Assessment of bedside transfusion practices at a tertiary care center: A step closer to controlling the chaos

Abstract

BACKGROUND:Blood transfusion chain can be divided into three phases: preanalytical (patient bedside), analytical (steps done at transfusion services), and postanalytical (bedside). Majority (~70%) of events due to blood transfusion have been attributed to errors in bedside blood administration practices. Survey of bedside transfusion practices (pre-analytical and post analytical phase) was done to assess awareness and compliance to guidelines regarding requisition and administration of blood components.MATERIALS AND METHODS:Interview-based questionnaire of ward staff and observational survey of actual transfusion of blood components in total 26 wards of the institute was carried out during November–December 2013. All the collected data were coded (to maintain confidentiality) and analyzed using SPSS (v 20). For analysis, wards were divided into three categories: medical, surgical, and others (including all intensive care units).RESULTS:A total of 104 (33 resident doctors and 71 nursing) staff members were interviewed and observational survey could be conducted in 25 wards during the study period. In the preanalytical phase, major issues were as follows: lack of awareness for institute guidelines (80.6% not aware), improper sampling practices (67.3%), and prescription related (56.7%). In the postanalytical phase, major issues were found to be lack of consent for blood transfusion (72%), improper warming of blood component (~80%), and problems in storage and discarding of blood units.CONCLUSION:There is need to create awareness about policies and guidelines of bed side transfusion among the ward staff. Regular audits are necessary for compliance to guidelines among clinical staff.

Safe Blood Transfusion Practices among Nurses in a Major Referral Center in Ghana

“…In this study, 24%–35% of the participants knew the right issues to discuss whilst obtaining informed consent for blood transfusion ( Table 2 ). A previous observational prospective study similarly found that 72% of the participants did not obtain informed consent from the patients and family before initiating blood transfusion [ 17 ]. Another observational study of two tertiary hospitals in Nepal also found that 2.4%–8.2% of 86 observations of blood transfusions done involved informing patients and family of reasons for transfusion, benefits, and potential risks whilst seeking informed consent to transfuse [ 18 ].…”

Nature and causes of errors in the blood transfusion chain – a step towards patient safety

“…Khetan et al . reported lack of awareness regarding guidelines, improper sampling practices and lack of technology to be the major contributing factor in bedside errors.…”

“…Among the various wards, maximum errors occurred in emergency wards. This could be clearly explained by the increased work load and [23] reported lack of awareness regarding guidelines, improper sampling practices and lack of technology to be the major contributing factor in bedside errors.…”

Problems evidenced by nursing care in blood transfusions: an integrative review

“…It is necessary to control and increase the safety of the patient during transfusion practice and analysis of the main critical points that allow the error [14]. Therefore, the advancement of public policies, clinical guidelines and standard procedures with updated approaches in blood transfusion practices and internal audits are necessary to analyze the conditions of care and the implementation of standards [13,23]. These events direct the professionals to perform new researches which aim at improving evidence regarding patient safety and quality of care [14].…”