Transfusion Safety: Less is More

Purpose:
Blood product tranfusions are one of the top two procedures for hospital inpatients. The goal of this initiative was to insure transfusion practices were consistent with current research findings, & eliminate unnecessary transfusions thereby decreasing adverse outcomes and improving patient safety

Significance:
Transfusions are life saving procedures, but are sources of risks & complications. Studies show a correlation between increased blood tranfusions & increased risks of infections & length of stay. Proper blood management reduces patient risks, conserves the blood supply & reduces healthcare costs.

Strategy and Implementation:
Initial assessment of blood utilization practices was completed. Physician leaders, nursing leaders,nurse educators and blood bank leaders attended mandatory meetings that shared current transfusion evidence and the findings from the initial assessment. Medical staff leadership developed & approved transfusion guidelines for PRBC consistent with current literature. Education on the current evidence based transfusion practice was required for all physicians, nurses and blood bank staff. The new guidelines were included in the education. Transfusion order sets were built in the electronic medical record. Indication for transfusion is a mandatory field in the order set. To decrease healthcare acquired anemia, smaller phlebotomy tubes are now used to minimize blood loss. Slogans were adopted to facilitate communication: "Seven is the new ten" & "Why order two when one will do". These catchy phrases promote compliance & facilitate discussion between physicians & nurses.

Evaluation:
From Jan 2011 to Feb 2013, RBC's per 1000 patient days decreased from 65.73 to 34.55, Average RBC transfused per patient decreased from 2.83 to 1.86. Cost of all blood products has decreased 12% during this time.

Implications for Practice:
Educating physicians and nurses at the same time and implementing order sets with current guidelines has decreased blood use, increased awareness of transfusion risks, and improved communication about the rationale for appropriate transfusion therapy.