Can a pop‐up stop a TACO ? A best practice advisory alert as a clinical decision support tool to mitigate the occurrence of transfusion‐associated circulatory overload

BACKGROUND: Transfusion-associated circulatory overload (TACO) prevention requires identification of susceptible patients and enactment of appropriate mitigation strategies. We implemented a clinical decision support (CDS) tool at our institution to reduce TACO occurrence by alerting transfusing clinicians to at-risk patients. METHODS AND MATERIALS: A CDS tool was designed to screen patient charts for TACO risk factors (age > 60, renal/cardiac impairment and prior TACO) at the time of inpatient blood component ordering through the electronic health record (EHR). The presence of risk factors triggered a Best Practice Advisory (BPA) pop-up featuring mitigation strategies. TACO rates and frequencies were compared pre- and post-BPA implementation using a Z-test. RESULTS: TACO as a proportion of transfusion reactions decreased 40% from 9.6% (406/4208) to 5.8% (47/804) in the 941 days after BPA implementation (z = 3.44, p = 0.00056). TACO frequency decreased 44% from 1 of 11.2 days to 1/20.0 days post-BPA (z = 4.00, p < 0.00001), while overall reaction frequency decreased 8% from 1 of 1.08 days to 1 of 1.17 days (z = 7.31, p < 0.00001). Among 47 post-BPA TACO events, 38 were subjected to the CDS algorithm, with the BPA firing for 4 of 36 (11%) of cases with TACO risk factors. CONCLUSIONS: TACO rates decreased at our institution following BPA implementation, despite BPA under-firing. Ongoing monitoring for BPA sustained effects is needed.