.1 There are many signs that this                servation and quantitative data of telephone communica-
situation is changing, particularly with the emphasis on                  tion.
the role of pathology in patient pathways beginning with
the selection of the most appropriate test or investigation                                        METHODS
onto the interpretation and provision of clinical advice                                   Design and Research Setting
across many clinical specialties.2 Information and com-
                                                                             The study was carried out in the blood bank of a 600-bed
munication technology has a critical part to play in this
                                                                          teaching hospital in Sydney, Australia, which provides a net-
development. This technology is a central feature of pa-                  worked blood banking service throughout a large metropolitan
thology laboratories, particularly in complex hospital set-               area and is involved in the investigation of antibodies and trans-
tings reliant on the efficient management of information                   fusion-related issues. The blood bank has 13 full-time equivalent
for patient care.3                                                        staff, including 5 scientists and 8 technical officers/assistants.
                                                                          There are also 6 hematologists available on site. It is part of a
                                                                          pathology service made up o
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