National Comparative Audit of Blood Transfusion

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National Comparative Audit of Blood
Transfusion
Re-Audit of Bedside Transfusion Practice
A regional perspective for the Manchester
Lancaster RTC

• Prepared by
• John Grant-Casey Project Manager

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History

• Repeat of an audit performed in 2003, but
  modified in light of comments from Transfusion
  Practitioners

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How the audit works

• The audit is in 2 parts
• Hospital Organisational Questionnaire
• Audit of 40 transfusion episodes

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40 Transfusion episodes

• NBS supplied a quota of cases
• Visit clinical area at time of blood transfusion
• Complete questions on audit proforma
• Return later to complete rest

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Participating Hospitals

• 270 (25) hospitals sent Organisational Audit data
• 234 (17) NHS hospitals and 35 (3) private
  hospitals sent transfusion episode data

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Evidenced-based audit

• Policy and practice was audited against
  guidelines from British Committee for Standards
  in Haematology
• The administration of blood and blood components
  and the management of transfused patients
  (Transfusion Medicine, 1999,9, 227-238).

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Re-Audit of Bedside Transfusion Practice

• Scope

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Aspects audited

• Is patient wearing wristband?
• Does it contain Forename, Surname, Gender,Date of
  Birth ID number?
• Do the details on the wristband match with the
  details on the compatibility report form, unit of
  blood, prescription sheet medical records?
• Is compatibility report signed?
• Is date of transfusion recorded?

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Aspects audited

• Pre-transfusion BP, Pulse Temperature taken?
• Start time recorded?
• Pulse Temperature at 15 mins?
• Stop time recorded
• Post-transfusion BP, Pulse Temperature taken?
• Patient location, consciousness, clinical
  speciality

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Re-Audit of Bedside Transfusion Practice

• Results

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Organisational Audit
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Organisational Audit
Hospital V did not send organisational audit data
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National practice results

• Data from 8054 transfusions were collected
• Key findings
• Patients transfused without wristband
• Documents unsigned undated
• Start stop times not recorded
• Observations not done

For the region 651 transfusions were audited
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Practice results - Wristbands
Hospitals A, I S, T X did not send data
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Compatibility Report or Prescription Sheet signed
Hospitals A, I S, T X did not send data
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Date of transfusion recordedon compatibility
report or prescription sheet
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Start time recordedon compatibility report or
prescription sheet
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Pre-transfusion observations recordedBP,Temperatu
re and Pulse
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First observations recordedTemperature Pulse
within 30 minutes of start
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Post-transfusion observations recordedBP,Temperat
ure and Pulse
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Assessing Risk

• This audit has looked at two key elements of
  minimising
• transfusion risks.
• 1. The risk of receiving the wrong unit
• of blood
• 2. The risk of suffering an unobserved
• transfusion reaction

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Assessing Risk

• A risk assessment for each transfusion
  episode has been carried out based on the
  following criteria
• Is the patient identifiable?
• Is the patient conscious?
• Are the patients vital signs monitored?
• Is the patient visible to the nursing staff?

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Risk scoring system

• Points awarded if
• Wristband is missing
• Data is missing from wristband
• Data is mismatched on wristband
• Patient is unconscious
• Vital signs poorly monitored

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Risk scoring system

• Add up the points for each transfusion audited,
  then
• Low risk lt2
• Moderate risk 2-3.75
• High risk 4-5
• Severe risk gt5
• Depending on their score, we suggest patients are
  being put at risk

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at risk patients per hospital
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Conclusions

• Overall, some improvement on 2003 findings
• Some patients at risk because they are not
  independently identifiable
• Some patients at risk of unidentified transfusion
  reactions because of poor monitoring

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Next Steps

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• whatever points you may wish to concerning
• what your hospital / Trust should do next.
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• show it.

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National Comparative Audit of Blood
Transfusion
Re-Audit of Bedside Transfusion Practice
A regional perspective for the Manchester
Lancaster RTC

• Prepared by
• John Grant-Casey Project Manager