Making blood transfusions safer

In March 2018 I joined the software development team of the Hôpital du Valais, a group of eight hospitals in Switzerland.

The software that is used at the hospital is purchased from an external company, but there is a possibility to create custom pages or “forms” within it. A little while back those customised forms had to be built with a very restrictive visual composer included in the software, but recently the software provider allowed for web-forms to be embedded.

It had been decided that the first project to be implemented with the web technology was a form that allows nurses to register blood products before they are transfused.

More than UI design

Unlike most consumer products, the context in which software is used in a hospital is highly specific.

  • Are there always enough computers available?
  • Is the connection good enough in the patient room?
  • What other touch points does the user need to handle while using the software?
  • How are the different users communicating with each other?

To answer these questions, we conducted intensive fieldwork along the journey of the blood product – from the lab to the transfusion.

Considering best practices

The process of blood transfusion is regulated and certain rules must be followed. For example, a patient’s identity can be verified by scanning the patient’s wristband, but requires a double control by the nurse.

To understand if there were gaps between best practices and the reality at the hospital we interviewed experts and conducted extensive desk research, including the following sources:

Handling research findings

To better understand which points of the transfusion process could be improved by our application, I visualised all research findings in a user journey. I accentuated on two main areas: patient safety and efficiency of the process. Here are some of the things we discovered:

The process is very time consuming – With the current solution two nurses are needed to control the compatibility between patient and blood product. There is no digital support, even though the required information exists in the system.

Use of paper increases likelihood of errors – Once the blood product leaves the laboratory, the only information about which patient the product is intended for is a piece of paper attached to the blood bag. If an error occurs in the lab when attaching the card, there is a high risk that the error is not discovered before the transfusion.

Transfusion reactions are not documented sufficiently – The documentation of transfusion reactions often gets neglected because the required form is hard to find. This makes it hard to establish quality control.

The solution

The new user interfaced is a web-form built with Google Material components.  When the form is opened it directly displays the patients blood type, past transfusions and reactions and a bold button invites the user to add a new blood transfusion.

Consistent user interface – The form includes a header with main actions as well as a sidebar with crucial patient information.

A new one person workflow thanks to a bar code scanner – A nurse can now scan the blood product and patient bracelet which triggers a control in the laboratory database. This replaces the control by a second person.

Control at the point of transfusion – The bar code of the patient bracelet and the blood product are compared to the laboratory database directly before transfusion. This means nurses no longer have to rely solely on a piece of paper attached to the blood product.

Simplified documentation of transfusion reaction – The new interface includes all necessary links to make it easier to properly document transfusion reactions.

Prototyping & testing

I created a prototype with Figma and tested it with several nurses to understand if the interactions are intuitive and the copy reflects the language they use in their day-to-day work.

What’s next?

The web application is currently developed. After the release data will be collected and analysed to answer questions like:

  • Is the compatibility control always completed directly before transfusion? (time of compatibility control vs. time of actual transfusion)
  • Are all transfusion reactions reported correctly? (transfusion reactions documented vs. transfusion reactions reported)