Implementation of a neonatal platelet transfusion guideline to reduce non-indicated transfusions using a quality improvement framework

Abstract

Objective Variation exists in neonatal platelet transfusion practices. Recent studies found potential harm in liberal platelet transfusion practices, supporting the use of lower transfusion thresholds. Our aim was to reduce non-indicated platelet transfusions through implementation of a restrictive platelet transfusion guideline. Study design Platelet transfusions from January 2017 to December 2019 were classified as indicated or non-indicated using the new guideline. Interventions included guideline implementation and staff education. Outcomes were evaluated using statistical process control charts. Major bleeding was the balancing measure. Result During study, 438 platelet transfusions were administered to 105 neonates. The mean number of non-indicated platelet transfusions/month decreased from 7.3 to 1.6. The rate of non-indicated platelet transfusions per 100 patient admissions decreased from 12.5 to 2.9. Rates of major bleeding remained stable. Conclusions Implementation of a restrictive neonatal platelet transfusion guideline significantly reduced potentially harmful platelet transfusions in our NICU without a change in major bleeding.

Platelet transfusion practice pattern before and after implementation of a local restrictive transfusion protocol in a neonatal intensive care unit

“…Another retrospective comparison of two cohorts of preterm infants with BW <1500 g before (2002–2004, N = 121) and after (2004–2006, N = 134) restrictive platelet transfusion guideline implementation in the same NICU reported a 40% decrease in platelet transfusions following restrictive guidelines 12 . More recently, a study compared the number of non‐indicated platelet transfusions before ( N = 1388) and after ( N = 678) implementation of a restrictive platelet transfusion guideline in the Boston Children's Hospital NICU in January 2019 13 . The rate of non‐indicated platelet transfusions according to the restrictive guideline decreased from 12.5% to 2.9%.…”

“…12 More recently, a study compared the number of non-indicated platelet transfusions before (N = 1388) and after (N = 678) implementation of a restrictive platelet transfusion guideline in the Boston Children's Hospital NICU in January 2019. 13 The rate of non-indicated platelet transfusions according to the restrictive guideline decreased from 12.5% to 2.9%. In all three studies, the rates of adverse outcomes such as NEC, IVH, other major bleeding and mortality remained stable.…”

Neonatal platelet transfusions: New evidence and the challenges of translating evidence‐based recommendations into clinical practice

“…Through a range of strategies, the authors reported a decrease in unnecessary (potentially harmful) platelet transfusions from a rate of 12.5 to 2.9 per 100 patient admissions over a 3-year period. 27 Many other potential strategies to enact change have been described in medicine, including audit and feedback, automated reminder systems, and use of opinion leaders [28][29][30][31][32] (Table 2).…”

“…A first step considered the quality of the evidence and breadth of short‐term and long‐term outcomes reported, as described previously. Through a range of strategies, the authors reported a decrease in unnecessary (potentially harmful) platelet transfusions from a rate of 12.5 to 2.9 per 100 patient admissions over a 3‐year period 27 …”

Platelet Transfusions in Neonates: Beyond Hemostasis

“…Until then, in the absence of national guidelines, a judicious, evidence-based approach to neonatal platelet transfusions is the best clinical strategy. 2,17…”