Auditing Blood Transfusion Administration Against National Guidelines in Medical Same Day Emergency Care

Abstract Objective The objective of this quality improvement project was to assess whether blood transfusion administration in a medical same day emergency care unit followed national guidelines 1–5. Methods In Cycle 1, data were collected between 11 August 2023 and 13 November 2023 on 48 patients attending the medical same day emergency care unit at Darlington Memorial Hospital, County Durham, England. The results of Cycle 1 demonstrated that we could improve in all aspects of blood transfusion administration, particularly the provision of relevant information to patients and the documentation of obtained consent/refusal of treatment. To improve practice, the results have been shared with colleagues through teaching presentations and daily handovers. An electronic checklist was designed and implemented in our electronic prescribing system, focusing on those aspects that needed improvement. Cycle 2 assessed practice following the implementation of those interventions. Data collected between 29 February 2024 and 29 June 2024 involved 50 patients. Results Cycle 2 demonstrated that alternatives to blood transfusion were considered in 80% of cases compared with 68.75% patients in Cycle 1 (moderate improvement). A restrictive red blood cell transfusion threshold was followed in 81.4% of cases in Cycle 2 compared with 77.78% of patients in Cycle 1 (mild improvement). Adherence to single-unit red blood cell transfusions was 83% in Cycle 2 compared with 77% in Cycle 1 (mild improvement). Documentation of consent was obtained in 44% of patients in Cycle 2 compared with 6.8% patients in Cycle 1 (marked improvement). Discussion regarding the risks/benefits of blood transfusion was undertaken in 39% of patients in Cycle 2 compared with 2.2% of patients in Cycle 1 (a marked improvement). Evidence of the blood transfusion checklist being used was 10% in Cycle 2. Conclusion Overall, between Cycles 1 and 2, there was a mild to moderate improvement in all parameters assessed in this project. In particular, there was a marked improvement in clinicians discussing the risks/benefits of blood transfusion administration (36.8%) and obtaining valid consent for patients receiving a blood transfusion (37.2%). It was disappointing that the blood transfusion checklist was used only in 10% of patients in Cycle 2. However, it seems that other interventions implemented between Cycle 1 and Cycle 2 have resulted in positive changes in practice. It will be important to continue distributing the results of this quality improvement project to colleagues, to continue to raise awareness of the blood transfusion checklist, and to re-audit practice in Cycle 3. References 1. Evidence reviewed from JPAC - Joint United Kingdom (UK) Blood Transfusion and Tissue Transplantation Services Professional Advisory Committee and NICE guidelines regarding blood transfusion guidelines. 2. The National Institute for Health and Care Excellence. Published: 18 November 2015. Blood transfusion NICE guideline NG24. Published 18 November 2015. Sponsored by the Department of Health and Social Care. Date accessed 2 November 2023. 3. Joint United Kingdom (UK) Blood Transfusion and Tissue Transplantation Services Professional Advisory Committee; Date created/updated – not stated; Consent for Blood Transfusion; 84.2% - NHS Blood and Transplant, England (NHSBT), 8.2% - Scottish National Blood Transfusion Service (SNBTS), 4.7% - Welsh Blood Service (WBS), 2.8% - Northern Ireland Blood Transfusion Service (NIBTS). Date accessed 13 November 2023. 4. Joint United Kingdom (UK) Blood Transfusion and Tissue Transplantation Services Professional Advisory Committee; Updated 7 March 2023. Effective transfusion in medical patients; 84.2% - NHS Blood and Transplant, England (NHSBT), 8.2% - Scottish National Blood Transfusion Service (SNBTS), 4.7% - Welsh Blood Service (WBS), 2.8% - Northern Ireland Blood Transfusion Service (NIBTS). Date accessed 13 November 2023. 5. Joint United Kingdom (UK) Blood Transfusion and Tissue Transplantation Services Professional Advisory Committee; Date created/updated – not stated; Consent for Blood Transfusion - Guidance for Healthcare Practitioners in the UK; 84.2% - NHS Blood and Transplant, England (NHSBT), 8.2% - Scottish National Blood Transfusion Service (SNBTS), 4.7% - Welsh Blood Service (WBS), 2.8% - Northern Ireland Blood Transfusion Service (NIBTS). Date accessed 13 November 2023.