Reduction of inappropriate use of blood products by prospective monitoring of transfusion request forms
| Autor: | Annabel Tuckfield, Jack Metz, Michael N Haeusler, Andrew Grigg |
|---|---|
| Rok vydání: | 1997 |
| Předmět: |
medicine.medical_specialty
Quality Assurance Health Care Blood Component Transfusion Platelet Transfusion Medical practitioner Teaching hospital Plasma Blood product Internal medicine medicine Humans Prospective Studies High rate Medical Audit Hematology business.industry Patient Selection Outcome measures General Medicine Hospital Records Surgery Clinical trial Practice Guidelines as Topic Emergency medicine Forms and Records Control Fresh frozen plasma Erythrocyte Transfusion business |
| Zdroj: | Medical Journal of Australia. 167:473-476 |
| ISSN: | 1326-5377 0025-729X |
| DOI: | 10.5694/j.1326-5377.1997.tb126674.x |
| Popis: | OBJECTIVE To determine the effect of prospective monitoring on appropriateness of transfusions of red cells, platelets and fresh frozen plasma (FFP). DESIGN Prospective interventional study. SETTING Royal Melbourne Hospital (a tertiary teaching hospital), Melbourne, Victoria, March-May 1996. INTERVENTION The blood product request form was modified to incorporate indications for transfusion and clinical and laboratory data. Requests were monitored by blood bank laboratory staff for conformation with hospital transfusion guidelines; non-conforming requests were discussed with the requesting medical practitioner by the Haematology Registrar before blood products were issued. In case of disagreement, blood products were always issued. SUBJECTS 200 consecutive transfusion episodes for each product (red cells, platelets and FFP). OUTCOME MEASURES Appropriateness of transfusion, assessed by a Consultant Haematologist according to hospital guidelines. Rates of inappropriate transfusion episodes after intervention were compared with rates in a previous study. RESULTS After intervention, rates of inappropriate transfusion episodes fell significantly (red cells, 16% to 3% [P = 0.004]; platelets, 13% to 2.5% [P = 0.02]; and FFP, 31% to 15% [P = 0.02]). Almost all inappropriate FFP transfusion episodes post-intervention were due to failure to demonstrate prolongation of prothrombin or activated partial thromboplastin times more than 1.5 times the control value. CONCLUSION Prospective monitoring of request forms can reduce rates of inappropriate transfusions. High rates of inappropriate FFP transfusions possibly reflect uncertainty about appropriate laboratory criteria for FFP transfusion. While results of large prospective randomised controlled clinical trials of FFP transfusions are awaited, currently laboratory criteria can be retained, but should be applied with flexibility. |
| Databáze: | OpenAIRE |
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