Implementation of a patient blood management program based on a low-income country-adapted clinical decision support system

Duarte, Gustavo de Carvalho; Neto, Francisco Guilherme Fujita; Júnior, José Francisco Comenalli Marques; Langhi, Dante Mário

doi:10.1016/j.htct.2020.12.010

Cited by 6 publications

(6 citation statements)

References 12 publications

(16 reference statements)

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“…Compared with these results, our analysis has shown approximately a percentage of inappropriate transfusions of 91%. The study carried out in Northern Ireland by Barr et al ( 22 ) demonstrated that 23% of the transfusions were considered inappropriate with a sample size of n = 1,474, taking into account the difference in the sample and the limitations of our study, our results could hypothesize that in hospitals there is still an over-transfusion in patients, in concordance with other studies ( 23 – 29 ). These over-transfusions can seriously compromise their safety, exposing patients to the risk of serious transfusion reactions and unwanted situations cardiac overload ( 26 ) situations that could be improved with the development of patient blood management programs.…”

Section: Discussionsupporting

confidence: 90%

Profile and characteristics of the adequacy of blood transfusions in Trauma Intensive Care. A cross sectional multicenter study

Juárez‐Vela

Quintana-Díaz

Rodríguez-Calvo

et al. 2023

Front. Public Health

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IntroductionMajor trauma is one of the major health care problems facing modern society, trauma systems require careful planning to achieve an ideal level of coverage for the population. The Patient Blood Management Program is an integrated and global strategy to provide patient care that aims to assess and address, when possible, the etiology of blood abnormalities rather than transfuse without treating the underlying cause. We aimed to describe the factors that are associated with the clinical decision to transfuse polytraumatized patients admitted to the Intensive Care Unit (ICU).MethodWe performed a cross sectional multicenter study of patients admitted to ICUs for trauma in 14 Spanish hospitals from September 2020 to December 2021.ResultsA total of 69 patients were treated in the emergency room due to polytrauma, 46% of them were considered serious in the initial triage. Thirty were caused by a fall from considerable height (43.47%), followed by 39 patients admitted due to trac accidents (56.52%). The location of the trauma was mainly cranioencephalic, followed by thoracic trauma. Of the 69 patients, 25 received a blood transfusion during their ICU stay (36.23%).DiscussionNo significant differences were observed between transfused and non-transfused patients, except for the severity scales, where transfused patients have a higher score on all the scales assessed in the ICU except for the Revised Trauma Score. As we can see, the incidence of kidney failure was also different between the groups analyzed, reaching 44.00% in transfused patients and 13.64% in the group of patients without blood transfusion, p = 0.005. In this sense, 92.00% of the transfusions performed were inadequate according to the criteria of Hb in blood prior to the decision to transfuse (Hb < 9). Our data support the need to consider clinical practice guidelines regarding blood transfusion and its practices.

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Section: Discussionsupporting

confidence: 90%

Profile and characteristics of the adequacy of blood transfusions in Trauma Intensive Care. A cross sectional multicenter study

Juárez‐Vela

Quintana-Díaz

Rodríguez-Calvo

et al. 2023

Front. Public Health

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“…Blood transfusion is still associated with a number of dangers for patients. Although advances in blood transfusion safety have been made since the introduction of new generation infectious disease investigations, leukoreduction, and donor selection criteria, blood transfusions are still linked to dangerous reactions [14].…”

Section: Discussionmentioning

confidence: 99%

“…The CDS system is becoming more popular in the developed world, but there are still some obstacles to be resolved before it can be used in developing countries. Segmented health-care systems, the lack of a national patient medical archive, and the presence of various software modes that are not incorporated into the patient-care structure limit its widespread use [14].…”

Section: Discussionmentioning

confidence: 99%

Appraisal of awareness of medical staff about preoperative patient blood management in Saudi Arabia: questionnaire based study

Hakami

Almohammadi

Alqahtani

et al. 2023

Preprint

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Background Patients blood management (PBM) is a comprehensive approach to optimizing the care of patients who might need transfusion. It involves the use of evidence-based strategies to reduce or avoid the need for allogeneic blood transfusions, while ensuring that patients receive safe and appropriate care. PBM includes strategies such as preoperative autologous donation, intraoperative cell salvage, and minimally invasive techniques to reduce bleeding. The purpose of this study is to assess medical staff awareness of preoperative patient blood management in Saudi Arabia Methods Between April 2022 and July 2022, data was collected using a 10-minute online (Google Forms) self-administered, anonymous, researcher-structured questionnaire adapted from previous studies and translated into both English and Arabic. The questionnaire was divided into three sections. The first section contained sociodemographic data, while the second section was used to estimate physicians' and nurses' knowledge of preoperative PBM. Two questions in Part 3 of the questionnaire were used to assess doctors' and nurses' preoperative PBM attitudes and practices. Results The average relationship between patients' blood management attitudes and levels of awareness. It was revealed that there was a positive attitude (p ≤ 0.005) as well as a high level of awareness (p ≤ 0.002). The effect of job, gender, or geographical distribution on PBM awareness, attitude, and practice was not significant. Conclusion Despite the fact that the majority of participants have a positive attitude and good awareness of PBM, more efforts should be implemented to improve PBM awareness, which was linked to increased transfusion practices and lower product costs.

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“…It has been described in 1998 by Hunt et al as "any software designed to directly aid in clinical decision-making in which characteristics of individual patients are matched to a computerized knowledge base for the purpose of generating patient-specific assessments or recommendations that are then presented to clinicians for consideration" [26]. These systems usually lead to an increased percentage of single-unit transfusions, which translates into a decrease in the number of blood components used while the number of orders remains unchanged [27,28]. It is also correlated with the reduction of costs associated with these procedures [29].…”

Section: Discussionmentioning

confidence: 99%

Let Us Know Transfusion Triggers for Prophylactic Use of Platelet Concentrate—Analysis of Compliance with Recent Transfusion Guidelines in a Large Academic Medical Center

Czempik,

Herzyk,

Wilczek

2023

JCM

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Platelet concentrate (PC) is a blood component that is used to prevent or manage bleeding associated with thrombocytopenia or impaired platelet function. The aim of our study was to assess the compliance of ordering physicians with the most recent PC transfusion guidelines in our academic medical center. All PC transfusions performed between January 2019 and December 2022 were analyzed. The appropriateness of PC transfusions was assessed based on the most recent PC transfusion guidelines. During 2019–2022, there were 362 (0.2%) PC recipients out of 161,762 hospitalized patients. There were 971 PCs transfused during the analyzed period. Inappropriate transfusions accounted for 53.3% of cases, and most of them were given prophylactically (80.2%). Compliance with platelet transfusion guidelines varied among departments. The overall percentage of inappropriately transfused PC ranged from 50.7% to 60.8% in successive years. Educational activities should target clinicians performing procedures associated with high rates of inappropriate PC transfusions. Implementing clinical decision support systems can help reduce unnecessary PC transfusions and associated costs. The majority of inappropriate PC transfusions in our medical center were given as prophylaxis against bleeding. Prescribers should be educated about evidence-based transfusion triggers for the prophylactic use of PC in various clinical scenarios.

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Implementation of a patient blood management program based on a low-income country-adapted clinical decision support system

Cited by 6 publications

References 12 publications

Profile and characteristics of the adequacy of blood transfusions in Trauma Intensive Care. A cross sectional multicenter study

Profile and characteristics of the adequacy of blood transfusions in Trauma Intensive Care. A cross sectional multicenter study

Appraisal of awareness of medical staff about preoperative patient blood management in Saudi Arabia: questionnaire based study

Let Us Know Transfusion Triggers for Prophylactic Use of Platelet Concentrate—Analysis of Compliance with Recent Transfusion Guidelines in a Large Academic Medical Center

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