engleski

DOES HOSPITAL-BASED HEMOVIGILANCE IMPROVE TRANSFUSION PRACTICE? THE EXPERIENCE AT MERKUR UNIVERSITY HOSPITAL

The pre- and post-hemovigilance related interventions were compared according to the following: reports on adverse transfusion reactions and events, traceability of blood products, patient information on transfusion issues, audit and surveillance of transfusion practice. Data were collected from patient medical files, nursing files, blood transfusion prescriptions, patient interviews and other available documents (monitoring sheets, etc.). The measurement of improvement included an education package with guidelines for transfusion ; introduction of new hand-written blood component requests ; waste reduction policy ; education of nursing and medical staff ; review of routine blood ordering ; and consultation and rounds of transfused patients by a transfusiologist. All measurement packages were successfully carried out as planned. During the 2006-2008 period, a total of 23095 RBC units, 15911 platelet units, 8972 FFP units, and 529 cryoprecipitate units were issued, of which 16.8% of RBC, 7.6% of FFP and 9.3% of cryoprecipitate units were returned unused. HTS covered approximately 30% of the work per year. Out of the total number of blood product units, 72% of RBC, 56% of FFP and 48% of cryoprecipitate units were released by HTS. The percentage of returned units was greater for those released by CITM than for those issued by HTS (19% vs. 16% for RBC ; 15% vs. 1.6% for FFP, and 13% vs. 6% for cryoprecipitate units). The proportion of FFP units returned unused decreased from 11% in 2006 to 6% in 2008, and of cryoprecipitate units from 12% in 2006 to 8% in 2008. The policy of waste reduction resulted in 6% reduction in the cost of blood transfusion therapy. Reports on adverse transfusion reactions increased from 3 to 30 cases per year. Our experience showed that hemovigilance as a crucial step in patient safety is a useful tool in assessing and improving the quality of transfusion practice, thus pointing to the role of HTS in quality assurance of transfusion therapy. We have identified the need to improve the present transfusion practice (a high rate of inappropriate plasma utilization, questionable justification of cryoprecipitate administration, non-documented indications for blood component treatment, high rate of blood units returned unused, and under-reported adverse transfusion reactions). Proper education of medical and nursing staff combined with all other activities has resulted in a more appropriate use of blood products, to the benefit of our patients and resources. Improvement of transfusion practice involves not only the entire blood chain, but also the input from the hospital management team, active Hospital Transfusion Committee including all medical personnel, and accepting the concept of overall healthcare improvement.

hemovigilance ; transfusion practice

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