Recidivism in Transfusion Quality Improvement: Support for the Role of Transfusion Nurses

Abstract

Aim To evaluate longer term outcomes of a quality improvement strategy in transfusion. Method A Clinical Health Improvement Program (CHIP) quality improvement project was conducted in a 290 bed acute general hospital, to decrease the rate of transfusions with high pre-transfusion haemoglobins. Strategies for improvement included: formation of a Transfusion Committee; development of transfusion pathway; implementation of a Maximum Blood Order Schedule; educational strategies targeting clinical staff at all levels; promulgation of the NHRMC Clinical Practice Guidelines on the Use of Blood Components; and feedback to clinicians. The CHIP project was superseded by the ACT Haemovigilance Project, and an ACT wide concurrent transfusion audit was undertaken. There was no formal feedback on clinician performance during, or for 6 months prior to, the Haemovigilance audit. Red cell transfusion was assessed for compliance with the NHMRC Guidelines and compared with CHIP results. Result The CHIP project demonstrated successful implementation of the selected strategies, leading to a reduction in transfusions with pre-transfusion haemoglobins greater than 90 g/L. Follow up auditing commencing six months later demonstrated a progressive, and statistically significant, increase in inappropriate transfusions over the following six months. Conclusion Although improvement in transfusion practice was demonstrated with a multi-factorial approach to quality improvement, the improvement was not sustained in the medium term. Our results indicate the need for organisational commitment to long term quality improvement strategies in transfusion, and support the development of Transfusion Officers or Nurses to improve bedside clinical practice.