Audit of transfusion procedures in 660 hospitals. A College of American Pathologists Q-Probes study of patient identification and vital sign monitoring frequencies in 16494 transfusions.
BACKGROUND
Hemolytic transfusion reactions are often the result of failure to follow established identification and monitoring procedures.


OBJECTIVE
To measure the frequencies with which health care workers completed specific transfusion procedures required for laboratory and blood bank accreditation.


METHODS
In 2 separate studies, participants in the College of American Pathologists Q-Probes laboratory quality improvement program audited nonemergent red blood cell transfusions prospectively and completed questionnaires profiling their institutions' transfusion policies.


METHODS
A total of 660 institutions, predominantly in the United States, at which transfusion medicine services are provided.


METHODS
The percentages of transfusions for which participants completed 4 specific components of patient and blood unit identifications, and for which participants monitored vital signs at 3 specific intervals during transfusions.


RESULTS
In the first study, all components of patient identification procedures were performed in 62.3%, and all required patient vital sign monitoring was performed in 81.6% of 12 448 transfusions audited. The median frequencies with which institutions participating in the first study performed all patient identification and monitoring procedures were 69.0% and 90.2%, respectively. In the second study, all components of patient identification were performed in 25.4% and all patient vital sign monitoring was performed in 88.3% of 4046 transfusions audited. The median frequencies with which institutions participating in the second study performed all patient identification and monitoring procedures were 10.0% and 95.0%, respectively. Individual practices and/or institutional policies associated with greater frequencies of patient identification and/or vital sign monitoring included transporting units of blood directly to patient bedsides, having no more than 1 individual handle blood units in route, checking unit labels against physicians' orders, having patients wear identification tags (wristbands), reading identification information aloud when 2 or more transfusionists participated, using written checklists to guide the administration of blood, instructing health care personnel in transfusion practices, and routinely auditing the administration of transfusions.


CONCLUSIONS
In many hospitals, the functions of identification and vital sign monitoring of patients receiving blood transfusions do not meet laboratory and blood bank accreditation standards. Differences in hospital transfusion policies influence how well health care workers comply with standard practices. We would expect that efforts designed to perfect transfusion policies might also improve performance in those hospitals in which practice compliance is substandard.
Novis
David A
DA
Department of Pathology, Wentworth-Douglass Hospital, Dover, NH 03820, USA. ynpa@nh.ultranet.com
Miller
Karen A
KA
Howanitz
Peter J
PJ
Renner
Stephen W
SW
Walsh
Molly K
MK
D000068:Accreditation / Q000592:standards; D000328:Adult; D001771:Blood Banks / Q000592:standards; D001803:Blood Transfusion / Q000379:methods* / Q000592:standards*; D002983:Clinical Competence / Q000592:standards; D019538:Health Care Surveys; D006761:Hospitals / Q000592:standards*; D006801:Humans; D007755:Laboratories, Hospital / Q000592:standards; D008991:Monitoring, Physiologic / Q000379:methods* / Q000592:standards*; D010355:Patient Identification Systems / Q000379:methods / Q000592:standards*; D011446:Prospective Studies; D011785:Quality Assurance, Health Care / Q000592:standards; D012955:Societies, Medical / Q000458:organization & administration*; D011795:Surveys and Questionnaires; D014481:United States; D000078329:Workforce; D000094902:Blood Banking / Q000379:methods