Reduction of inappropriate use of blood products by prospective monitoring of transfusion request forms.
OBJECTIVE
To determine the effect of prospective monitoring on appropriateness of transfusions of red cells, platelets and fresh frozen plasma (FFP).


METHODS
Prospective interventional study.


METHODS
Royal Melbourne Hospital (a tertiary teaching hospital), Melbourne, Victoria, March-May 1996.


METHODS
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.


METHODS
200 consecutive transfusion episodes for each product (red cells, platelets and FFP).


METHODS
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.


CONCLUSIONS
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.
Tuckfield
A
A
Department of Diagnostic Haematology, Royal Melbourne Hospital, VIC.
Haeusler
M N
MN
Grigg
A P
AP
Metz
J
J
D016913:Blood Component Transfusion / Q000592:standards* / Q000706:statistics & numerical data; D017707:Erythrocyte Transfusion / Q000592:standards* / Q000706:statistics & numerical data; D005568:Forms and Records Control; D006753:Hospital Records / Q000592:standards*; D006801:Humans; D008485:Medical Audit; D018579:Patient Selection; D010949:Plasma; D017713:Platelet Transfusion / Q000592:standards* / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D011785:Quality Assurance, Health Care / Q000458:organization & administration*