NSW Blood Transfusion Improvement Collaborative: Where to From Here

Abstract

The NSW Blood Transfusion Improvement Collaborative completed its project in mid 2003 and presented the final report in November 2003. The focus of the collaborative was on the appropriateness of red cell transfusion using the ‘breakthrough’ methodology of the Institute for Healthcare Improvement. Results showed that the goal of 50% reduction in inappropriate transfusion of red cells had been met. The largest improvements were seen at sites that used vetting of transfusion requests based upon a restrictive threshold as per the guideline parameters. This was most effective when combined with endorsement, distribution and education re the guidelines. There has been no further funding for BTIC. In NSW there are currently no systems in place for monitoring the safety and appropriateness of transfusion practice. It is essential that this is addressed particularly in view of the findings of the Collaborative and the NSW Coroner indicating that there are inappropriate transfusion practices and serious preventable adverse events associated with transfusion occurring. Necessary measures include improvement in the governance of transfusion practice in the clinical setting, establishment of measurement systems to provide data on the management and use of blood and improvement in education for the staff who prescribe and administer transfusions. Valuable transfusion practice improvement work is progressing in a number of other States and overseas. However, securing commitment for resources to allow these to proceed is an ongoing problem. With the restructuring of the state and national systems of management of blood and transfusion services, there is the opportunity to establish a coordinated approach to ensuring safe and appropriate transfusion practice.