Transfusion in adults: description of a quality-assurance programme.

Objectives: In 1995, a fatal transfusion complication led to the developmen t of a quality-assurance programme (QAP). Initial analysis showed important deficiencies in practice patterns for both nurses and physicians. No writt en guidelines had been previously produced. Study design: Evaluation of practice patterns and quality-assurance program me. Methods: A QAP was prepared and implemented, a booklet describing completel y the transfusion process and institutional policies and providing practica l information was edited and the medical and non-medical personnel was info rmed and trained on a regular basis. Implementation was evaluated during a three-year period by measuring previously defined surrogate endpoints of th e quality of the transfusion process. Results: Implementation became rapidly close to 100% either for well-accept ed requirements (i.e. patient's identity reporting on transfusion forms) or when physicians were highly motivated (i.e autologous blood transfusion). For other indicators, implementation progressed more slowly (i.e. traceabil ity of labile blood products) although significant efforts were made to imp rove the computerised system of data collection and although hospital admin istration showed a very positive behaviour. Finally, other indicators showe d only partial implementation. Several practical barriers (perceived lack o f time, excessive increase in writing requirements) were described for tran sfusion checklist or transfusion prescription form but more in-depth insuff iciencies (patients' information) were also observed. Conclusion: The success of a change of practice patterns relies on hospital administration positive role, education and feedback, written and immediat ely available guidelines, employment of specially trained personnel, long-s tanding actions. Future accreditation of hospitals based on well-defined an d well-implemented procedures will also be a major help to increase the qua lity of the transfusion process. (C) 2001 Editions scientifiques et medical es Elsevier SAS.