Audit of appropriate use of platelet transfusions: validation of adjudication criteria

Abstract

Background and Objectives Platelet (PLT) transfusions must be used appropriately, as they are in chronic short supply, costly and risky to patients. The goals of this audit were to: (1) validate preset adjudication criteria through an audit of appropriateness at four large academic hospitals; (2) identify variability in appropriateness across medical services, physician specialties or hospital locations; and (3) inform logistical or educational interventions that may reduce inappropriate use.Materials and Methods A chart review of two hundred patients receiving PLT transfusions was performed. Fifty consecutive transfusion episodes per site were audited in detail. Each transfusion episode was independently adjudicated as appropriate or inappropriate by two transfusion specialists based on predetermined criteria. ResultsThe adjudication criteria performed well with simple agreement of 95% (kappa statistic 0Á83) between reviewers. Overall, 78% (95% CI: 72-84%) of PLT transfusions were adjudicated as appropriate, with results varying significantly by hospital site (range 62-94%). Prophylactic transfusions for non-bleeding patients had the highest proportion of appropriateness (85%, n = 80), and therapeutic transfusions for bleeding patients had the lowest (73%, n = 99). The lowest levels of appropriate platelet transfusions were observed in the operating rooms (60%) and when ordered by the general surgery service (55%).Conclusions One in five platelet transfusions may be unnecessary, suggesting that interventions to improve PLT transfusion practice are warranted. Background and objectives

Evaluating the appropriateness of platelet transfusions compared with evidence‐based platelet guidelines: An audit of platelet transfusions at 57 hospitals

“…Compared to prior platelet audits finding inappropriate rates of 2% to 66%, 25–47 our inappropriateness rate of 42% for adult and 63% for pediatric patients is at the higher end of this range. This may be due to application of strict criteria, broad inclusion of hospital types, specification of consecutive orders, and inclusion of all clinical services.…”

“…The detailed criteria (Table 1) for adjudication for pediatric (nonneonatal) and adult patients were derived from published guidelines and published literature 14,49,50 and have been previously validated in a pilot study 47 . Separate adjudication criteria were used for the neonatal subjects based on published guidelines and published literature 50–53 .…”

“…Platelet transfusion quality‐improvement audits are important to understand compliance with guidelines and have reported inappropriateness rates ranging from 2.5% to 66% 25–47 . These studies occurred over a broad time period, with retrospective and prospective designs, performed at single and multiple sites, and applied stringent and liberal criteria and in many different clinical settings.…”

“…This multicenter platelet transfusion audit aimed to determine platelet transfusion appropriateness and common patient scenarios with deviations from evidence‐based guidelines across all patient groups without any patient exclusions. This audit was unique in using established a priori appropriateness criteria validated in a pilot study 47 with detailed medical chart reviews and adjudication performed independently by two transfusion medicine specialists.…”

Audit System for Usage of Blood Product in Sanglah General Hospital Denpasar Bali

“…Another issue that arises is the inefficiency of the components of the pretransfusion examination and the declining quality of the blood. The decline in the quality of blood is due to the prolonged period of 2,4 storage of blood products.…”