Error management of emergency transfusions: a surveillance system to detect safety risks in day to day practice.
Acute hemolysis due to AB0-incompatibility caused by transfusion of red blood cell concentrates (RBCC) to the wrong recipient is one of the major causes of transfusion-related death. As part of our policy to improve quality and safety in emergency transfusion, we have developed a standardized surveillance system for supplying RBCC in emergency situations. This surveillance system involves the implementation of a standardized set of basic data transmitted from the requesting unit to the blood bank by phone and a scoring system to check for compliance with guidelines and errors in daily routines. Communication deficiencies and delayed pretransfusion sampling were the most common errors.
Schmidt-Hieber
Martin
M
Medizinische Klinik III (Hämatologie, Onkologie und Transfusionsmedizin), Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany. martin.schmidt-hieber@charite.de
Schuster
Ronny
R
Nogai
Axel
A
Thiel
Eckhard
E
Hopfenmüller
Werner
W
Notter
Michael
M
D001787:Blood Group Incompatibility / Q000517:prevention & control*; D017707:Erythrocyte Transfusion; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D019451:Information Management; D008297:Male; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012308:Risk Management; D017751:Safety Management