Audit and education: Role in safe transfusion practice

Abstract

BACKGROUND:Auditing and education are the tools for improvement in the transfusion practices. Clinicians are not providing patient's demographic data and medical history to the blood bank that required transfusion. This missing information in blood request forms can lead to transfusion reactions to the patient. So we planned to analyse the blood request forms received at our blood bank and the impact of educational program for the clinicians.METHODS:A total of 6894 blood request forms were received from the month of July 2014 to December 2014 at a blood bank in Amritsar, India. We evaluated for completeness of the blood request form in parameter columns like second identification (CR No. or Father/Husband Name), diagnosis, pre transfusion hematological parameters, quality and quantity of blood component required, history of previous transfusion and adverse transfusion reaction, urgency of transfusion, medical officer name and signature, phlebotomist name and signature etc. A series of CMEs on “Safe Transfusion Practices” were organized for clinicians and hospital staff from 1st August 2014 and improvement in clinicians’ behavior was analysed.RESULTS:A total of 60.83% requests were not filled completely during the study period. Of these 91.42% were in the month of July, which decreased to 48.76% in the month of December 2014 with a total improvement of 42.66%. Incomplete second identification (91.03%) and history of previous transfusion and adverse transfusion reactions (80.21%) were the commonest incomplete fields in the month of July 2014. In the month of December 2014, an improvement in incomplete second identification was observed (12.8%) however phlebotomist signature was still a major incomplete field (45.19%). A statistically significant (p value = 0.004, paired ‘t’ test) improvement in completeness of forms was observed.SUMMARY:Results of medical audit and using those as a basis for developing a highly targeted educational program, can improve the clinicians’ approch towards transfusion practices.

Prospective audit of blood transfusion request forms and continuing medical education to optimise compliance of clinicians in a hospital setting

“…Patient's name, the referring physician's name and gender were the most completed information on the forms evaluated, with 99.0%, 99.0% and 90.3% completion, respectively. Patidar et al found that the highest number of incomplete fields observed (91.42%) varied from second identification (91.03%) to medical officer's name and signature (1.48%) 18 . They also found that 51.44% of forms did not mention urgency of requirements, and pretransfusion haematological parameters were not provided in 53.67% of the request forms.…”

“…Osegbe et al educated clinicians about the completion of request forms, and they found significant improvement in the recording of patient age, hospital number, clinician's name, ward, clinical diagnosis and specimen type 22 . Patidar et al found that the most common incomplete column was second identification followed by previous transfusion history and adverse transfusion reactions due to previous transfusion 18 . After education of clinicians and their staff, there were significant improvements in the filling of blood request forms.…”

Haemovigilance: Role and importance of blood request forms in routine hospital practice.

“…Some more info like transfusion history and history of any reactions in previous transfusions are also required for the data to be complete and comprehensive. 25 A complete data shortens the delay of proper blood product issuance. On the other hand, it also provides means to cross-check discrepancies.…”

Utility of a combined approach using audit, education and information technology tools to improve transfusion practices

“…Most of these inappropriate transfusions/reactions due to errors are preventable with improved transfusion practices. Predetermined transfusion guidelines, transfusion audits and training of clinical staff have been shown to improve the transfusion practices [4][5][6]. Clinical audits are an important part of the quality assurance programme which can be used to provide information for improving transfusion medicine practice [5,6].…”

“…Predetermined transfusion guidelines, transfusion audits and training of clinical staff have been shown to improve the transfusion practices [4][5][6]. Clinical audits are an important part of the quality assurance programme which can be used to provide information for improving transfusion medicine practice [5,6]. Significant reduction of blood component usage can be achieved by auditing with feedback to physicians, a continuous medical education programme for hospital staff, introduction of a request form of blood and component and providing a computerized decision support system [7,8,9].…”