In Focus
Importance of data quality in IT systems
Setting up the National Registry of Blood Donors in Poland
Jolanta Antoniewicz-Papis Institute of Hematology and Transfusion Medicine Warsaw, Poland
Quality and risk management are indispensable for the preparation of safe blood and blood components for clinical use.
Implementation of the National Registry of Blood Donors (NRBD)
Information systems are tools that support risk management and contribute to donor and recipient safety and the implementation of new, improved treatment standards. The main task of modern transfusion medicine is the continuous advancement and improvement of the safety and quality of the practical procedures. This can be achieved through introducing information systems, processes involved in donor recruitment as well as in the collection, testing, preparation, issuing and transfusion of blood and blood components, and quality issues. The project "The setting-up of the National Registry of Blood Donors (NRBD)” was the most important contribution to risk management and quality management in the Polish BTS. The overall aim of the project was to strengthen the activity of blood establishments (BEs) by providing access to public services online; the immediate aim was to create a digital platform for faster flow of information between establishments as well as to ensure the safety of the transmitted data. Before introducing the NRBD, 23 BEs relied on various, sometimes self-modified information systems, which resulted in a large variety of formats and scope of data, even within a single BE. The lack of uniform and fully reliable BTS data became a problem when analysis and evaluation on both national and international levels were required. The implementation of NRBD provided a uniform electronic platform for all establishments, ensured data uniformity, reliability, and systematic information flow. The goal of NRBD implementation was optimal blood use and good blood management. Thanks to the system, test results performed in one BE became available to all other BEs which helped monitor donor deferrals for different health reasons, including infectious viral markers.
The project consisted of 4 main components:
- Central – information about donors and donor candidates who donated blood at any BE in Poland
- IHiT – supports all transfusion medicine-related activities at the competent authority supervisor activity
- BE – monitors all activities of BEs from donor registration to issuing blood components. It also covers the activities related to quality assurance and hemovigilance.
- HBB –complete software for hospital blood banks.
Non-compliance in IT systems
As BEs were connected to the common database one by one, data incompatibility was expected due to the risk of mistakes and data confusion during donor and blood registrations at different locations. The risk of non-compliance was estimated as significant because each BE relied on independent recording systems at the main collection site, local collection sites and mobile units. Moreover, apart from the new digital information systems, paper documentation was still in use. Data of 2.5 million donors and 2.7 million donations were finally transferred to the common database. Some BEs transferred data from only a several year period. Analysis revealed that not all data was transferred and that some transferred data was incomplete. An analysis of detected inconsistencies was performed in the entire range of transmitted data, ie. name, surname, place of residence, blood group, date of last donation, and the cause of deferral.
The most frequently occurred errors were:
- Discrepancies between dates of donor registration, donations and visits to the BEs
- Lack of registration date for numerous donors
- Discrepancies in the spelling of the donors' names
- Incorrect date of birth (eg. donor donated blood at the age of 2)
- No information of the last donation (date and method of collection) for approx. 70 - 95% deferrals depending on the BE.
Furthermore, discrepancies in individual causes for deferral eg. permanent deferral was imposed several times at different intervals or on the same day, etc were noticed.
Non-compliances detected in ABO and RhD blood grouping were of particular importance as they put the recipients' safety at immediate risk. Cases were reported where the same donor identification number was transferred from different BEs with different blood groups: ABRhD- and BRhD- or ORhD+ and ARhD+ or ARhD+ and ARhD-. Errors of this kind are extremely dangerous, because transfusion of incompatible blood group is one of the main causes of severe adverse reactions. We found 461 such cases in the total number of transferred data.
Summary
The importance of IT systems in the management and risk management of blood establishments is steadily growing. NBDR has demonstrated how much can be achieved in this field as well as has signaled the objectives to be achieved in the near future for further strengthening of donor and patient safety as well as improvement of BTS. Implementation of the system resulted in more effective donor management; it was found supportive in everyday activities of the blood establishment; it was used for plan development, reports, identification and supervision of employees’ work, it facilitates in-depth blood traceability with respect to operators and date of performance. The problem is getting all the hospitals on the same system. Currently, hospitals performing blood transfusions use different IT systems. This makes it difficult to collect all the data in the same way. A new IT systems should being developed to make it easier to collect data. Particular attention is always paid to patient’s safety. Transfusion-associated errors are the main cause of health deterioration and sometimes death. Errors may be attributed to lack of information on previous transfusions or test results. New technologies can be helpful here, eg. access to a central database with up-dated information on the same patient coming from different hospitals. However, it is extremely important to ensure that the data transferred to the IT systems are reliable and correct.
