Audit of Nurses- Adherence to Pre-transfusion Checking

Abstract

Background Errors in blood product administration occur not infrequently and cause morbidity and mortality. Pre-transfusion checking at the bedside is the final opportunity to detect errors and is thus a vital step in preventing wrong transfusions. Unfortunately, pre-transfusion checking is the area where most common errors are documented. We developed a number of strategies to improve nurses’ adherence to pre-transfusion checking guidelines. Method Pre-transfusion checking practices were audited by direct observation. Nurses in Haematology/Oncology unit and PICU were targeted because both units are major blood users in our hospital. Pre defined key measures of adherence to best practice recommendations were noted, including checking of the blood product, the recipient’s wristband and the compatibility report. An audit of practice was carried out before and after the introduction of a multifaceted educational intervention, comprised of information transfer (posters, in-services, and hospital web-based clinical practice guidelines), audit feedback, and the provision of pre-transfusion checking reminders on the reverse side of the issued compatibility report. Result There was significant improvement in the results for two aspects of pre-transfusion checking following intervention. Checking of the blood unit for normal appearance (Haem/Onc Pre intervention 43%, Post 81% and PICU Pre 11%, Post 58%) and checking the patient’s identification wristband prior to administering a blood product. (Haem/Onc Pre 19%, Post 81% and PICU Pre 68%, Post 79%). Conclusion Baseline compliance with pre transfusion checking was poor in a tertiary hospital. The introduction of a multifaceted educational intervention appears to be effective in improving nurses’ adherence to pre-transfusion checking.