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National Comparative Audit of Blood Transfusion

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Does it contain Forename, Surname, Gender,Date of Birth & ID number? ... Is compatibility report signed? Is date of transfusion recorded? ... – PowerPoint PPT presentation

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Title: National Comparative Audit of Blood Transfusion


1
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

2
History
  • Repeat of an audit performed in 2003, but
    modified in light of comments from Transfusion
    Practitioners

3
How the audit works
  • The audit is in 2 parts
  • Hospital Organisational Questionnaire
  • Audit of 40 transfusion episodes

4
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

5
Participating Hospitals
  • 270 (25) hospitals sent Organisational Audit data
  • 234 (17) NHS hospitals and 35 (3) private
    hospitals sent transfusion episode data

6
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).

7
Re-Audit of Bedside Transfusion Practice
  • Scope

8
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?

9
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

10
Re-Audit of Bedside Transfusion Practice
  • Results

11
Organisational Audit
12
Organisational Audit
Hospital V did not send organisational audit data
13
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
14
Practice results - Wristbands
Hospitals A, I S, T X did not send data
15
Compatibility Report or Prescription Sheet signed
Hospitals A, I S, T X did not send data
16
Date of transfusion recordedon compatibility
report or prescription sheet
17
Start time recordedon compatibility report or
prescription sheet
18
Pre-transfusion observations recordedBP,Temperatu
re and Pulse
19
First observations recordedTemperature Pulse
within 30 minutes of start
20
Post-transfusion observations recordedBP,Temperat
ure and Pulse
21
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

22
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?

23
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

24
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

25
at risk patients per hospital
26
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

27
Next Steps
  • This slide is deliberately blank for you to add
  • whatever points you may wish to concerning
  • what your hospital / Trust should do next.
  • Please delete the slide if you do not wish to
  • show it.

28
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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