Background

In November 2006, the National Patient Safety Agency (NPSA) issued Safer Practice Notice 14 – “Right Patient, Right Blood: advice for safer blood transfusions”.

Part of this notice is a national IT specification which provides guidance on how to ensure that patients receive blood which is cross-matched for them “Right Patient – Right Blood”. The specification is titled, “Electronic Clinical Transfusion Management System (ECTMS)".

It was developed by the NPSA, National Blood Transfusion Committee (NBTC) and Serious Hazards of Transfusion (SHOT) and is endorsed by NHS Connecting for Health (NHS CFH) who is responsible for delivering the National Programme for Information Technology (NPfIT). It is a collaborative drive aimed at achieving vein to vein traceability of blood/ blood products and reducing blood administration errors by reducing the risk of human error.

NHS CFH funded a pilot at Croydon Health Services (Mayday) Healthcare NHS Trust, of which the main objective was the deployment of an Electronic Blood Tracking System which complied with the specifications contained in the ECTMS. NHS CFH set up a steering group to monitor progress of the pilot. Lessons learnt from the pilot have been disseminated by NHS CFH throughout the pilot to inform the NHS, Local Service Providers and suppliers how ECTMS can be delivered in an acute hospital setting.

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 the ECTMS was based on a widely-used Software Requirements Specification (SRS) template (Weigers et al, 2003) with some minor modifications by the NPSA. The implementation of the ECTMS at Mayday needed more than the development of software, as it needed 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.

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:

• 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
• 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.

Croydon Health Services (Mayday) Pilot

One of the key outcomes of the pilot was a review of the electronic blood tracking system implemented and its compliance with the ECTMS specification and Use Cases. Diagram 1 shows the IT systems, Clinicom, Winpath and BloodTrack available to the Trust to investigate potential compliance with the ECTMS specification and a summary table of the level of compliance with each Use Case. The e-Prescribing system is a future requirement. No single application could meet all of the requirements stated; an integration of systems is required.

An in-depth analysis of the Use Cases against the system implemented was undertaken. Compliance measure was grouped as follows:

• Full compliance
• Partial compliance
• Planned for future implementation
• Requiring additional resources to achieve compliance
• Compliance is achievable but cannot be physically tested at the Trust

It is acknowledged by the NHS CFH steering group responsible for the pilot that some use cases refer to nationally unavailable processes/ systems e.g. reference to Care Records System (CRS) and Electronic Patient Record (EPR) which are viewed as potential development.

Further information on ECTMS compliance can be found in the Appendices section of the Croydon Health Services (Mayday) Right Patient Right Blood report.

Download:

• The Electronic Clinical Transfusion Management System (ECTMS)
• ECTMS Use Case Compliance Review (PDF, 86.7kB)