Audit of clinical-laboratory practices in haematology and blood transfusion at Muhimbili National Hospital in Tanzania

Abstract

In Tanzania, there is paucity of data for monitoring laboratory medicine including haematology. This therefore calls for audits of practices in haematology and blood transfusion in order to provide appraise practice and devise strategies that would result in improved quality of health care services. This descriptive cross-sectional study which audited laboratory practice in haematology and blood transfusion at Muhimbili National Hospital (MNH) aimed at assessing the pre-analytical stage of laboratory investigations including laboratory request forms and handling specimen processing in the haematology laboratory and assessing the chain from donor selection, blood component processing to administration of blood during transfusion. A national standard checklist was used to audit the laboratory request forms (LRF), phlebotomists’ practices on handling and assessing the from donor selection to administration of blood during transfusion. Both interview and observations were used. A total of 195 LRF were audited and 100% of had incomplete information such as patients’ identification numbers, time sample ordered, reason for request, summary of clinical assessment and differential diagnoses. The labelling of specimens was poorly done by phlebotomists/clinicians in 82% of the specimens. Also 65% (132/202) of the blood samples delivered in the haematology laboratory did not contain the recommended volume of blood. There was no laboratory request form specific for ordering blood and there were no guidelines for indication of blood transfusion in the wards/clinics. The blood transfusion laboratory section was not participating in external quality assessment and the hospital transfusion committee was not in operation. It is recommended that a referral hospital like MNH should have a transfusion committee to provide an active forum to facilitate communication between those involved with transfusion, monitor, coordinate and audit blood transfusion practices as per national guidelines.

Evaluation of Laboratory Request Form Variables as Filled by Clinicians at Msambweni County Referral Hospital, Kwale County, Kenya.

“…However, patient name (100%) and requested tests (100%) were recorded in all evaluated LRFs. Comparable ndings regarding patient names have been reported in various studies [1,2,18,19]. Remarkably, in terms of the unique identi cation of patients through their outpatient or inpatient numbers, three-quarters (75.74%) of the LRFs were completed.…”

Systematic review of prevalence and risk factors of transfusion transmissible infections among blood donors, and blood safety improvements in Southern Africa

“…The two articles from Tanzania recommend preliminary measures for the first stages of blood safety efforts 35,39 . Makubi et al 35 recommend the implementation of a blood transfusion monitoring systems and committee in hospitals and to conduct regular audits to monitor transfusion practice. Valerian et al 39 call for appropriate preventive measures to address the main causes of deferrals focusing on HIV and HBV infections.…”

“…Twelve articles investigated blood safety in the SADC region (Table 3). 24,28,[32][33][34][35][36][37][38][39][40][41] Of the 12 studies, 41% (5/12) were done in South Africa, while Tanzania and DRC had 2 articles each. The other three articles were from Botswana, Mozambique, and Zimbabwe.…”

“…35,39,40 The two articles from Tanzania recommend preliminary measures for the first stages of blood safety efforts. 35,39 Makubi et al 35 recommend the implementation of a blood transfusion monitoring systems and committee in hospitals and to conduct regular audits to monitor transfusion practice.…”

Appropriateness of transfusions of red cells, platelets and fresh frozen plasma: An audit in referral hospitals in Tanzania

“…1 The audits defined as a quality improvement process that seeks to improve patient care and outcome through a systematic review of care against published criteria. 2 It is part of a continuous quality improvement process and an essential element of clinical governance.…”