Designing and implementing a clinical decision support tool to improve compliance with NICU transfusions

Infants in a neonatal intensive care unit (NICU), out of all hospitalized patients, are among those with the highest likelihood of receiving blood products. Because liberal transfusion strategies can be harmful, transfusion risks should be weighed against potential benefits. In the adult population, implementing electronic clinical decision support (CDS) tools for transfusion have resulted in decreased transfusion rates, conservation of resources, and lower costs. The NICU at the University of Utah Hospital has transfusion guidelines, but a recent audit indicated that a considerable proportion of transfusions were not compliant. Clinicians indicated that one reason for guideline deviation is not having guidelines immediately available in a timely reminder during the transfusion ordering process. Therefore, we built a new electronic transfusion CDS tool for our NICU. To our knowledge, this is the first report of an electronic health record-based CDS tool for both red blood cell and platelet transfusions in a NICU.