Reduction of inappropriate use of blood products by prospective monitoring of transfusion request forms

• Published in: Medical journal of Australia 1997-11, Vol.167 (9), p.473-476
• Main Authors: Tuckfield, Annabel, Haeusler, Michael N, Grigg, Andrew P, Metz, Jack
• Format: Article
• Language: English
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Blood Component Transfusion - standards; Blood Component Transfusion - statistics & numerical data; Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis; Erythrocyte Transfusion - standards; Erythrocyte Transfusion - statistics & numerical data; Forms and Records Control; Hospital Records - standards; Humans; Medical Audit; Medical sciences; Patient Selection; Plasma; Platelet Transfusion - standards; Platelet Transfusion - statistics & numerical data; Practice Guidelines as Topic; Prospective Studies; Quality Assurance, Health Care - organization & administration; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Tropical medicine
• ISSN: 0025-729X; 1326-5377
• DOI: 10.5694/j.1326-5377.1997.tb126674.x

Objective To determine the effect of prospective monitoring on appropriateness of transfusions of red cells, platelets and fresh frozen plasma (FFP). Design Prospective interventional study. Setting Royal Melbourne Hospital (a tertiary teaching hospital), Melbourne, Victoria, March‐May 1996. Intervention The blood product request form was modified to Incorporate indications for transfusion and clinical and laboratory data. Requests were monitored by blood bank laboratory staff for conformation with hospital transfusion guidelines; non‐conforming requests were discussed with the requesting medical practitioner by the Haematology Registrar before blood products were issued. In cases of disagreement, blood products were always issued. Subjects 200 consecutive transfusion episodes for each product (red cells, platelets and FFP). Outcome measures Appropriateness of transfusion, assessed by a Consultant Haematologist according to hospital guidelines. Rates of inappropriate transfusion episodes after intervention were compared with rates in a previous study. Results After intervention, rates of inappropriate transfusion episodes fell significantly (red cells, 16% to 3% [P= 0.004]; platelets, 13% to 2.5% [P=0.02]; and FFP, 31% to 15% [P=0.02]). Almost all Inappropriate FFP transfusion episodes post‐intervention were due to failure to demonstrate prolongation of prothrombin or activated partial thromboplastin times more than 1.5 times the control value. Conclusion Prospective monitoring of request forms can reduce rates of inappropriate transfusions. High rates of Inapproriate FFP transfusions possibly reflect uncertainty about appropriate laboratory criteria for FFP transfusion. While results of large prospective randomised controlled clinical trials of FFP transfusions are awaited, current laboratory criteria can be retained, but should be applied with flexibility.