QUALITY ASSURANCE OF CLINICAL TRANSFUSION PRACTICE BY IMPLEMENTATION OF THE PRIVILEGE OF BLOOD PRESCRIPTION AND COMPUTERIZED PROSPECTIVE AUDIT OF BLOOD REQUESTS

Guidelines, algorithms and recommendations have been issued in the att empt to ensure appropriateness of transfusion practice, but the result s are less than satisfactory, mainly due to the difficulty to turn pap er procedures into actual practice. In our hospital we have tried to o vercome this difficulty through the implementation of a quality which includes giving the blood prescription to a limited number of physicia ns and a computerized prospective audit of blood requests. The latter is performed through verification of the compliance of blood requests, which are designed to include a patient's laboratory and clinical dat a, with hospital guidelines for the proper use of blood. In the 12 mon ths since implementation of the computerized prospective audit the tra nsfusion service has evaluated 7884 requests. Of these, 63.4% (n = 499 8) were for red blood cells, 21.1% (n = 1664) for platelets and 15.5% (n = 1222) for fresh frozen plasma. The prospective audit showed that 96.8% and 98.1% of requests for red units and platelets were appropria te, respectively. Conversely, approximately 27% of plasma requests did not comply with guidelines, mainly because the evidence of coagulopat hy was missing. However, inappropriateness of plasma requests for elec tive general surgery decreased from 39% at the onset of the programme to 14% in the last trimester considered. Moreover, the evaluation by r etrospective audit of the proportion of patients transfused with both red blood cells and plasma in the perioperative period out of those tr ansfused with red blood cells only, as an indicator of unwanted recons titution of whole blood, showed that this proportion decreased from 47 .6% (320/672) in the 12 months before implementation of computerized a udit to 37.8% (244/646) in the following 12 months (difference = -9.8% , 95% confidence interval of the difference from -4.5% to -15.1%; P < 0.005 by chi(2) test). Our initial experience, together with the prese nt system, shows that (1) the restriction of nonurgent blood prescript ion to a group of clinicians more educated in transfusion medicine tha n average clinicians practicing in a large multispecialty hospital is feasible; (3) prospective audit is a useful tool for assuring the qual ity of blood requesting.