1.0 General queries

1.1 Why is this pilot being carried out?

The IT specification (the Electronic Clinical Transfusion Management System – ECTMS) which is being piloted was developed by the National Patient Safety Agency (NPSA) in conjunction with the National Blood Transfusion Committee (NBTC) and the Serious Hazards of Transfusion (SHOT).

It is based on work carried out for NHS Connecting for Health (NHS CFH) by the Do Once and Share (DOAS) Blood Transfusion Project Team at the Oxford John Radcliffe hospital. Incidents reported to SHOT showed that ABO incompatible blood transfusion was an area of concern for patient safety.

Between 1996 and 2004 five patients died as a direct result of being given ABO incompatible blood. ABO incompatibility also contributed to the deaths of a further nine patients and caused major illness in 54 patients.

The NPSA set a goal of reducing the number of ABO incompatible transfusions by 50% over 3-5 years from 1 January 2005 as measured by the SHOT database.

This was to be achieved essentially through improved methods and procedures for ensuring a correct match between patients and the blood being administered as described in the Safer Practice Notice.

1.2 What are the major steps in setting up the pilot?

Setting up the pilot involved three tenders - for the electronic blood tracking system; the wi-fi based asset tracking system; and, for RFID wristbands and associated hardware.

There has also been baseline data gathering for comparison with data gathered after the system is in place and working effectively. All staff involved needed to be appropriately trained.

1.3 What are the deadlines for the pilot?

Setting up the pilot will be completed in July 2008 and it will then run for a year to test its effectiveness and identify any problems and potential changes. Subject to any unforeseen difficulties, the report by the Trust to NHS CFH will be delivered by July 2009.

2.0 Queries about the aims and organisation of the pilot

2.1 What is the aim of the pilot?

The primary aim is to pilot the IT specification (the ECTMS – (see question 4.1 below) in a non-teaching hospital that is also smaller than the John Radcliffe where its development was based, with a view to developing an IT system which could be readily adopted by other hospitals. A secondary aim is to develop a system which could be readily adapted to other areas of healthcare delivery (see question 5.1 below).

2.2 Why is Mayday carrying out the pilot?

The pilot was advertised on the NHS CFH website and organisations which were interested in carrying out this project were asked initially to express an interest and then to complete an application form.

Twenty-one trusts submitted applications. Shortlisting was by a panel of experts in relevant disciplines and seven organisations were invited to make a presentation to the panel and discuss their proposals in detail on 28 November 2006. Mayday Healthcare NHS Trust was considered the organisation that met all the criteria and had the best plan for the pilot.

2.3 What were the criteria for selection for the pilot?

Please visit the criteria for selection.

2.4 What are the deliverables for the project?

On completion of the pilot, the Mayday will deliver a report to NHS CFH detailing the following:

• system – kit, software and related procedures and protocols – introduced
• actions required to design and install the system
• project management, technical and administrative skills and support needed to implement the system
• changes in clinical and other working practices required to implement the system
• what went well, and badly, around implementation (including, for example, issues around training, maintenance, utility of the equipment, unforeseen problems)
• response of clinical and other staff to the system
• efficiency, effectiveness and reliability of the system particularly in terms of ensuring the correct matching of patients and blood
• deficiencies or problems identified with the system and its use
• lessons learned from the pilot which would be of potential relevance to other users of the system
• analysis of the costs of system design, planning, implementation and operation
• ideas for capturing and sharing the learning from this experience.

3.0 Queries about the technologies being used in the pilot

3.1 What technologies were used in the pilot?

The pilot is using both barcoding and radio frequency identification (RFID) technology.

Patient wristbands will also have passive RFID chips and are read electronically by staff using hand-held readers, to check each patient's identity and to ensure that patients get the right blood.

Staff identification badges will incorporate a barcode which is scanned to identify staff using the blood tracking system. Doctors ordering bloods will look up patient specific information by scanning a barcode on the wristband containing the patient's NHS Number or local hospital number if the NHS Number is not available.

Sample tubes labels are printed with a barcode linking the sample to the order for bloods and patient details on the Pathology Laboratory Information System (PLIMS). The compatibility label on the blood bag has a 2D barcode on it containing patient specific data. This is scanned as part of the checking process before transfusion.

3.2 Why did the pilot using two different technologies?

Passive RFID was used in patient wristbands for the purpose of storing patient data which will be used for identification. The pilot did not involve tracking patients which would need active RFID.

Intended use of active RFID is to electronically track the journey of the blood once it leaves the Issue fridge until it is transfused into the patient.

On the patient wristband, the information output when scanned from the RFID chip isdentical to that stored in the 2D barcode. Should the Chip become unreadable in any way, the 2D barcode can be scanned. The RFID chip however is gernerally much more resilient than a barcode which can fade over time and become difficult to scan.

3.3 Why is IT being used to reduce transfusion errors?

The work done at the John Radcliffe, as well as evidence from other sources, shows that blood safety is an area in which modern information technology can have a key role in ensuring the reliability of checking procedures and reducing the potential for error.

4.0 Queries about the ECTMS

For more information please visit Pilot site: Mayday NHS Trust.

4.1 What is the ECTMS?

The Electronic Clinical Transfusion Management System (ECTMS) is a specification that focuses on the steps in the transfusion pathway and is relevant to both barcoding and radio frequency identification (RFID) technology.

It identifies all the safety and functionality issues that the NPSA were aware of when it was developed and that future systems will need to address.

The ECTMS addresses the requirements of the 2005 Blood Safety and Quality Regulations (Medicines and Healthcare Products Regulatory Agency, MHRA) to maintain a complete record for all blood components and products from donor to recipient for 30 years.

The specification for an ECTMS is based on a widely-used Software Requirements Specification (SRS) template (Weigers et al, 2003) with some minor modifications by the NPSA. The implementation of an ECTMS will require more than the development of software, as it will need to be integrated with, for example, server hardware, client devices and remote terminals. In this respect the project can be seen as one of systems engineering rather than software engineering per se.

4.2 What is new about the ECTMS?

The ECTMS requires adaptations to existing software and kit. Technology exists which could be used with either a barcode or radio frequency identification (RFID) system or both.

The pilot required Mayday to:

1. work with suppliers to identify and source appropriate kit and develop the necessary software for an IT system which will achieve the desired aims; and
2. install and implement the system on a sufficient scale and over a sufficient period of time to provide a reliable test of its effectiveness and to allow detection and correction of teething problems.

5.0 Queries about wider use of the system being piloted

5.1 Is the IT system just for blood transfusion?

The pilot has focused on the safe management of blood transfusions. In the longer term, systems developed for blood safety could be applied to other areas of healthcare delivery, including, for example, pharmacy, medication administration, radiology and pathology.

6.0 Queries about the use of coding standards

6.1 What coding standard has been used?

The GS1 identifier was used in this pilot. Staff involved in the pilot have been in touch with colleagues in NHS CFH who are working on auto-ID and data capture technologies and the related purchase of GS1 identifiers.

The Mayday pilot is one of the early adopters for the GS1 identifiers which were recommended by the Department of Health in 2007 (Coding for Success) for use throughout the NHS in England.

7.0 Queries about evaluation of the pilot

7.1 Will the pilot be evaluated?

Mayday has evaluated the system from the point of view of its effectiveness for managing blood and reducing the likelihood of errors in blood transfusions, and its potential applicability to other areas of healthcare delivery.

NHS CFH has also funded, through the NHS CFH Evaluation Programme, a full independent evaluation of the pilot, which Mayday has facilitated.

The evaluation is being led by Professor Jonathan Kay and Professor Abdul Roudsari from City University, London. Find further details (PDF 27Kb).

8.0 Other queries

These Questions and Answers will be supplemented as the pilot progresses. If you have queries about the pilot which are not answered here or on our website please email them to clinical.safety@nhs.net

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