Increasing transfusion safety by reducing human error

Transfusion of the wrong blood is a rare but measurable event that may resu lt in serious complications and whose main cause is human error. Any preven tive strategy should be based on a careful assessment of the incidence of t hese events and of their causes, and requires a standardized confidential r eporting system, to avoid underreporting, covering also near misses. Creati ng or revising written procedures and monitoring their implementation are i ndispensable to Improve blood safety, but human error can occur in spite of these measures. Technologic instruments are now available to fill the gap between written. and implemented procedures, forcing the operator to carry Out the critical steps in the process according to the adopted guidelines. Curr Opin Hematol 2000, 7:382-386 (C) 2000 Lippincott Williams & Wilkins, I nc.