The “sticky” business of “adherence” to transfusion guidelines

[Evaluation of training in transfusion safety offered to medical students in Morocco]

Introduction

students worldwide receive little training on blood transfusion therapies during their time at medical schools and hospitals, then reformulation of academic programs is mandatory. Indications for blood transfusions are more frequent than recommended, which helps to increase the risks associated with this procedure. To overcome this, structured objective training on nursing care and procedures was organised with the topic of transfusion safety. The purpose of our study was to assess medical students´ appreciation of this training and the degree to which this population had mastered it.

Methods

we conducted a cross-sectional, descriptive, single-centre study. We conducted a survey among the 3rd-year medical students. A self-administered assessment questionnaire, as well as an evaluation grid for acquired skills, filled in by the training doctors during the session, were used. Data analysis was based on descriptive statistics using Excel software.

Results

three hundred and eighty-four (n=384) students were invited to attend this training course, 275 (71.6%) of whom were enrolled in the study. The overall satisfaction rate was 93.8%. The objectives and organisation were 95.6% successful. The quality of the training was 90.3% satisfactory. The choice of topic for the station was satisfactory for 80% of participants, the flow of the session for 86.3%, the quality of the organisation and debriefing for 89%, the interaction between trainers and learners for 90.2%, the motivation of trainers and the reflection stimulated in the learners for 92%. We noted that 93% of students had never participated in training in transfusion safety. Mastery of global skills was total for 67%, partial for 26% and absent for 7%. The students mastered the procedures for checking the identity and grouping of the product to be transfused at 97%, the principle of interpreting the ultimate pre-transfusion test (96%), the purpose of ultimate test at the patient´s bedside 93% with mastery of its technical implementation 83%.

Conclusion

training in transfusion safety was well received, with a satisfactory level of proficiency. This experience can easily be extended to other topics.

Teaching transfusion medicine: current situation and proposals for proper medical training

The current curricula in medical schools and hospital residence worldwide lack exposure to blood transfusion medicine, and require the reformulation of academic programs. In many countries, training in blood transfusion is not currently offered to medical students or during residency. Clinical evidence indicates that blood transfusions occur more frequently than recommended, contributing to increased risk due to this procedure. Therefore, the rational use of blood and its components is essential, due to the frequent undesirable reactions, to the increasing demand of blood products and the cost of the process. Significant improvements in knowledge of and skills in transfusion medicine are needed by both students and residents. Improvements are needed in both background knowledge and the practical application of this knowledge to improve safety. Studies prove that hemovigilance has an impact on transfusion safety and helps to prevent the occurrence of transfusion-related adverse effects. To ensure that all these aspects of blood transfusion are being properly addressed, many countries have instituted hospital transfusion committees. From this perspective, the interventions performed during the formation of medical students and residents, even the simplest, have proven effective in the acquisition of knowledge and medical training, thereby leading to a reduction in inappropriate use of blood. Therefore, we would like to emphasize the importance of the exposure of medical students and residents to blood services and transfusion medicine in order for them to acquire adequate medical training, as well as to discuss some changes in the current medical curricula regarding transfusion medicine that we judge critical.

Impact of guideline implementation on transfusion practices in a surgical intensive care unit

BACKGROUND

Anemia is a common clinical problem in cardiac surgery patients in the postoperative period and may result in transfusion in up to 90% of this population. There is tremendous variation in transfusion rates by hospital and individual physician. It is unknown if implementation of a clinical practice guideline lowers unnecessary transfusion in hospital practices that already have a restrictive transfusion culture .

OBJECTIVE

To evaluate transfusion practice before and after implementation of a clinical practice guideline.

DESIGN

Pre/post intervention study.

SETTING

Sixteen bed surgical intensive care unit in an academic hospital.

PARTICIPANTS

Four hundred ninety-five adult patients undergoing cardiac surgery.

INTERVENTIONS

Implementation of an anemia clinical practice guideline reinforced with education and retrospective audit/feedback.

MEASUREMENTS AND MAIN RESULTS

A total of 252 pre-intervention and 243 postintervention cases were examined. Unnecessary transfusion occurred in 14.7% of pre-intervention patients and decreased to a rate of 8.1% after guideline implementation (p = 0.016).

CONCLUSIONS

This study suggests that clinical guideline implementation utilizing guideline development, education, and compliance audit/feedback may reduce unnecessary transfusion in cardiac surgery patients. A fully powered prospective trial would be necessary to validate these findings.

Impact of national transfusion indicators on appropriate blood usage in critically ill patients

BACKGROUND

The objective was to investigate the impact of three national blood transfusion indicators (NBTIs) specifically designed for critical care regarding the appropriate blood transfusion indications.

STUDY DESIGN AND METHODS

This was a prospective, single-center study, carried out at a university hospital. A total of 1808 patients admitted to the intensive care unit (ICU) in 1 year were included.

RESULTS

The study consisted of four 90-day periods (P). P1 was a control period with no intervention. P2 followed the inclusion of NBTIs into the ICU database, aimed at reinforcing NBTI knowledge. After presenting and discussing the results of P1 and P2, the early (P3) and late (P4) impacts of NBTI knowledge were evaluated. All patients who were transfused with at least 1 unit of any blood component (33.3%) were included. Thirteen percent of red blood cell transfusions (RBCTs) were given outside of NBTI protocols (13% deviation of NBTIs for RBCTs) without a significant change throughout the duration of the study. Most RBCTs (95%) were prescribed for a hemoglobin threshold of less than 90 g/L. There was a steady and significant improvement in the adherence to NBTI guidelines for platelet concentrate transfusions (PCTs) from 36% (P1) to 52% (P4; p < 0.01). In contrast, the lack of adherence to NBTI guidelines for fresh-frozen plasma transfusions (FFPTs) remained high (74%) and stable throughout the study period. The most frequent reason for inappropriate use of FFPTs or PCTs was absence of severe bleeding.

CONCLUSION

The introduction of NBTI guidelines demonstrated a variable impact on the appropriateness of blood component transfusions in critically ill patients.