Background: Current guidelines from the AABB (formerly known as the American Association of Blood Banks) recommend a red blood cell transfusion for hospitalized patients who are hemodynamically stable if the hemoglobin is 7 g/dL or less. This threshold also includes critically ill patients who are hemodynamically stable in the intensive care unit. The guidelines also recommend a red blood cell transfusion for patients undergoing orthopedic surgery, cardiac surgery and those with preexisting cardiovascular disease if the hemoglobin is 8 g/dL or less. However, at our institution some transfusions were occurring with a documented hemoglobin greater than 10 g/dL. In addition, there were transfusions also occurring with hemoglobin between 8 g/dL and 10 g/dL without a clear indication.
Purpose: The goal of our quality improvement project was to decrease the rate of inappropriate blood transfusions and to educate the physicians on the recommended indications based on the AABB guidelines. At our institution, we noticed that red blood cell transfusions were often ordered according to each provider’s own clinical assessment rather than following the guidelines. In addition, patients were being transfused multiple sequential units without an interval hemoglobin and hematocrit being checked post-transfusion.
Description: We reviewed and analyzed data from our institution’s database of transfusion orders over a span of twelve months, from 2017 to 2018. During this time, we devised and implemented multiple interventions along the way that were based on the results of the data. Our first intervention modified and improved the electric medical record order set. We noticed that the physicians were bypassing the order set by selecting “other” as a reason for the transfusion. The new order set now includes clear indications that the physician must select prior to ordering a red blood cell transfusion. In addition, the order set also includes checking the hemoglobin and hematocrit post-transfusion. The second intervention involved physician education that consisted of lectures. Our last intervention was a directed targeted feedback that consisted of the blood bank calling the physician if the indication for the transfusion was not clear in the order set.
Conclusions: This quality improvement project aimed to decrease the rate of inappropriate red blood cell transfusions at our institution. We implemented multiple interventions, as mentioned above, to achieve this goal. Our data revealed an overall decrease in the rate of transfusions from 60.03 to 51.23 units per 1000 patient-hours. This represents a successful decrease in the rate of inappropriate transfusions with an overall reduction of blood utilization by 14.7%.
To cite this abstract:Olmedo, K; Hwang, AW; Whitmore, M; Popa, A. DECREASING INAPPROPRIATE BLOOD TRANSFUSIONS. Abstract published at Hospital Medicine 2019, March 24-27, National Harbor, Md. Abstract 336. https://www.shmabstracts.com/abstract/decreasing-inappropriate-blood-transfusions/. Accessed August 19, 2019.