Aim: To evaluate the use of a computerized physician order entry (CPOE) protocol on manual red blood cell (RBC) exchange transfusion in critically ill children with sickle cell disease.
Methods: We conducted a retrospective study of children with sickle cell disease who received a manual RBC exchange transfusion before (2001 to 2008, n=22) and after (2008 to 2009, n=11) implementation of a CPOE protocol. Outcomes included compliance with protocol, percentage reduction in sickle hemoglobin, and peak hemoglobin during exchange.
Results: Compliance with the manual exchange protocol improved after introduction of CPOE (pre-CPOE: 20 protocol violations vs. post-CPOE: 3 violations, P=0.02). Percentage reduction in sickle hemoglobin also improved (pre-CPOE: 55% vs. post-CPOE: 70%, P=0.04), whereas peak hemoglobin during RBC exchange was similar (pre-CPOE: 12.0 g/dL vs. post-CPOE: 11.5 g/dL, P=0.25). However, hemoglobin levels after the mean of 7 hours of exchange were significantly higher pre-CPOE (pre-CPOE: 11.5 g/dL vs. post-CPOE: 10.5 g/dL, P=0.006).
Conclusions: Use of CPOE for manual RBC exchange transfusion in children is associated with improved protocol compliance, improved reduction of sickle hemoglobin, and better maintenance of hemoglobin levels in a goal range during prolonged exchanges.
*Departments of Anesthesiology and Pediatrics, Pediatric Critical Care, Baptist Hospital, School of Medicine, Wake Forest University, Winston-Salem, NC
†Department of Pediatrics, Pediatric Hematology, Johns Hopkins University School of Medicine, Baltimore, MD
‡Departments of Pediatrics and Anesthesiology, Cardiovascular Anesthesiology and Critical Care, Texas Children’s Hospital/Baylor College of Medicine, Houston, TX
The authors declare no conflict of interest.
Reprints: Michael C. McCrory, MD, Departments of Anesthesiology and Pediatrics, Pediatric Critical Care, Baptist Hospital, School of Medicine, Wake Forest University, Medical Center Boulevard, Winston-Salem, NC 27157 (e-mail: email@example.com).
Received October 16, 2012
Accepted February 20, 2013