Transfusion insurgency: practice change through education and evidence-based recommendations

Practices for rational use of blood components in a universitary hospital

“…The increase in the relative proportion of requests for blood components in the post-intervention period indicates the need for a separate approach with surgeons, emphasizing appropriate indications and risks of blood transfusion, such as the program developed by Soumerai et al 25 This program was effective in reducing the proportion of transfusions in surgical patients that did not conform to the transfusion protocol. 25,26 Establishing protocols for transfusion of blood components has led to a significant reduction in the use of packed red blood cells, as observed by Brandt et al 16 But in this study, proportionally, there was a non-significant reduction in requests for red blood cells, with an increased proportion of requests for fresh frozen plasma. Since the main diagnoses did not differ in the pre-and post-interventional periods, the relative increase in requests for fresh plasma was due to a reduction in requests of packed red cells.…”

“…Multiple organ failure after injury, transmission of bacterial, viral and other microorganisms, increased mortality and immunosuppression, and febrile reactions are some of the most damaging consequences of blood transfusions. [16][17][18][19] With the increase of complexity of therapy related to blood components, there is a need to reduce inadequate transfusion, through reliable educational programs. [20][21][22][23] These programs are based on multiple strategies, such as teaching, development of protocols, creation of new transfusion requests, among others.…”

Evaluation of RBC Transfusion Practice in Adult ICUs and the Effect of Restrictive Transfusion Protocols on Routine Care

“…For interventions intended to affect clinicians’ practice, however, prior studies implementing transfusion guidelines or protocols are frequently single center “before-after” studies[23, 35, 36]. Many studies also included other initiatives, like education[37], targeted provider feedback[22, 38, 39], communication with blood bank staff[40], or a combination of these[41–43], reflecting local barriers and solutions.…”

Rational use of blood: how to do it?

“…They then concluded that the introduction of NBTI guidelines demonstrated a variable impact on the appropriateness of blood component transfusions in critically ill patients (15) .…”