Transfusion Documentation Research Articles

Using Quality Improvement to Optimize Blood Product Utilization in a Pediatric Cardiac Catheterization Laboratory.

Packed red blood cells (PRBC) are frequently ordered for cardiac catheterization procedures, which increases resource utilization and patient charges. We applied the Plan-Do-Study-Act (PDSA) principle in order to optimize the ordering of PRBC for pediatric cardiac procedures and reducing charges. Our primary aim was to increase adherence to ordering guidelines to greater than 97%, with a global aim to reduce resource utilization. The existing PRBC ordering guidelines were revised and procedure reports were updated to include administration of PRBC. The rate of pre-procedure PRBC orders, adherence to the new protocol guidelines, presence of documentation and rate of blood transfusion within 24h post-procedure, frequency of emergency release blood during a procedure were monitored. During our study period, there was an increased adherence from 86 to 100% adherence following implementation of the updated guidelines. With improved adherence, we decreased PRBC ordering and hospital charges to the patient in low-risk cardiac catheterization procedures, without an increase in blood transfusions.

EP186 - Blood transfusion documentation in surgical patients - are we doing it correctly? An audit on the blood transfusion documentation in surgical patients at a district general hospital in the United Kingdom

Abstract Aim Transfusion of blood products is commonly indicated in surgical patients, especially in patients with gastro-intestinal bleeding, gastro-intestinal cancers, and trauma patients. However, the documentation regarding blood transfusion in these patients often does not meet the guidelines. The aim of this clinical audit was to improve the blood transfusion (BT) related documentation in patients of general surgery (GS) at a district general hospital (DGH) in the United Kingdom, in accordance with the national guidelines (Administration of blood components: a British Society for Haematology Guideline) and the local trust guidelines. Method For the 1st-cycle of the audit, we did retrospective study of all adult patients admitted under GS in our DGH from 1st July 2023 to 15th August 2023 (6weeks) who received BT, and their electronic records were assessed with regards to documentation regarding the following criteria: decision to transfuse, patient's consent and understanding, post-transfusion effect and discharge notes. Following this, we had a discussion with the junior doctors in the department, who do these documentation, to make them aware of the BT guidelines, and to improve adherence. The 2nd-cycle included retrospective data collection from 1st September 2023 to 15th October 2023 (6 weeks). Results BT-documentation during the 2nd-cycle showed significant improvement to adherence above 80% in most of the criteria where it needed improvement in the 1st-cycle. Conclusion This clinical audit successfully improved the BT-documentation adherence to the guidelines, showing that through simple educational methods, the documentation practices could be improved significantly. Our plans for subsequent improvement includes posters in the departmental resource room to increase the awareness, and to re-audit in December 2023.

283 Blood Transfusion Documentation in Surgical Patients - Are We Doing It Correctly? an Audit on the Blood Transfusion Documentation in Surgical Patients at a District General Hospital in the United Kingdom

283 Blood Transfusion Documentation in Surgical Patients - Are We Doing It Correctly? an Audit on the Blood Transfusion Documentation in Surgical Patients at a District General Hospital in the United Kingdom

Implementation of a prehospital whole blood program: Lessons learned.

Early blood administration by Emergency Medical Services (EMS) to patients suffering from hemorrhagic shock improves outcomes. Prehospital blood programs represent an invaluable resuscitation capability that directly addresses hemorrhagic shock and mitigates subsequent multiple organ dysfunction syndrome. Prehospital blood programs must be thoughtfully planned, have multiple safeguards, ensure adequate training and credentialing processes, and be responsible stewards of blood resources. According to the 2022 best practices model by Yazer etal, the four key pillars of a successful prehospital program include the following: (1) the rationale for the use and a description of blood products that can be transfused in the prehospital setting, (2) storage of blood products outside the hospital blood bank and how to move them to the patient in the prehospital setting, (3) prehospital transfusion criteria and administration personnel, and (4) documentation of prehospital transfusion and handover to the hospital team. This concepts paper describes our operational experience using these four pillars to make Maryland's inaugural prehospital ground-based low-titer O-positive whole blood program successful. These lessons learned may inform other EMS systems as they establish prehospital blood programs to help improve outcomes and enhance mass casualty response.

Compliance of Documentation by Health-Care Professionals

Background and Objectives: In transfusion practices, noncompliance with standard guidelines may lead to cause adverse events. Bedside assessment during and posttransfusion is equally important as overall transfusion-related precautions. The current study was conducted to observe the practices of health-care professionals related to transfusion documentation through a structured questionnaire. Methods: A cross-sectional study was conducted from 2018 to 2019 after ethical approval. A questionnaire structured for the documentation of transfusion process at bedside was filled having information of the name of the product receiver, date, time, name of patient with a medical identification number, ABO group match with the product, name of two health-care staff who started transfusion, and start and stop timings of transfusion. Initials of staff and patient vital record at onset, 15 min, and the end of transfusion were also recorded. Analysis was performed by using SPSS 23.0. Results: A total of 500 transfusion episodes were analyzed, out of which 115 (23%) forms were available in the patient files and 88 (76%) forms were filled. The overall compliance rate was 18%. The highest compliance was observed in the documentation of the name of nursing staff at the start of transfusion 79 (90%) and noncompliance was observed in the documentation of duty doctor initials at the completion 85 (96%). Conclusions: We observed scarce practice regarding transfusion-related documentation by health-care staff at the bedside. Stringent steps should be taken to avoid morbidities and mortalities. Training and education in this context is the need of time.

Improving Transfusion Safety in the Operating Room With a Barcode Scanning System Designed Specifically for the Surgical Environment and Existing Electronic Medical Record Systems: An Interrupted Time Series Analysis.

Manual processes for verifying patient identification before blood transfusion and documenting this pretransfusion safety check are prone to errors, and compliance with manual systems is especially poor in urgent operating room settings. An automated, electronic barcode scanner system would be expected to improve pretransfusion verification and documentation. Audits were conducted of blood transfusion documentation under a manual paper system from January to October 2014. An electronic barcode scanning system was developed to streamline transfusion safety checking and automate documentation. This system was implemented in 58 operating rooms between October and December 2014, with follow-up compliance audits through December 2015. The association of barcode scanner implementation with transfusion documentation compliance was assessed using an interrupted time series analysis. Anesthesia providers were surveyed regarding their opinions on the electronic system. In mid-2016, the scanning system was modified to transfer from the Metavision medical record system to Epic OpTime. Follow-up analysis assessed performance of this system within Epic during 2017. In an interrupted time series analysis, the proportion of units with compliant documentation was estimated to be 19.6% (95% confidence interval [CI], 10.7-25.6) the week before scanner implementation, and 74.4% (95% CI, 59.4-87.4) the week after implementation. There was a significant postintervention level change (odds ratio 10.80, 95% CI, 6.31-18.70; P < .001) and increase in slope (odds ratio 1.14 per 1-week increase, 95% CI, 1.11-1.17; P < .001). After implementation, providers chose to use the new electronic system for 98% of transfusions. Across the 2 years analyzed (15,997 transfusions), the electronic system detected 45 potential transfusion errors in 27 unique patients, and averted transfusion of 36 mismatched blood products into 20 unique patients. A total of 69%, 86%, and 88% of providers reported the electronic system improved patient safety, blood transfusion workflow, and transfusion documentation, respectively. When providers used the barcode scanner, no transfusion errors or reactions were reported. The scanner system was successfully transferred from Metavision to Epic without retraining staff or changing workflows. A barcode-based system designed for easy integration to different commonly used anesthesia information management systems was implemented in a large urban academic hospital. The system allows a single user with the assistance of a software system to perform and document pretransfusion safety verification. The system improved transfusion documentation compliance, averted potential transfusion errors, and became the preferred method of blood transfusion safety checking.

PF809 ARE NATIONAL GUIDELINES AND MANDATORY TRAINING ENOUGH TO ENSURE SAFE TRANSFUSION PRACTICE?

Background:Errors in administering blood product represent a risk for patient safety. The British Society of Haematology (BSH) published guidelines to promote safe transfusion practice (1). These guidelines states that should be recorded: the unique component donation number and the date, start time and the identification of the person administering the component.The guideline also sets the standard for monitoring the patient during the transfusion with pulse, temperature, respiratory rate and blood pressure at the start of the transfusion, after 15 minutes of the start and within one hour from the end.Transfusion training is mandatory for all health professionals involved in transfusion practice.Aims:The aim of this study was to establish if the guidelines established by BSH are applied in clinical practice across different departments.Methods:We performed a retrospective audit on transfusion documentation and patient monitoring and in a district general hospital. We included transfusion of red packed cells, platelets and fresh frozen plasma.Results:We identified 160 unit transfused (132 RPC, 16 PLTS and 12 FFP). Documentation of donation number and the date, start time and the identification of the person administering the component were complete in 88% of the cases, in 8% of the cases there was no documentation at all (Figure 1A); of the remaining in 80% of the cases was missing the signature of the administering person.Regarding the monitoring of the patient only 25% of the unit transfusions were monitored according to the guidelines, in 33% of the cases there was no documentation of the patient monitoring. The least monitored parameter was respiratory rate; the most frequent missed monitoring point was the one at the end of the transfusion (Figure 1B).Summary/Conclusion:Despite clear guidelines and compulsory training transfusion practice is still poor with more than a tenth of the transfusion being not fully documented in the notes and the number of transfusion episodes lacking adequate patient monitoring information outnumbering the transfusion monitored according to the guidelines (33% vs 25%).imagePerforming an audit across the entire hospital allowed us to identify the departments where transfusion procedures were not applied systematically with the plan to offer target training and re‐audit to improve transfusion practice.

Proceedings of the Food and Drug Administration public workshop on pathogen reduction technologies for blood safety 2018 (Commentary, p. 3026).

On November 29, 2018, experts in the field of infectious diseases, pathogen reduction technologies (PRTs) and other participants from blood centers, academia, and industry gathered at the Food and Drug Administration (FDA) White Oak Campus in Silver Spring, Maryland, for a 2‐day public workshop entitled “Pathogen Reduction Technologies for Blood Safety.” The workshop opened with welcome remarks from Dr. Nicole Verdun, Director, Office of Blood Research and Review (OBRR), Center for Biologics Evaluation and Research (CBER), FDA, followed by introductory remarks from Dr. Peter Marks, Director, CBER, FDA. The first day of the workshop focused on blood‐borne infectious agents and their impact on blood safety, experiences of the American Red Cross, and other blood establishments in implementing FDA‐approved pathogen inactivation (PI) technology for plasma and platelets (PLTs) in the United States and novel PRTs under consideration for whole blood (WB) and red blood cells (RBCs). The second day opened with welcome remarks from Dr. Chintamani Atreya, Associate Director for Research, OBRR, CBER, FDA. The focus was on emerging innovations relevant to PRTs and potential alternatives to PRTs. The workshop concluded with remarks on insights for future research and development in this area for blood and blood product safety from infectious agents. A brief introduction of each session by the session moderator followed by a summary of the speaker presentation as submitted by the moderator and speaker are reported here.

The administration of blood components: a British Society for Haematology Guideline.

The administration of blood components: a British Society for Haematology Guideline.

Adequacy of physician documentation and correlation with assessment of transfusion appropriateness: a follow-up study in the setting of prospective audits and patient blood management.

A previous study in our hospitals correlated suboptimal documentation and failure to justify transfusions. In light of implemented blood-conservation strategies, including patient blood management (PBM) and prospective audits (PAs), we performed a follow-up study. We reviewed prospectively audited red blood cell (RBC) transfusions received by adult patients from January to July 2014. Survey forms were used to assess the level of documentation and to classify documentation as adequate, intermediate, or inadequate. Transfusions were deemed justified or not by comparisons with hospital transfusion guidelines. We also analyzed the effect of implemented blood-conservation strategies on our hospital transfusion rates and costs from 2009 to 2015. During the study period, there were 259 prospectively audited transfusion events (TEs) (one or more RBC units transfused to a patient), of which we reviewed 94 TEs (36.3%) in 87 patients. TEs with suboptimal (intermediate and inadequate) documentation accounted for 46.8% of the reviewed TEs, of which 81.8% could not be justified compared with 18.0% of nonjustified, adequately documented TEs. The correlation between suboptimal documentation and failure to justify transfusion was significant (p < 0.001). This correlation remained even in a comparison between the site with a PBM program and the sites without such a program. Overall transfusion rates declined after the introduction of PA, although the decline was only statistically significant at the sites with a PBM program. Suboptimal transfusion documentation remains problematic and is highly correlated with nonjustifiable transfusions. Newly adopted approaches to minimize blood transfusions have not improved transfusion documentation and corresponding out-of-guideline transfusions, although overall transfusions have been reduced by PA, particularly in the setting of a PBM program.

Lessons learned from transfusion audits

BackgroundIn times of patient blood management, studies focus on appropriate transfusion strategies to improve patient's outcome. Little is known about the quality assurance in preparation of blood transfusion and thereafter. In the present study, the indication, informed consent, mandatory immunohematology tests and documentation of blood transfusions were evaluated using assessed self-inspection forms approved by the hospital transfusion committee. Materials and Methods47 medical records of transfused patients were retrospectively reviewed by a clinical transfusion audit team in six hospital facilities from 2012 to 2015. Self-inspection forms were used to classify the physicians' documentation of transfusion into 3 groups: adequately, intermediately, and inadequately documented. ResultsAdequate documented records were only found in 5 cases (10.6%), followed by intermediate (51.1%) and inadequate documentation (38.3%). Informed consent was identified most often as inappropriate, and this was a critical point with respect to medico legal aspects. ConclusionContinuous education of physicians defining parameters to be documented is almost essential in daily transfusion medicine routine. The use of a check list with physician's documentation of transfusion is strongly recommended.

254 Neonatal Blood Transfusion-Can we make it Safer?

Background and AimsA specific blood transfusion booklet was implemented in the Southern Health and Social Care Trust in 2010 for babies less than four months of age. This aimed to...

End‐to‐end electronic transfusion management in hospital practice

Background Errors occur at all stages of the hospital transfusion process and the resulting morbidity and mortality are well documented. Recent initiatives in the UK and elsewhere to reduce transfusion errors have focussed on implementing recommended manual procedures for good practice, but have only been partially effective.Aims Our approach was to ‘re‐engineer’ bedside and laboratory transfusion procedures.Materials and Methods We implemented barcode patient identification, bedside handheld computers and electronically controlled blood fridges to simplify transfusion procedures and improve practice.Results There was an improvement from 11.8% to 100% of staff following the process for correct pre‐transfusion bedside patient identification; no ABO incompatible red cell transfusions in 5 years; a reduction in wrong blood component transfused events from 1 in 27,523 to 1 in 67,935; reduced nursing (one nurse rather than 2 and half the time to administer blood) and laboratory workload; and more rapid delivery of urgently required red cell units to patients (from a median of 18 minutes to 45 seconds). The electronic system provided a simple mechanism for compliance with UK/EU regulatory requirements for the traceability of blood, and the documentation of transfusion and training. Feedback from both staff and patients was positive.Discussion The project was taken through pilot stages between 2001 and 2006 through to its full implementation across the acute hospitals in Oxfordshire in 2006/07. Our group wrote a national specification for the electronic transfusion process, but the implementation elsewhere in the UK has been slow. There is the potential to introduce an additional module into the electronic transfusion process to provide ‘decision support’ for doctors ordering blood to minimise inappropriate use of blood as part of a patient blood management programme, and use the same ‘end‐to‐end electronic’ approach for other clinical procedures such as drug administration.Conclusion The implementation of a hospital electronic transfusion management system was shown to provide improvement in transfusion practice and in the efficiency of the service.

The quality of blood transfusion documentation and consent in surgical patients at a central London teaching hospital. What should we be teaching to maintain good transfusion practice?

The quality of blood transfusion documentation and consent in surgical patients at a central London teaching hospital. What should we be teaching to maintain good transfusion practice?

A Transfusion Audit In An Ugandan Hospital

AbstractAbstract 4410Over the past 20–30 years the quality of hospital transfusion services and the optimal use of blood components have been major preoccupations of hospitals in developed countries and are now beginning to be addressed in hospitals in developing countries. In order to assess the quality of transfusion practices in an university-affiliated hospital in Uganda and to identity areas of strength and areas requiring improvement we undertook an audit of all RBC, either whole blood (WB) or pediatric packed cell (PC), transfusions administered over a 72 hour week-day period in March 2010, at Mulago Hospital Complex (MHC), Kampala, Uganda. MHC, the teaching hospital affiliated with the College of Health Sciences, Makerere University, provides medical, surgical and obstetrical services; there are over 140,000 in-patient admissions per year of which approximately 15,000 are pediatric (i.e. < 12 year old) medical patients; over 30,000 deliveries are performed per year. MHC receives all its blood units from the Uganda Blood Transfusion Service (UBTS). MHC has 4 blood banks – the main hospital blood bank (MBB), an affiliated blood bank serving the pediatric medical wards (PBB) and independent blood banks serving the MHC cardiac and cancer institutes. This audit was limited to the MBB and the PBB. During the audit period the unit numbers of RBC units received by the MBB from the UBTS were recorded and for all RBC units recorded as leaving the MBB or the PBB the following information was recorded: whether or not a cross-match (XM) was performed, the ABO/Rh group of patients and units, the time of issue and time of beginning and ending the transfusion, the indication for the transfusion and the pre-transfusion (PT) hemoglobin (Hb) level, if performed. General observations on transfusion practices related to patient identification and documentation of transfusion in patient charts were made but not systematically collected for all transfusions. In total 225 units (WB 196, PC 29) were either present in the MBB/PBB or received from the UBTS during the audit period. Of these, 143 units (104 from the MBB, 39 from the PBB) were issued to the wards; 49 remained in the MBB or PBB at the end of the audit period; 33 units could not be accounted for (i.e. not recorded as issued but no longer in the MBB or the PBB). Of the 143 units issued, 102 were transfused (36 in the pediatric medical wards and the other 66 in other hospital wards), 5 were not transfused, 9 were issued to the cancer institute (so not further tracked), 11 were inadvertently not tracked and 16 proved impossible to trace after issuing (13 from MBB, 3 from PBB). In only 1 case was a group O unit transfused to a non-group O patient. For units issued from the PBB, XMs were performed for 87% of units while XMs were only performed for 54% of units issued from the MBB. The time from unit issue to the completion of transfusion was the similar whether or not a XM was performed – median (range) 5.4 (2.2-13.9) and 4 (2.3-6) hours for units issued from the MBB and PBB respectively. PT Hb levels were performed for 82% of transfusions in the pediatric medical wards; median (range) PT Hb level was 3.9 g/dL (1.9-9.6). A PT Hb level was obtained in only 13% of cases in the adult/sx/ob wards; median (range) PT Hb level was 5.9 g/dL (3.4-12.6). Indications for transfusion in the pediatric medical wards were: malarial anemia 64%, sickle cell anemia 18%, other specific anemias 8%, unable to determine 10%. Indications on the adult/sx/ob wards were: medical 39% (hematology 11%, malarial anemia 8%, other 20%), trauma/sx 31%, ob/gynecology 25%, unable to determine 5%. Only 5 patients received more than 1 unit (4 × 2 units and 1 × 3 units) within a 12 hour period or less. Among the informal observations, it was noted that labelling of blood specimens used in PT testing was often inadequate, patient identification was difficult to ensure because of lack of unique patient identifiers (e.g. birth dates are not recorded and the hospital does not use patient identification bands) and details of the transfusion (including timing, unit number) are often not recorded in the patient chart. In summary, in this sub-Saharan setting, it appears that RBC transfusions are likely usually given for appropriate indications (with the caveat that PT Hb levels are often not performed in adult patients) but that stricter controls regarding PT testing, patient and sample identification, unit administration, and documentation are required to ensure patient safety. Disclosures:No relevant conflicts of interest to declare.

Improving transfusion practice: ongoing education and audit at two tertiary speciality hospitals in Western Australia

Institutions undertaking transfusion have a responsibility to ensure safe and appropriate practice. The hospital transfusion committee (HTC) plays a major role in monitoring all aspects of transfusion. Dedicated staff with the responsibility of undertaking transfusion education and audit have been employed at many hospitals. The question is 'Do these positions improve practice?'. In 2005, a transfusion coordinator was employed by the King Edward Memorial Hospital (KEMH) and Princess Margaret Hospital (PMH) in Perth, Western Australia. After an initial audit to collect baseline data on transfusion documentation and compliance with national guidelines, a series of interventions was undertaken. In addition, the transfusion protocols were rewritten and published electronically. Further audits were undertaken in 2006, 2007 and 2009. Sequential audits show measured improvements in transfusion documentation. Baseline, hourly and completion observations are now correctly recorded in >94% of records at KEMH and >96% of records at PMH. Compliance with recording of 15 min observations has shown a 23% magnitude increase at KEMH and 36% at PMH. Compliance with recording of consent has increased by 20% at KEMH and 31% at PMH. Promotion of positive patient identification, when collecting specimens and administering blood, has been undertaken. The initiatives implemented by the transfusion coordinator and endorsed by the HTCs have improved the standard of transfusion documentation and practice at both institutions.

Bedside practice of blood transfusion in a large teaching hospital in Uganda: An observational study

Background:Adverse transfusion reactions can cause morbidity and death to patients who receive a blood transfusion. Blood transfusion practice in Mulago Hospital, Kampala, Uganda is analyzed to see if and when these practices play a role in the morbidity and mortality of patients.Materials and Methods:An observational study on three wards of Mulago Hospital. Physicians, paramedics, nurses, medical students and nurse students were observed using two questionnaires. For comparison, a limited observational study was performed in the University Medical Centre Groningen (UMCG) in Groningen, The Netherlands.Results:In Mulago Hospital guidelines for blood transfusion practice were not easily available. Medical staff members work on individual professional levels. Students perform poorly due to inconsistency in their supervision. Documentation of blood transfusion in patient files is scarce. There is no immediate bedside observation, so transfusion reactions and obstructions in the blood transfusion flow are not observed.Conclusion:The poor blood transfusion practice is likely to play a role in the morbidity and mortality of patients who receive a blood transfusion. There is a need for a blood transfusion policy and current practical guidelines.

P19 Appropriateness of Red Cell Transfusion in Medical patients

There is now increasing attention focused on promoting appropriate use of blood transfusion on the background of significant concerns regarding safety. Wide variations have been described in surgical usage of blood but there is relatively little data available on red cell transfusion in medical patients with anemia.Methods We retrospectively audited transfusion practice in general medical patients over a 1 month period. Appropriateness of transfusion was assessed against national guidance (British Journal of Haematology 2001; 113, 24). Documentation of transfusion episodes was measured against the criteria given in Better Blood Transfusion (HSC 2002/009). Over‐transfusion was classified as a post transfusion haemoglobin (Hb) increment of &gt;2 g dL−1 above transfusion threshold.Results Out of 72 consecutive cases audited, 18 were excluded (three patients transferred to surgical care, five on long term transfusion regimes, 10 case notes unavailable). Data was available on 54 patients (31F;23M) aged 23 to 91 years (mean 67 years) with a wide variety of medical diagnoses. 66 cross‐matches were undertaken resulting in 56 transfusions. 201 units of red cells were cross‐matched with 15 units transfused giving a transfusion ratio of 1.3 and a transfusion index of 2.8. 55 cross‐matches (83.5%) were assessed as appropriate and of these four were not transfused. The indication for transfusion was not recorded in 21% (n = 14) of cases and the outcome was not recorded in 20% (n = 11) of cases. Pre‐transfusion Hb levels ranged between 5.4 g dL−1 and 12.7 g dL−1 (mean 8.2 g dL−1). Post transfusion Hbs ranged between 7.0 g dL−1 and 15.2 g dL−1 (mean 10.7 g dL−1); there were no post transfusion Hb samples taken in five cases (7.6%). The post transfusion increment was found to be &gt;2 g dL−1 in 51.5% (n = 34) of transfusions.Conclusions The documentation of transfusions remains poor with indications and outcome not being recorded in a significant proportion of medical cases audited. Over 15% of cross‐matches were found to be inappropriate against objective audit criteria and there was evidence of overtransfusion. Transfusion practice for medical indications warrants further scrutiny with a view to promoting appropriate use of red cells and better documentation to improve safety.

Adequacy of Physician Documentation of Red Blood Cell Transfusion and Correlation With Assessment of Transfusion Appropriateness

A major function of the hospital transfusion service is to assess the appropriateness of blood transfusion. Inadequate documentation of transfusions may hamper this assessment process. To correlate the level of physician documentation of transfusion with the ability to justify transfusion. Retrospective review of red blood cell transfusions in adult patients in 2 hospital facilities during 1-week audit periods of each month from April 2001 to March 2003. Assessment forms were used to classify the level of physician documentation of transfusions into 3 groups: adequately, intermediately, and inadequately documented. Transfusions were deemed justified or not via comparison with hospital transfusion guidelines. There were 5062 audited red blood cells transfused to 2044 adult (> or = 18 years) patients. Medical records from 154 patients transfused with 257 units of red blood cells during 172 transfusion events were reviewed after initial screenings of hemoglobin/hematocrit values failed to justify the transfusions. Nine percent of adequately documented, 50% of intermediately documented, and 73% of inadequately documented transfusion events could not be justified. Transfusion events with suboptimal (intermediate and inadequate) documentation accounted for 49% of all medical record-reviewed transfusion events and 62% could not be justified. The correlation between inadequate documentation and failure to justify transfusion was significant (P < .001), as was the correlation between suboptimal documentation and failure to justify transfusion (P = .03). There is a significant correlation between suboptimal documentation and failure to justify transfusions. Educating clinicians to improve documentation along with appropriate indications for transfusions may enhance efficiency of blood utilization assessment and lead to reduced rates of unjustifiable transfusions.

Adequacy of physician documentation of red blood cell transfusion and correlation with assessment of transfusion appropriateness.

Abstract Context.—A major function of the hospital transfusion service is to assess the appropriateness of blood transfusion. Inadequate documentation of transfusions may hamper this assessment process. Objective.—To correlate the level of physician documentation of transfusion with the ability to justify transfusion. Design.—Retrospective review of red blood cell transfusions in adult patients in 2 hospital facilities during 1-week audit periods of each month from April 2001 to March 2003. Assessment forms were used to classify the level of physician documentation of transfusions into 3 groups: adequately, intermediately, and inadequately documented. Transfusions were deemed justified or not via comparison with hospital transfusion guidelines. Results.—There were 5062 audited red blood cells transfused to 2044 adult (≥18 years) patients. Medical records from 154 patients transfused with 257 units of red blood cells during 172 transfusion events were reviewed after initial screenings of hemoglobin/hematoc...