Evaluation of a Pre-Filled Table and a Flowchart-Based Algorithm as Cognitive Aids to Reduce Deviations in Dose...

Area of Science:

• Pediatric Anesthesiology
• Transfusion Medicine
• Patient Safety

Background:

• Accurate dosing of red blood cell concentrate is critical for pediatric transfusions.
• Existing guidelines exist, but adherence can be challenging.

Purpose of the Study:

• To evaluate the effectiveness of cognitive aids in improving pediatric transfusion dose calculations.
• To assess if cognitive aids enhance adherence to German National Transfusion guidelines.

Main Methods:

• Four online questionnaire scenarios were used, involving pediatric anesthetists.
• Scenarios included hemodynamically stable and unstable children.
• Cognitive aids tested were pre-filled tables and algorithms, with deviations classified into three categories (DRV120, DRV300, DRV1000).

Main Results:

• Pre-filled tables reduced DRV120 deviations by 60% and DRV300 deviations by 17-20%.
• Algorithms reduced DRV120 deviations (15-20%) but increased DRV300/DRV1000 deviations in unstable cases.
• Unassisted, participants used higher transfusion thresholds in emergency/unstable pediatric cases.

Conclusions:

• Cognitive aids, particularly pre-calculated tables, improve adherence to pediatric transfusion recommendations.
• These aids can potentially minimize dosing errors outside recommended transfusion guidelines.
• Careful selection of cognitive aids is necessary, as algorithms may increase deviations in critical scenarios.