RESUMO
Abstract Introduction Audit and education are essential pre-requisites in the review and update of blood transfusion practices. Although standard guidelines on appropriate utilization of blood components exists, erroneous use of blood components with no justification still continues. This study evaluates appropriateness of blood transfusion in obstetric settings and identifies key areas requiring educational intervention to improve blood transfusion practice toward the evidence-based at our hospital. Method This was a prospective observational study on the analysis of blood transfusion requisition forms for obstetric patients before and after educational intervention, performed in two Phases from September 2011 to August 2012 and October 2012 to September 2013. The appropriateness of blood utilization was assessed against the Royal College of Obstetricians and Gynecologists Guidelines for blood transfusion and Green-Top Guideline no. 47. Data required for the study were obtained from department records and statistical analysis was performed using the SPSS, version 20 (IBM, USA). Results The total transfusion episodes were 214 in 51 patients and 181 in 43 patients in Phases 1 and 2, respectively. Fresh frozen plasma was the most misused blood component, next to whole blood in Phase 1. However, appropriate utilization of components, including cryoprecipitate (6.6%), reduction in whole blood (34.5-14.4%) and single unit transfusion (23.3-18.2%) were observed in Phase 2. Inappropriate use of blood components, namely, packed red blood cells and fresh frozen plasma dropped significantly (p < 0.05) from 29.7% to 13.1% and 45.1% to 22.5%, respectively, with the exclusion of platelet concentrate (33.3-20.6%, p-value 0.414). Conclusion Audit and targeted education helped in optimizing transfusion practices in the obstetric setting.
Assuntos
Humanos , Feminino , Adulto , Adulto Jovem , Conscientização , Transfusão de Sangue , Intervenção Educacional Precoce , Administração em Saúde , ObstetríciaRESUMO
INTRODUCTION: Audit and education are essential pre-requisites in the review and update of blood transfusion practices. Although standard guidelines on appropriate utilization of blood components exists, erroneous use of blood components with no justification still continues. This study evaluates appropriateness of blood transfusion in obstetric settings and identifies key areas requiring educational intervention to improve blood transfusion practice toward the evidence-based at our hospital. METHOD: This was a prospective observational study on the analysis of blood transfusion requisition forms for obstetric patients before and after educational intervention, performed in two Phases from September 2011 to August 2012 and October 2012 to September 2013. The appropriateness of blood utilization was assessed against the Royal College of Obstetricians and Gynecologists Guidelines for blood transfusion and Green-Top Guideline no. 47. Data required for the study were obtained from department records and statistical analysis was performed using the SPSS, version 20 (IBM, USA). RESULTS: The total transfusion episodes were 214 in 51 patients and 181 in 43 patients in Phases 1 and 2, respectively. Fresh frozen plasma was the most misused blood component, next to whole blood in Phase 1. However, appropriate utilization of components, including cryoprecipitate (6.6%), reduction in whole blood (34.5-14.4%) and single unit transfusion (23.3-18.2%) were observed in Phase 2. Inappropriate use of blood components, namely, packed red blood cells and fresh frozen plasma dropped significantly (p<0.05) from 29.7% to 13.1% and 45.1% to 22.5%, respectively, with the exclusion of platelet concentrate (33.3-20.6%, p-value 0.414). CONCLUSION: Audit and targeted education helped in optimizing transfusion practices in the obstetric setting.
RESUMO
A terapia transfusional tem permitido diminuir a mortalidade e melhorar a qualidade de vida em diferentes condições clínicas. A sua indicação deve ser muito criteriosa, pois o sangue é um produto escasso e de elevado custo. Entretanto, tem sido discutido um número crescente de indicações desnecessárias e/ou incorretas. O objetivo deste trabalho foi demonstrar os custos agregados à transfusão, apresentar guias para auxiliar na auditoria transfusional e propor ações para evitar uso indevido de sangue. Foi realizado revisão da literatura até o mês de março de 2009, incluindo Google e Medline, utilizando os seguintes termos: auditoria transfusional, transfusão de sangue, custo da doação, custo da transfusão de sangue, comitê transfusional. É de conhecimento que a realização de transfusão de forma não criteriosa expõe o receptor a uma série de complicações. Recentes avanços na segurança e qualidade do sangue e o aumento de custos têm levado a uma reavaliação da prática transfusional. Verificam-se percentuais elevados de transfusões desnecessárias ou com indicação duvidosa. Promover o conhecimento e a aplicação correta dos critérios para indicação de transfusão, participação ativa dos comitês transfusionais e auditores com experiência na área de hemoterapia, estão entre propostas para a racionalização da transfusão de sangue. Concluímos que é essencial transfundir com muita cautela em virtude dos riscos relacionados à transfusão e o crescente aumento dos custos. Torna-se imperativa a adoção de uma política efetiva para a educação de todos os participantes desse processo.
Transfusional therapy has allowed to decrease mortality and improve quality of life in different clinical conditions. Its indication must be very careful, because blood is in short supply and its cost is high. However, a growing number of unnecessary and/or incorrect indications have been discussed. The aim of this study was to demonstrate the costs added to transfusion, to provide guidelines to assist in transfusion audits, and to propose actions to prevent misuse of blood. A literature review was performed through the month of March 2009, including Google and Medline, using the following search terms: transfusion audit, blood transfusion, donation cost, cost of blood transfusion, transfusion committee. It is known that blood transfusions performed carelessly may expose the recipient to a number of complications. Recent advances in blood safety and quality and increasing costs have led to a reassessment of the transfusion practices. There are high rates of unnecessary transfusions or doubtful indications. Promoting knowledge and correct application of the criteria for indication of transfusion, active participation of transfusional committees, and auditors with experience in hemotherapy are among the proposals for the streamlining of blood transfusion. We conclude that it is essential to transfuse with caution because of the risks related to transfusion and the ever increasing costs. It has become vitally important to implement an effective policy for education of all participants in this process.