Inappropriate Use Of Blood Components Research Articles

Insights from developing and evaluating the NHS blood choices transfusion app to support junior and middle-grade doctor decision making against guidelines.

To: 1. Develop a CE-marked smartphone App to support doctors' concordance with transfusion guidelines in non-bleeding adult patients, emphasising informed consent and anaemia management. 2. Test App accuracy and potential to improve user decisions. Studies have shown inappropriate use of blood components and that most junior doctors own smartphones with medical apps. A multidisciplinary team developed App screens and logic through an iterative process based on national guidelines. Thirty medical or surgical transfusion scenarios were developed based on national guidelines and each sent to Consultant Haematologist experts in Transfusion Medicine. To obtain a clinical consensus and exclude ambiguous scenarios, their independent decisions and associated certainty were compared. The consensus clinical decision was then compared with guidance from the App. To explore potential App impact on simulated user decisions, 26 junior doctors responded to five transfusion scenarios before and after access to the App. The Blood Choices App agreed with 91% (95% CI: 72%-99%) of expert decisions with a sensitivity of 100% (69% to 100%) and specificity of 85% (55%-98%). Excluding one malfunction scenario, the App had the potential to increase correct decisions by junior doctors from 83% (73%-90%) pre-App use to 96% (88%-99%) post (p-value 0.013), with 90% (67%-99%) saying they would use it in practice. Transfusion guidelines can be converted into an App with potential to improve guideline concordance. However, evaluating such Apps is essential to understand their limitations, detect malfunctions and prevent harm.

Outcome of audit and education on blood transfusion practice in obstetrics setting

IntroductionAudit and education are essential pre-requisites in the review and update of blood transfusion practices. Although standard guidelines on appropriate utilization of blood components exists, erroneous use of blood components with no justification still continues. This study evaluates appropriateness of blood transfusion in obstetric settings and identifies key areas requiring educational intervention to improve blood transfusion practice toward the evidence-based at our hospital. MethodThis was a prospective observational study on the analysis of blood transfusion requisition forms for obstetric patients before and after educational intervention, performed in two Phases from September 2011 to August 2012 and October 2012 to September 2013. The appropriateness of blood utilization was assessed against the Royal College of Obstetricians and Gynecologists Guidelines for blood transfusion and Green-Top Guideline no. 47. Data required for the study were obtained from department records and statistical analysis was performed using the SPSS, version 20 (IBM, USA). ResultsThe total transfusion episodes were 214 in 51 patients and 181 in 43 patients in Phases 1 and 2, respectively. Fresh frozen plasma was the most misused blood component, next to whole blood in Phase 1. However, appropriate utilization of components, including cryoprecipitate (6.6%), reduction in whole blood (34.5–14.4%) and single unit transfusion (23.3–18.2%) were observed in Phase 2. Inappropriate use of blood components, namely, packed red blood cells and fresh frozen plasma dropped significantly (p<0.05) from 29.7% to 13.1% and 45.1% to 22.5%, respectively, with the exclusion of platelet concentrate (33.3–20.6%, p-value 0.414). ConclusionAudit and targeted education helped in optimizing transfusion practices in the obstetric setting.

Blood Component Transfusion in a Tertiary Care Hospital.

ObjectivesTo study the rational use of the blood components in pediatric and neonatal wards.MethodsIt was a retrospective study conducted by department of pediatrics of a tertiary care centre in western part of India. The patients were included from the pediatric ward, pediatric surgery ward, neonatal intensive care unit (NICU), pediatric intensive care unit (PICU) over a period of three months. All the patients below 12 y of age receiving blood components, admitted in general pediatric wards, pediatric intensive care unit, neonatal intensive care unit and pediatric surgery ward were included in the study. Each transfusion episode was assessed as per predetermined guidelines.ResultsOf the total 336 episodes of blood component transfusions, 244 episodes were appropriate and 92 episodes were inappropriate. Among these, platelets had highest inappropriate (36.84%) episodes followed by fresh frozen plasma (FFP) (28.95%) and packed red blood cell transfusions (PRBC) (21.21%). Majority inappropriate transfusions were seen in intensive care settings.ConclusionsAlmost one-third of blood component transfusions (FFP, platelets and PRBC) were given without any definitive indication. Judicious use of various blood products by following recommended guidelines may help in decreasing the inappropriate use of blood components.

Transfusion support in patients with dengue fever.

Dengue fever has emerged as a global public health problem in the recent decades. The clinical spectrum of the disease ranges from dengue fever to dengue hemorrhagic fever and dengue shock syndrome. The disease is characterized by increased capillary permeability, thrombocytopenia and coagulopathy. Thrombocytopenia with hemorrhagic manifestations warrants platelet transfusions. There is lack of evidence-based guidelines for transfusion support in patients with dengue fever. This contributes to inappropriate use of blood components and blood centers constantly face the challenge of inventory management during dengue outbreaks. The current review is aimed to highlight the role of platelets and other blood components in the management of dengue. The review was performed after searching relevant published literature in PubMed, Science Direct, Google scholar and various text books and journal articles.

A retrospective clinical audit of blood transfusion requests in tertiary care hospital

Introduction: The inappropriate use of medical technology is a major factor in increased health care expenses and inappropriate use of blood is costly. There is a need for continuous audit of the use of products as therapy. Audits are useful tools in the education of those ordering blood components, potentially resulting in the reduction of inappropriate use of blood components. Aim: A retrospective clinical audit of blood transfusion requests in patients at a tertiary care hospital. Material and Methods: This retrospective clinical audit conducted at NKP salve institute of medical sciences and research center and lata mangeshkar hospital Nagpur for a period of 3 months from April 2013 to June 2013. A retrospective analysis of blood and its component requisitions in all patients from different clinical departments was reviewed regarding diagnosis, indication for transfusion, number of units requested and the speciality prescribing it. Reports of silent investigations like hemoglobin, platelet count, coagulogram was also recorded. Results: Out of 869 requisitions, 301 were for male patients and 568 were for female patients. Total number of blood components distribution request was 1188. 632 were for whole blood, 364 were for packed red cells, 182 were for FFP and 10 for platelet concentrate. Pre transfusion Hemoglobin was &gt;8 gm/dl in 273 requests. Pre transfusion hemoglobin values were not available for 192. The urgency for transfusion was mentioned on 728, indication was mentioned on 804 and diagnosis was mentioned on 755 requisition forms. Multiple blood components requests were 97. The maximum request was from Department of Obstetrics and Gynaecology. Total blood components issues were 707. Out of which 329 whole blood, 194 packed red cells, 182 FFPs and platelet concentrate were 2. Total donors were 554. Conclusion: Clinical audits helps to reduce inappropriate use of blood and blood components, avoids blood transfusion reaction and avail the deprived patients.

A Review of Blood Transfusion Requests in Rl Jalappa Hospital and Research Centre for Blood and Blood Components

Predetermined transfusion guidelines, pretransfusion approval, and transfusion audits are useful tools in the education of those ordering blood components, potentially resulting in the reduction of inappropriate use of blood components. In spite of advice by the blood bank physician, blood components released based on the demand of the ordering physician, which was deemed as inappropriate transfusions. The present study was conducted upon 1694 episodes of transfusion units for different blood components over a period of 3 months from November 2011 to January 2012. Of the total 1694 transfusion episodes in 920 requests for 796 patients. 124 patients had multiple requests. 208 males and 588 were females. Single unit requisitions were 456, and two unit requisitions were 354, and 3 or more unit requisition in 110 requests. 222 requests contained > 10 gms% as indication, 330 requests had 7.1- 9.9 gms%, and 250 requests with < 7 gms%. Elective transfusion requests found in 100 requests and 369 had emergency request, and 451 didn’t contain any information.136 patients received single unit transfusion. 660 patients had 2 or more than 2 unit transfusion. During this 3 month period 20.3 units /day was bled at blood bank and in camps. 26.4 units/day issued to both Inpatient (IP) and Outpatient (OP) requests. 18.4 units/day was issued to IP requests.450 requests from Obstetrics and Gynecology (OBG) department, 735 requests had indication for blood transfusion written in the requisition. The objective of this study is prospective audits of blood component orders can help reduce inappropriate transfusions and can be a valuable educational tool for the ordering physicians as well as for residents in training.

A Prospective Audit of Blood Transfusion Requests in Rl Jalappa Hospital and Research Centre for Blood and Blood Components

Predetermined transfusion guidelines, pre transfusion approval, and transfusion audits are useful tools in the education of those ordering blood components, potentially resulting in the reduction of inappropriate use of blood components. In most cases, blood components released based on the demand of the ordering physician, despite the advice of the blood bank physician, were deemed as inappropriate transfusions. The present study was conducted upon 1694 episodes of transfusion units for different blood components over a period of 3 months from November 2011 to January 2012, out of total 1694 transfusion episodes in 920 requests for 796 patients. 124 patients had multiple requests. 208 males and 588 were females. . Single unit requisitions were 456, and two unit requisitions were 354, and 3 or more unit requisition in 110 requests. 222 requests contained >10 gms% as indication, 330 requests had 7.1- 9.9 gms%, and 250 requests with <7 gms%. Elective transfusion requests found in 100 requests and 369 had emergency request, and 451 didn’t contain any information. 136 patients received single unit transfusion. 660 patients had 2 or more than 2 unit transfusion. During this 3 month period 20.3 units /day was bled at blood bank and in camps. 26.4 units/day issued to both IP and OP requests. 18.4 units/day was issued to IP requests. 450 requests from Department of Obstetrics and Gynecology (OBG dept), 735 requests had indication for blood transfusion written in the requisition. This study therefore suggests that prospective audits of blood component orders can help reduce inappropriate transfusions and can be a valuable educational tool for the ordering physicians as well as for residents in training.

Rational use of blood components — an audit

The present study was designed to study appropriateness of use of the blood components in pediatric and neonatal wards. It was an observational study conducted in a tertiary care institute. The patients were selected from various pediatric subsections over a period of six months. All the patients below 12 years of age, who received blood components in any of the pediatric subsections including general pediatric wards, pediatric intensive care unit, pediatric hematology section, neonatal intensive care unit and pediatric surgery ward were included in the study. Each transfusion episode was assessed to decide whether it satisfied the predetermined criteria. Of the total 184 episodes of blood component transfusions, 153 (83.1%) episodes were appropriate and 31 (16.9%) episodes were inappropriate. Among these, fresh frozen plasma transfusions had highest inappropriate [18/41 (58%)] episodes followed by packed red cell transfusions [11/110 (35.5%)] and platelet transfusions [2/5 (6.45%)]. There was no inappropriate episode of cryoprecipitate transfusion. The present study reinforces the importance of blood audit in the clinical setting. Judicious implementation of guidelines for use of various blood products may help decrease the inappropriate use of blood components.

A Prospective Audit Program to Determine Blood Component Transfusion Appropriateness at a Large University Hospital: A 5-Year Experience

Predetermined transfusion guidelines, pretransfusion approval, and transfusion audits are useful tools in the education of those ordering blood components, potentially resulting in the reduction of inappropriate use of blood components. Our institution requires mandatory prospective audits for a proportion (10%) of packed red blood cell unit orders and all orders for fresh frozen plasma, platelets, and cryoprecipitate. Cases where the blood bank physician recommends against a transfusion and the ordering physician concurs, or when blood components are released against blood bank's recommendation, are referred to the transfusion committee. Transfusion committee members review the medical records to determine the circumstances surrounding the transfusion request as well as patient outcomes relating to their receiving or not receiving the transfusion. We analyzed 220 transfusion episodes brought before the transfusion committee from 2001 to 2005. The most requested blood component denied or changed was fresh frozen plasma. With only a few exceptions, the denial or change of blood components had no adverse effect on the patient. Nonetheless, these interventions were deemed appropriate by the transfusion committee. In most cases, blood components released based on the demand of the ordering physician, despite the advice of the blood bank physician, were deemed as inappropriate transfusions. This study therefore suggests that prospective audits of blood component orders can help reduce inappropriate transfusions and can be a valuable educational tool for the ordering physicians as well as for residents in training.