title: Utilization of frozen plasma in Ontario: a provincewide audit reveals a high rate of inappropriate transfusions.
abstract: BACKGROUND
  Frozen plasma (FP) is frequently transfused inappropriately, an intervention that results in risk without benefit for the patient. To better understand current utilization practices in our region, we undertook a provincewide prospective audit to evaluate the clinical indications and appropriateness of FP transfusion.
  
  
  METHODS
  All hospitals in the Canadian province of Ontario with transfusion medicine services were invited to participate in a 5-day audit of FP utilization. FP dose, indication, and clinical patient data were collected for each transfusion request. Indications for FP transfusions were independently adjudicated as appropriate, inappropriate, or indeterminate based on predefined criteria.
  
  
  RESULTS
  Seventy-six (49%) of 155 invited hospitals participated in the audit, which included 573 requests for 2012 units of FP. A total of 559 transfusions (1909 units) were administered. Of 573 requests, 164 (28.6%) were deemed inappropriate most often because: 1) they were administered to patients with an international normalized ratio below 1.5 or 2) they were administered in absence of bleeding or emergency surgery. The most frequent indications for FP transfusions were before surgery and warfarin reversal. Overall, patients admitted to the clinical areas of surgery, internal medicine, and the emergency department represented the largest users of FP, but this varied by hospital type (community vs. academic). The most frequently requested doses of FP were 2 and 4 units.
  
  
  CONCLUSIONS
  This point-prevalence hospital audit revealed that transfusion of FP is frequently inappropriate. Focusing on reducing the two most common reasons for inappropriate FP transfusions could lead to a significant improvement in FP utilization.
authors.affiliation: Department of Medicine, Ottawa Hospital and University of Ottawa, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Ontario Regional Blood Coordinating Network Office, Toronto, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Laboratory Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Canadian Blood Services, Ottawa and Hamilton, Ontario, Canada.
authors.forename: Alan
authors.initials: A
authors.lastname: Tinmouth
authors.forename: Troy
authors.initials: T
authors.lastname: Thompson
authors.forename: Donald M
authors.initials: DM
authors.lastname: Arnold
authors.forename: Jeannie L
authors.initials: JL
authors.lastname: Callum
authors.forename: Kate
authors.initials: K
authors.lastname: Gagliardi
authors.forename: Deborah
authors.initials: D
authors.lastname: Lauzon
authors.forename: Wendy
authors.initials: W
authors.lastname: Owens
authors.forename: Peter
authors.initials: P
authors.lastname: Pinkerton
mesh_terms: D016913:Blood Component Transfusion / Q000706:statistics & numerical data*; D006801:Humans; D008485:Medical Audit; D009864:Ontario; D010949:Plasma