Improving Blood Product Transfusion Premedication Plan Documentation: A Single-institution Quality Improvement Effort

Abstract

Introduction: Premedication with acetaminophen and/or diphenhydramine to prevent febrile nonhemolytic transfusion reactions and minor allergic transfusion reactions is a common practice based on historical recommendations. However, recent small randomized-controlled trials showed no benefit of premedication. This inconsistency leads to practice variability, which results in the inefficiency of our institution’s blood product ordering process. This project aimed to improve the number of transfusion encounters with premedication plan documentation from a baseline of 19% to 80% in 12 months. Methods: A multidisciplinary quality improvement (QI) team used QI tools to design interventions to improve the efficiency of the ordering process for blood products. Measures were tracked monthly and analyzed using statistical process control. Results: From September 2018 to January 2021, 5,351 blood product transfusion visits were scheduled. At baseline, 34% of patients received premedication, and 19% had premedication plans documented. Interventions included a passive computerized provider order entry alert, clinical care pathway development, and clinician education. Postimplementation, the average number of encounters with a premedication plan increased from 19% to 87%, whereas encounters receiving premedication decreased from 34% to 25%. There was no change in the average number of transfusion reactions (1.8 per 100 transfusions). Conclusions: Using QI methods, our team successfully standardized the blood product premedication plan documentation despite unclear best practices regarding blood product transfusion premedication. The team added premedication plan documentation training to new employee orientation for sustainability.

Decreasing Premedication for Blood Transfusions: A Quality Improvement Project

“…However, the focus of this QI project wasn't only to add to the already robust evidence that premedication doesn't reduce adverse reactions, but also to implement evidence-based strategies to change a longstanding culture and reduce ordering clinicians' use of premedication. Four articles found in the literature search focused on evidence-based interventions to decrease the use of premedication in blood transfusions (see Table 1 [5][6][7][8] ); these were used as the basis for the QI project. Three of these articles were published in 2022, [6][7][8] while the fourth, by Wong-Sefidan and colleagues, was published in 2014.…”

“…Four articles found in the literature search focused on evidence-based interventions to decrease the use of premedication in blood transfusions (see Table 1 [5][6][7][8] ); these were used as the basis for the QI project. Three of these articles were published in 2022, [6][7][8] while the fourth, by Wong-Sefidan and colleagues, was published in 2014. 5 This article was included because it was a systematic review of all relevant articles on this topic published before 2014, and has served as the foundation for future initiatives on the topic.…”