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Computerized Physician Order Entry Improves Compliance With a Manual Exchange Transfusion Protocol in the Pediatric Intensive Care Unit

McCrory, Michael C. MD; Strouse, John J. MD, PhD; Takemoto, Clifford M. MD; Easley, R. Blaine MD

Journal of Pediatric Hematology/Oncology: March 2014 - Volume 36 - Issue 2 - p 143–147
doi: 10.1097/MPH.0b013e31828e55e6
Original Articles

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:

Received October 16, 2012

Accepted February 20, 2013

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