1
|
Lenet T, Berthelot P, Grudzinski AL, Banks A, Tropiano J, McIsaac DI, Tinmouth A, Patey AM, Fergusson DA, Martel G. Nonclinical factors affecting intraoperative red blood cell transfusion: a systematic review. Can J Anaesth 2024; 71:1023-1036. [PMID: 38509437 DOI: 10.1007/s12630-024-02739-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 03/22/2024] Open
Abstract
PURPOSE There is significant variability in intraoperative red blood cell (RBC) transfusion practice. We aimed to use the theoretical domains framework (TDF) to categorize nonclinical and behavioural factors driving intraoperative RBC transfusion practice in a systematic review of the literature. SOURCE We searched electronic databases from inception until August 2021 to identify studies evaluating nonclinical factors affecting intraoperative RBC transfusion. Using the Mixed Methods Appraisal Tool, we assessed the quality of included studies and identified relevant nonclinical factors, which were coded into TDF domains by two independent reviewers using NVivo (Lumivero, QSR International, Burlington, MA, USA). We identified common themes within domains and sorted domains based on the frequency of reported factors. PRINCIPAL FINDINGS Our systematic review identified 18 studies: nine retrospective cohort studies, six cross-sectional surveys, and three before-and-after studies. Factors related to the social influences, behavioural regulation, environmental context/resources, and beliefs about consequences domains of the TDF were the most reported factors. Key factors underlying the observed variability in transfusion practice included the social effects of peers, patients, and institutional culture on decision-making (social influences), and characteristics of the practice environment including case volume, geographic location, and case start time (environmental context/resources). Studies reported variable beliefs about the consequences of both intraoperative transfusion and anemia (beliefs about consequences). Provider- and institutional-level audits, educational sessions, and increased communication between surgeons/anesthesiologists were identified as strategies to optimize intraoperative transfusion decision-making (behavioural regulation). CONCLUSION Our systematic review has synthesized the literature on nonclinical and behavioural factors impacting intraoperative transfusion decision-making, categorized using the TDF. These findings can inform evidence-based interventions to reduce intraoperative RBC transfusion variability. STUDY REGISTRATION Open Science Framework ( https://osf.io/pm8zs/?view_only=166299ed28964804b9360c429b1218c1 ; first posted, 3 August 2022).
Collapse
Affiliation(s)
- Tori Lenet
- Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | - Alexa L Grudzinski
- Department of Anesthesiology and Pain Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada
| | - Alexander Banks
- Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Joseph Tropiano
- Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Daniel I McIsaac
- Department of Anesthesiology and Pain Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada
| | - Alan Tinmouth
- Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada
- Canadian Blood Services, Ottawa, ON, Canada
| | - Andrea M Patey
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Dean A Fergusson
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Canadian Blood Services, Ottawa, ON, Canada
| | - Guillaume Martel
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada.
- Department of Surgery, The Ottawa Hospital - General Campus, 501 Smyth Rd, CCW 1667, Ottawa, ON, K1H 8L6, Canada.
| |
Collapse
|
2
|
Dev K, Ahmed A. Surgical patients' perception about risks related to blood transfusion: A cross-sectional survey. Transfus Med 2024; 34:211-218. [PMID: 38644467 DOI: 10.1111/tme.13041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 03/27/2024] [Accepted: 04/12/2024] [Indexed: 04/23/2024]
Abstract
OBJECTIVE To determine the perception of surgical patients at Aga Khan University Hospital (AKUH) about the risks related to blood transfusion. The ultimate aim was to influence patients' acceptability of blood transfusion by reducing their fears through effective counselling. BACKGROUND AKUH has a hospital-based blood bank with more than 90% family replacement donation. Many patients perceive blood transfusion as a risky procedure. This survey will help healthcare practitioners in addressing patients' concerns more effectively while counselling them about blood transfusion. METHODS/MATERIALS It was a cross-sectional survey of patients attending anaesthesia clinic at AKUH during the study period. It assessed patients' perception about adverse effects associated with blood transfusion. RESULTS A total of 363 patients were included. Among the participants, 18% considered blood transfusion to be very often or always risky. Blood transfusion related infections were considered most frequently occurring adverse events. Female patients were more concerned about the risks (p = 0.046). CONCLUSION Many patients consider blood transfusion as a high-risk procedure. Healthcare professionals need to understand patient's perceptions and conduct patient counselling accordingly. This will help physicians in addressing patient-specific concerns related to blood transfusion. Improved knowledge is hoped to translate into improvement in transfusion practices at the national level.
Collapse
Affiliation(s)
- Kapeel Dev
- Department of Anaesthesiology, The Aga Khan University, Karachi, Pakistan
| | - Aliya Ahmed
- Department of Anaesthesiology, The Aga Khan University, Karachi, Pakistan
| |
Collapse
|
3
|
Wu DW, Friedman MT, Lombardi DP, Hwang R, Sender J, Cobaj V, Niazi M, Li Y, Karpinos R. Impact of Patient Blood Management on Red Blood Cell Utilization in an Urban Community Teaching Hospital: A Seven-Year Retrospective Study. Life (Basel) 2024; 14:232. [PMID: 38398741 PMCID: PMC10890656 DOI: 10.3390/life14020232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 01/24/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
OBJECTIVES This study aimed to showcase how implementing a patient blood management (PBM) program effectively cuts unnecessary red blood cell (RBC) transfusions in a New York City urban community teaching hospital. METHODS Analyzing seven years from 2013 to 2019, a retrospective review of RBC transfusions was conducted. RESULTS Following the introduction of PBM, considerable improvements were observed annually. These included a drop in mean pretransfusion hemoglobin levels from 7.26 g/dL (2013) to 6.58 g/dL (2019), a 34% reduction in yearly RBC unit transfusions, and fewer units given to patients with pre-Hgb levels ≥ 7 g/dL (from 1210 units in 2013 to 310 units in 2019). Furthermore, this study noted a decline in two-unit RBC orders when Hgb levels were ≥ 7 g/dL from 65 orders in 2013 to merely 3 in 2019. The estimated total cost savings attributed to the six-year PBM program duration after full implementation in 2014 amounted to USD 2.1 million. CONCLUSIONS Overall, PBM implementation significantly decreased RBC transfusions and enhanced transfusion practices. The findings emphasize that successful PBM strategies do not always necessitate extensive resources or increased budgets but instead rely on the application of intuitive methods, as evidenced by this study.
Collapse
Affiliation(s)
- Ding Wen Wu
- Department of Pathology, SBH Health System, Bronx, NY 10457, USA; (D.W.W.); (V.C.); (M.N.)
- Department of Pathology, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Mark T. Friedman
- Department of Pathology, New York University Grossman Long Island School of Medicine, Mineola, NY 11501, USA
| | - Daniel P. Lombardi
- Department of Medicine, SBH Health System, Bronx, NY 10457, USA; (D.P.L.); (J.S.)
| | - Richard Hwang
- Department of Pathology, SBH Health System, Bronx, NY 10457, USA; (D.W.W.); (V.C.); (M.N.)
| | - Joel Sender
- Department of Medicine, SBH Health System, Bronx, NY 10457, USA; (D.P.L.); (J.S.)
| | - Valdet Cobaj
- Department of Pathology, SBH Health System, Bronx, NY 10457, USA; (D.W.W.); (V.C.); (M.N.)
| | - Masooma Niazi
- Department of Pathology, SBH Health System, Bronx, NY 10457, USA; (D.W.W.); (V.C.); (M.N.)
| | - Yanhua Li
- Division of Transfusion Medicine, Department of Medicine, UMass Chan Medical School, Worcester, MA 01655, USA;
| | - Robert Karpinos
- Department of Anesthesiology, SBH Health System, Bronx, NY 10457, USA;
| |
Collapse
|
4
|
Chegini A, Jamalian A, Abolhassani MR, Alavi AB. A review of issues and challenges of implementation of patient blood management. Asian J Transfus Sci 2024; 18:115-123. [PMID: 39036697 PMCID: PMC11259357 DOI: 10.4103/ajts.ajts_128_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 06/14/2022] [Accepted: 07/10/2022] [Indexed: 07/23/2024] Open
Abstract
INTRODUCTION Patient blood management (PBM) is outlined as evidence-based medical and surgical concepts with a multidisciplinary method. AIMS AND OBJECTIVES The aim of this article is to review the PBM implementation and analyses the issues, challenges, and opportunities. METHODOLOGY In this article, we have an overview of PBM implementation in literature and our experience in one hospital in Iran. We used databases including Embase, CINAHL, Scopus, Google Scholar, Google, Science Direct, ProQuest, ISI Web of Knowledge, and PubMed to attain the related literature published in the English language. RESULTS There are different barriers and challenges of implementation of PBM, such as hospital culture confrontation, reduced staff with restricted time, lack of interdisciplinary conversation, change of practice, the lack of experience with PBM, the feasibility to integrate PBM, electronic documentation and schedule budget for required instruments, resources, and personnel. Hospitals differ globally in the aspect of infrastructure, personnel and properties, and it is necessary to individualize according to the local situation. CONCLUSION The review highlights the importance of PBM and its implementation for obtaining patient safety. PBM establishing in hospitals as a complex process have different challenges and barriers. Sharing experiences is essential to success in the PBM programs. Cooperation between countries will be useful in PBM spreading.
Collapse
Affiliation(s)
- Azita Chegini
- Department of Immunohematology, Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Sorkheh Hesar, Tehran, Iran
| | - Ali Jamalian
- Department of Cardiac and Cardiac Surgery, Shahid Lavasani Hospital, Sorkheh Hesar, Tehran, Iran
| | | | - Ali Boroujerdi Alavi
- Department of Cardiac and Cardiac Surgery, Shahid Lavasani Hospital, Sorkheh Hesar, Tehran, Iran
| |
Collapse
|
5
|
Souza MKBD, Araújo PS, Soares LCC, Cioffi JGM. Management of hemotherapy services in the context of the COVID-19 pandemic. CIENCIA & SAUDE COLETIVA 2023; 28:1387-1397. [PMID: 37194873 DOI: 10.1590/1413-81232023285.17062022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 02/17/2023] [Indexed: 05/18/2023] Open
Abstract
This study aimed to analyze the management of hemotherapy services (HS) in the context of the COVID-19 pandemic from the perspective of municipal managers in different regions of Brazil. A qualitative approach with semi-structured interviews was applied to HS managers in the three Brazilian capitals, from different regions of Brazil, during the period between September 2021 and April 2022. The textual content of the interviews was submitted to lexicographic textual analysis using the free access software, Iramuteq. The managers' perceptions resulted from the descending hierarchical classification (DHC) analysis, which generated six classes: availability of resources for the development of work; installed capacity of services; strategies and challenges for attracting blood donors; risks and worker protection; measures for crisis management; and communication strategies for the adhesion of candidates for donation. The analysis highlighted several strategies used by the management, as well as pointed out limits and challenges for HS organization and management, exacerbated in the context of the pandemic.
Collapse
Affiliation(s)
- Mariluce Karla Bomfim de Souza
- Instituto de Saúde Coletiva, Universidade Federal da Bahia. R. Basílio da Gama s/nº, Campus Universitário Canela. 40.110-040 Salvador BA Brasil.
| | - Patrícia Sodré Araújo
- Departamento de Ciências da Vida, Universidade do Estado da Bahia. Salvador BA Brasil
| | | | | |
Collapse
|
6
|
Neef V, Piekarski F, Choorapoikayil S, Helmer P, Zacharowski K, Meybohm P, Raimann FJ. Physician's Subjective Increase in Awareness towards Perioperative Anaemia, Patient's Blood Resource, and Transfusion after the Implementation of Patient Blood Management: A Nationwide Multicentre Survey. Acta Haematol 2021; 145:38-45. [PMID: 34464953 DOI: 10.1159/000517607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 05/28/2021] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Patient blood management (PBM) is a clinical and multidisciplinary, 3-pillar concept. The aim of this study was to detect the subjective increase in physician's awareness towards perioperative anaemia, patient's blood resource, and transfusion after the implementation of PBM in German hospitals. MATERIAL AND METHODS A survey among 56 hospitals from the German PBM Network group was conducted from October 27 to December 19, 2020. An electronic questionnaire with 28 questions was sent to the local PBM coordinator for the distribution at the hospital level. For assessment of the physician's subjective increase in awareness, numeric rating scales (0 [no increase] - 10 [maximum increase]) were used. RESULTS In total, 404 clinicians from 56 hospitals completed the survey. The mean (±standard deviation) time of an existing PBM program was 4.8 (±2.2) years. The physician's subjective increase in awareness towards anaemia (8.2 [±2.0]), patient's blood resource (7.6 [±2.5]), and transfusion (8.1 [±1.9]) was the highest in physicians from hospitals with ≥21 implemented PBM measures. In addition, a subjective increase in awareness towards anaemia (6.6 [±3.3]), patient's blood resource (7.0 [±3.3]), and transfusion (6.6 [±3.4]) was the highest in physicians with daily PBM contact. CONCLUSION Results suggest that physician's awareness towards perioperative anaemia, patient's blood resource, and transfusion has increased, depending on the hospital's number of implemented PBM measures and physician's PBM contact in everyday clinical practice.
Collapse
Affiliation(s)
- Vanessa Neef
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Florian Piekarski
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Suma Choorapoikayil
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Philipp Helmer
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Kai Zacharowski
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Patrick Meybohm
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Florian J Raimann
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| |
Collapse
|
7
|
Patient Blood Management Strategies to Avoid Transfusions in Body Contouring Operations: Controlled Clinical Trial. Plast Reconstr Surg 2021; 147:355-363. [PMID: 33565826 DOI: 10.1097/prs.0000000000007524] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Anemia is a frequent process of morbidity and mortality in body contouring procedures. In aesthetic surgery, there are no standardized processes to minimize bleeding during surgery. For this reason, a study was designed to implement patient blood management strategies to reduce bleeding and transfusions in patients undergoing body contouring operations. METHODS From January of 2017 to May of 2018, a prospective cohort-type observational study was conducted, including two groups of patients undergoing single or combined body contouring procedures. The first group did not receive patient blood management strategies, whereas the second group did receive these strategies. These measures consisted of preoperative strategies to ensure the patient had optimal hemoglobin and hematocrit levels and supportive intraoperative measures to minimize blood loss. The results were validated with different statistical tests according to the variables studied. RESULTS A total of 409 patients were included in the study and were divided into two groups. The anthropometric and hemoglobin variables were similar in both groups. The 207 patients for whom patient blood management strategies were implemented lost an average of 1.2 g/dl less hemoglobin at 72 hours than the 202 patients for whom patient blood management strategies were not implemented (p ≤ 0.0001). CONCLUSIONS Patient blood management strategies, such as increasing hemoglobin before surgery, and strategies to minimize blood loss during surgery, proved to be effective at reducing bleeding in patients undergoing body contouring surgery, also decreasing the need to perform postoperative blood transfusions. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, II.
Collapse
|
8
|
Pearse BL, Keogh S, Rickard CM, Fung YL. Barriers and facilitators to implementing evidence based bleeding management in Australian Cardiac Surgery Units: a qualitative interview study analysed with the theoretical domains framework and COM-B model. BMC Health Serv Res 2021; 21:550. [PMID: 34090421 PMCID: PMC8178922 DOI: 10.1186/s12913-021-06269-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 03/10/2021] [Indexed: 12/03/2022] Open
Abstract
Background Bleeding during cardiac surgery is a common complication that often requires the transfusion of blood products. The combination of bleeding and blood product transfusion incrementally increases adverse outcomes including infection and mortality. Following bleeding management guideline recommendations could assist with minimising risk but adherence is not high, and the cause for lack of adherence is not well understood. This study aimed to identify barriers and facilitators to practicing and implementing evidenced-based intra-operative, bleeding management in Australian cardiac surgery units. Methods We used a qualitative descriptive design to conduct semi-structured interviews with Australian cardiac surgeons, anaesthetists and perfusionists. The Theoretical Domains Framework (TDF) was utilised to guide interviews and thematically analyse the data. Categorised data were then linked with the three key domains of the COM-B model (capability, opportunity, motivation - behaviour) to explore and understand behaviour. Results Seventeen interviews were completed. Nine of the 14 TDF domains emerged as significant. Analysis revealed key themes to improving capability included, standardisation, monitoring, auditing and feedback of data and cross discipline training. Opportunity for change was improved with interpersonal and interdepartmental collaboration through shared goals, and more efficient and supportive processes allowing clinicians to navigate unfamiliar business and financial models of health care. Results suggest as individuals, clinicians had the motivation to make change and healthcare organisations have an obligation and a responsibility to partner with clinicians to support change and improve goal directed best practice. Conclusion Using a theory-based approach it was possible to identify factors which may be positively or negatively influence clinicians ability to implement best practice bleeding management in Australian cardiac surgical units. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06269-8.
Collapse
Affiliation(s)
- Bronwyn L Pearse
- School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia. .,Departments of Surgery, Anaesthesia and Critical Care, The Prince Charles Hospital, Sippy Downs, QLD, Australia. .,School of Health & Sports Sciences, University of Sunshine Coast, Sippy Downs, Australia.
| | - Samantha Keogh
- School of Nursing and Centre for Healthcare Transformation, Queensland University of Technology, Kelvin Grove, QLD, Australia.,Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Claire M Rickard
- School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia.,Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Yoke L Fung
- School of Health & Sports Sciences, University of Sunshine Coast, Sippy Downs, Australia
| |
Collapse
|
9
|
Seeking Strategies to Optimize Blood Utilization: The Preliminary Experience with Implementing a Patient Blood Management Program in a Greek Tertiary Hospital. J Clin Med 2021; 10:jcm10102141. [PMID: 34063464 PMCID: PMC8157216 DOI: 10.3390/jcm10102141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/03/2021] [Accepted: 05/14/2021] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES Our aim was to assess blood utilization after implementation of a patient blood management (PBM) program in a Greek tertiary hospital. METHODS An electronic transfusion request form and a prospective audit of transfusion practice were implemented. After the one-year implementation period, a retrospective review was performed to assess transfusion practice in medical patients. RESULTS Pre-PBM, a total of 9478 RBC units were transfused (mean: 1.75 units per patient) compared with 9289 transfused units (mean: 1.57 units per patient) post-PBM. Regarding the post-PBM period, the mean hemoglobin (Hb) level of the 3099 medical patients without comorbidities transfused was 7.19 ± 0.79 gr/dL. Among them, 2065 (66.6%) had Hb levels >7.0 gr/dL, while 167 (5.3%) had Hb levels >8.0 gr/dL. In addition, 331 (25.3%) of the transfused patients with comorbidities had Hb >8.0 gr/dL. The Hb transfusion thresholds significantly differed across the clinics (p < 0.001), while 21.8% of all medical non-bleeding patients received more than one RBC unit transfusion. CONCLUSION A poor adherence with the restrictive transfusion threshold of 7.0 gr/dL was observed. The adoption of a less strict threshold might be a temporary step to allow physicians to become familiar with the program and be informed on the safety and advantages of the restrictive transfusion strategy.
Collapse
|
10
|
Delaforce A, Duff J, Munday J, Hardy J. Preoperative Anemia and Iron Deficiency Screening, Evaluation and Management: Barrier Identification and Implementation Strategy Mapping. J Multidiscip Healthc 2020; 13:1759-1770. [PMID: 33293819 PMCID: PMC7718960 DOI: 10.2147/jmdh.s282308] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 11/04/2020] [Indexed: 12/18/2022] Open
Abstract
Introduction and aims Patients undergoing major surgery risk significant blood loss and transfusion, which increases substantially if they have pre-existing anemia. Preoperative Anemia and Iron Deficiency Screening, Evaluation and Management Pathways (PAIDSEM-P) outline recommended blood tests and treatment to optimize patients before surgery. Documented success using PAIDSEM-P to reduce transfusions and improve patient outcomes exists, but the reporting quality of such studies is suboptimal. It remains unclear what implementation strategies best support the implementation of PAIDSEM-P. Method Maximum variation, purposive sampling was used to recruit a total of 15 participants, including a range of health professionals and patients for semi-structured interviews. Data analysis utilized a deductive approach informed by the Consolidated Framework for Implementation Research (CFIR) for barrier identification and the Expert Recommendations for Implementing Change (ERIC) for reporting recommended implementation strategies. A modified version of the Action, Actor, Context, Target and Time (AACTT) framework assisted with conceptualisation and targeted strategy selection. Results The analysis revealed five barriers: access to knowledge and information, patient needs and resources, knowledge and beliefs about the intervention, available resources, and networks and communications, which had strong ERIC recommendations, including conduct educational meetings, develop educational materials, distribute educational materials, obtain and use patients/consumers family feedback, involve patients/consumers/family members, conduct a local needs assessment, access new funding, promote network weaving, and organize clinician implementation team meetings. Conclusions Mapping the barriers and strategies using the ERIC framework on the basis of individual actor categories proved to be useful in identifying a pragmatic number of implementation strategies that may help in supporting the utilisation of the PAIDSEM-P and other evidence-based healthcare implementation problems more broadly.
Collapse
Affiliation(s)
- Alana Delaforce
- School of Nursing and Midwifery, The University of Newcastle, Callaghan, NSW, Australia.,Mater Health Services, South Brisbane, QLD 4101, Australia
| | - Jed Duff
- School of Nursing and Midwifery, The University of Newcastle, Callaghan, NSW, Australia.,School of Nursing/Centre for Healthcare Transformation, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Judy Munday
- School of Nursing/Centre for Healthcare Transformation, Queensland University of Technology, Kelvin Grove, QLD, Australia.,School of Nursing, The University of Agder, Kristiansand, Norway
| | - Janet Hardy
- Mater Health Services, South Brisbane, QLD 4101, Australia
| |
Collapse
|
11
|
Maturity Assessment model for Patient Blood Management to assist hospitals in improving patients' safety and outcomes. The MAPBM project. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2020; 19:205-215. [PMID: 32955422 DOI: 10.2450/2020.0105-20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 05/26/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Patient blood management (PBM) is an evidence-based care bundle with proven ability to improve patients' outcomes by managing and preserving the patient's own blood. Since 2010, the World Health Organisation has urged member states to implement PBM. However, there has been limited progress in developing PBM programmes in hospitals due to the implicit challenges of implementing them. To address these challenges, we developed a Maturity Assessment Model (MAPBM) to assist healthcare organisations to measure, benchmark, assess in PBM, and communicate the results of their PBM programmes. We describe the MAPBM model, its benchmarking programme, and the feasibility of implementing it nationwide in Spain. MATERIALS AND METHODS The MAPBM considers the three dimensions of a transformation effort (structure, process and outcomes) and grades these within a maturity scale matrix. Each dimension includes the various drivers of a PBM programme, and their corresponding measures and key performance indicators. The structure measures are qualitative, and obtained using a survey and structured self-assessment checklist. The key performance indicators for process and outcomes are quantitative, and based on clinical data from the hospitals' electronic medical records. Key performance indicators for process address major clinical recommendations in each PBM pillar, and are applied to six common procedures characterised by significant blood loss. RESULTS In its first 5 years, the MAPBM was deployed in 59 hospitals and used to analyse 181,826 hospital episodes, which proves the feasibility of implementing a sustainable model to measure and compare PBM clinical practice and outcomes across hospitals in Spain. CONCLUSION The MAPBM initiative aims to become a useful tool for healthcare organisations to implement PBM programmes and improve patients' safety and outcomes.
Collapse
|
12
|
Rubinger DA, Cahill C, Ngo A, Gloff M, Refaai MA. Preoperative Anemia Management: What’s New in 2020? CURRENT ANESTHESIOLOGY REPORTS 2020. [DOI: 10.1007/s40140-020-00385-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
|
13
|
Meybohm P, Westphal S, Ravn HB, Ranucci M, Agarwal S, Choorapoikayil S, Spahn DR, Ahmed AB, Froessler B, Zacharowski K. Perioperative Anemia Management as Part of PBM in Cardiac Surgery – A Narrative Updated Review. J Cardiothorac Vasc Anesth 2020; 34:1060-1073. [DOI: 10.1053/j.jvca.2019.06.047] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 06/18/2019] [Accepted: 06/29/2019] [Indexed: 12/18/2022]
|
14
|
Sullivan HC, Roback JD. The pillars of patient blood management: key to successful implementation
(Article, p. 2840). Transfusion 2019; 59:2763-2767. [DOI: 10.1111/trf.15464] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 07/15/2019] [Indexed: 12/14/2022]
Affiliation(s)
| | - John D. Roback
- Pathology and Laboratory MedicineEmory University Atlanta Georgia
| |
Collapse
|
15
|
Desai N, Schofield N, Richards T. Perioperative Patient Blood Management to Improve Outcomes. Anesth Analg 2018; 127:1211-1220. [DOI: 10.1213/ane.0000000000002549] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
16
|
Wilson MJ, Koopman-van Gemert AW, Harlaar JJ, Jeekel J, Zwaginga JJ, Schipperus M. Patient blood management in colorectal cancer patients: a survey among Dutch gastroenterologists, surgeons, and anesthesiologists. Transfusion 2018; 58:2345-2351. [DOI: 10.1111/trf.14807] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 04/25/2018] [Accepted: 04/27/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Michael J. Wilson
- TRIP Hemovigilance and Biovigilance Office; Leiden The Netherlands
- Department of Surgery, Erasmus University Medical Center; Rotterdam The Netherlands
| | | | - Joris J. Harlaar
- Department of Surgery; VU Medical Center; Amsterdam The Netherlands
- Department of Surgery; Westfries Gasthuis; Hoorn The Netherlands
| | - Johannes Jeekel
- Department of Neuroscience; Erasmus University Medical Center; Rotterdam The Netherlands
| | - Jaap Jan Zwaginga
- Center for Clinical Transfusion Research; Sanquin Research
- Department of Immunohematology and Blood Transfusion; Leiden University Medical Center; Leiden The Netherlands
| | - Martin Schipperus
- TRIP Hemovigilance and Biovigilance Office; Leiden The Netherlands
- Department of Hematology; Haga Teaching Hospital; The Hague The Netherlands
| |
Collapse
|
17
|
Bielby L, Moss RL. Patient blood management and the importance of the Transfusion Practitioner role to embed this into practice. Transfus Med 2018; 28:98-106. [PMID: 29660827 DOI: 10.1111/tme.12526] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 03/12/2018] [Accepted: 03/18/2018] [Indexed: 11/28/2022]
Abstract
Patient blood management (PBM) is a widely established international initiative, with a multidisciplinary approach to reduce transfusion. The Transfusion Practitioner1 (TP) role is well embedded in the United Kingdom (UK) and Australia. The value of the TP in changing both culture and practice to implement an all-inclusive PBM approach to care will be discussed. The TP role was born from both a safety and haemovigilance culture, where the greatest identified risk to the patient undergoing a transfusion was human error. From this initial trigger for improved safety, the TP role has evolved to a multifaceted, highly specialised role, involved in both PBM and transfusion processes. As the transfusion paradigm shifted from product to patient, the TP role evolved to include PBM, with an emphasis on the patients and the impact transfusion has on them. A multidisciplinary team is required to drive both PBM and transfusion; the TP is recognised as a critical link in the multidisciplinary team. They are seen as a driving force for change, bridging the gap between the laboratory and clinical arenas. The TP plays a vital role in helping establish and embed PBM that improves patient and safety outcomes.
Collapse
Affiliation(s)
- L Bielby
- Department of Health and Human Services, Victoria and the Australian Red Cross Blood Service, Melbourne, Australia
| | - R L Moss
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| |
Collapse
|
18
|
Voorn VMA, van Bodegom-Vos L, So-Osman C. Towards a systematic approach for (de)implementation of patient blood management strategies. Transfus Med 2018; 28:158-167. [PMID: 29508467 DOI: 10.1111/tme.12520] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 01/26/2018] [Accepted: 02/12/2018] [Indexed: 12/14/2022]
Abstract
Despite the increasing availability of evidence in transfusion medicine literature, this evidence does not automatically find its way into practice. This is also applicable to patient blood management (PBM). It may concern the lack of implementation of effective new techniques or treatments, or it may apply to the (over)use of techniques and treatments (e.g. inappropriate transfusions) that have proven to be of limited benefit for patients (low-value care) and could be abandoned (de-implementation). In PBM literature, the implementation of restrictive transfusion thresholds and the de-implementation of inappropriate transfusions are described. However, most implementation strategies were not preceded by the identification of relevant barriers, and the used strategies were not often supported by literature on behavioural changes. In this article, we describe implementation vs de-implementation, highlight the current situation of (de)implementation in PBM and describe a systematic approach for (de)implementation illustrated by an example of a PBM de-implementation study regarding '(cost-) effective patient blood management in total hip and knee arthroplasty'. The systematic approach used for (de)implementation is based on the implementation model of Grol, which consists of the following five steps: the detection of improvement goals, a problem analysis, the selection of (de)implementation strategies, the execution of the (de)implementation strategy and an evaluation. Based on the description of the current situation and the experiences in our de-implementation study, we can conclude that de-implementation may be more difficult than expected as other factors may play a role in effective de-implementation compared to implementation.
Collapse
Affiliation(s)
- V M A Voorn
- Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands.,Department of Orthopaedic Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - L van Bodegom-Vos
- Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - C So-Osman
- Unit Transfusion Medicine, Sanquin, Leiden, The Netherlands.,Department of Internal Medicine, Groene Hart Hospital, Gouda, The Netherlands
| |
Collapse
|
19
|
Manzini PM, Dall'Omo AM, D'Antico S, Valfrè A, Pendry K, Wikman A, Fischer D, Borg-Aquilina D, Laspina S, van Pampus ECM, van Kraaij M, Bruun MT, Georgsen J, Grant-Casey J, Babra PS, Murphy MF, Folléa G, Aranko K. Patient blood management knowledge and practice among clinicians from seven European university hospitals: a multicentre survey. Vox Sang 2017; 113:60-71. [DOI: 10.1111/vox.12599] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Revised: 09/12/2017] [Accepted: 09/12/2017] [Indexed: 01/28/2023]
Affiliation(s)
- P. M. Manzini
- Banca del Sangue e del Plasma; Città della Salute e della Scienza di Torino; Torino Italy
| | - A. M. Dall'Omo
- Banca del Sangue e del Plasma; Città della Salute e della Scienza di Torino; Torino Italy
| | - S. D'Antico
- Banca del Sangue e del Plasma; Città della Salute e della Scienza di Torino; Torino Italy
| | - A. Valfrè
- Banca del Sangue e del Plasma; Città della Salute e della Scienza di Torino; Torino Italy
| | - K. Pendry
- Department of Transfusion; Central Manchester University Hospitals NHS Foundation Trust; Manchester UK
| | - A. Wikman
- Department of Clinical Immunology and Transfusion Medicine; Karolinska University Hospital; Stockholm Sweden
| | - D. Fischer
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy; University Hospital Frankfurt; Frankfurt Germany
| | - D. Borg-Aquilina
- Hospital Blood Bank; Mater Dei University Hospital; Msida Malta
| | - S. Laspina
- Hospital Blood Bank; Mater Dei University Hospital; Msida Malta
| | - E. C. M. van Pampus
- Laboratory of Medical Immunology; Radboud University Medical Center; Nijmegen The Netherlands
| | - M. van Kraaij
- Laboratory of Medical Immunology; Radboud University Medical Center; Nijmegen The Netherlands
- Department of Transfusion Medicine and Donor Affairs; Sanquin Blood bank; Amsterdam The Netherlands
| | - M. T. Bruun
- Department of Clinical Immunology; Odense University Hospital; Odense Denmark
| | - J. Georgsen
- Department of Clinical Immunology; Odense University Hospital; Odense Denmark
| | | | - P. S. Babra
- Oxford Blood Centre; NHS Blood & Transplant; Oxford UK
| | - M. F. Murphy
- Oxford Blood Centre; NHS Blood & Transplant; Oxford UK
| | - G. Folléa
- French Blood Establishment; Saint Denis France
| | - K. Aranko
- European Blood Alliance; Amsterdam The Netherlands
| |
Collapse
|
20
|
Meybohm P, Muellenbach RM, Keller H, Fichtlscherer S, Papadopoulos N, Spahn DR, Greinacher A, Zacharowski K. Patient Blood Management in der Herzchirurgie. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2017. [DOI: 10.1007/s00398-017-0168-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
|
21
|
Meybohm P, Froessler B, Goodnough LT, Klein AA, Muñoz M, Murphy MF, Richards T, Shander A, Spahn DR, Zacharowski K. "Simplified International Recommendations for the Implementation of Patient Blood Management" (SIR4PBM). Perioper Med (Lond) 2017; 6:5. [PMID: 28331607 PMCID: PMC5356305 DOI: 10.1186/s13741-017-0061-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 02/23/2017] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND More than 30% of the world's population are anemic with serious medical and economic consequences. Red blood cell transfusion is the mainstay to correct anemia, but it is also one of the top five overused procedures and carries its own risk and cost burden. Patient blood management (PBM) is a patient-centered and multidisciplinary approach to manage anemia, minimize iatrogenic blood loss, and harness tolerance to anemia in an effort to improve patient outcome. Despite resolution 63.12 of the World Health Organization in 2010 endorsing PBM and current guidelines which include evidence-based recommendations on the use of diagnostic/therapeutic resources to provide better health care, many hospitals have yet to implement PBM in routine clinical practice. METHOD AND RESULTS A number of experienced clinicians developed the following "Simplified International Recommendations for Patient Blood Management." We propose a series of simple, cost-effective, best-practice, feasible, and evidence-based measures that will enable any hospital to reduce both anemia prevalence on the day of intervention/surgery and anemia-related unnecessary transfusion in surgical and medical patients, including obstetrics and gynecology.
Collapse
Affiliation(s)
- Patrick Meybohm
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Bernd Froessler
- Department of Anaesthesia, Lyell McEwin Hospital, South Australia, Australia
| | | | - Andrew A. Klein
- Department of Anaesthesia and Intensive Care, Papworth Hospital, Cambridge, UK
| | - Manuel Muñoz
- Transfusion Medicine, School of Medicine, University of Málaga, Málaga, Spain
| | - Michael F. Murphy
- NHS Blood and Transplant, Oxford University Hospitals NHS Foundation Trust, University of Oxford, Oxford, UK
| | - Toby Richards
- Centre for CardioVascular and Interventional Research (CAVIAR), University College London, Rockerfellow Building, University Street, London, UK
| | - Aryeh Shander
- Department of Anaesthesiology and Critical Care and Hyperbaric Medicine, Englewood Hospital and Medical Center, TeamHealth Research Institute, Englewood, NJ USA
| | - Donat R. Spahn
- Institute of Anaesthesiology, University of Zurich and University Hospital of Zurich, Zurich, Switzerland
| | - Kai Zacharowski
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| |
Collapse
|
22
|
Valsami S, Grouzi E, Pouliakis A, Fountoulaki-Paparisos L, Kyriakou E, Gavalaki M, Markopoulos E, Kontopanou E, Tsolakis I, Tsantes A, Tsoka A, Livada A, Rekari V, Vgontza N, Agoritsa D, Politou M, Nousis S, Argyrou A, Manaka E, Baka M, Mouratidou M, Tsitlakidou S, Malekas K, Maltezo D, Papadopoulou P, Pournara V, Tirogala A, Lysikatos E, Pefani S, Stamoulis K. Red Blood Cell Transfusions in Greece: Results of a Survey of Red Blood Cell Use in 2013. Turk J Haematol 2016; 34:52-58. [PMID: 27873739 PMCID: PMC5451689 DOI: 10.4274/tjh.2016.0188] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Objective: Greece is ranked as the second highest consumer of blood components in Europe. For an effective transfusion system and in order to reduce variability of transfusion practice by implementing evidence-based transfusion guidelines it is necessary to study and monitor blood management strategies. Our study was conducted in order to evaluate the use of red blood cell units (RBC-U) in nationwide scale mapping parameters that contribute to their proper management in Greece. Materials and Methods: The survey was conducted by the Working Committee of Transfusion Medicine&Apheresis of the Hellenic Society of Hematology from January to December 2013. The collected data included the number, ABO/D blood group, patients’ department, and storage age of RBC-U transfused. Results: The number of RBC-U evaluated was 103,702 (17.77%) out of 583,457 RBC-U transfused in Greece in 2013. RBC-U transfused by hospital department (mean percentage) was as follows: Surgery 29.34%, Internal Medicine 29.48%, Oncology/Hematology 14.65%, Thalassemia 8.87%, Intensive Care Unit 6.55%, Nephrology 1.78%, Obstetrics/Gynecology 1.46%, Neonatal&Pediatric 0.31%, Private Hospitals 8.57%. RBC-U distribution according to ABO/D blood group was: A: 39.02%, B: 12.41%, AB: 5.16%, O: 43.41%, D+: 87.99%, D-: 12.01%. The majority of RBC-U (62.46%) was transfused in the first 15 days of storage, 25.24% at 16 to 28 days, and 12.28% at 29-42 days. Conclusion: Despite a high intercenter variability in RBC transfusions, surgical and internal medicine patients were the most common groups of patients transfused with an increasing rate for internal medicine patients. The majority of RBC-U were transfused within the first 15 days of storage, which is possibly the consequence of blood supply insufficiency leading to the direct use of fresh blood. Benchmarking transfusion activity may help to decrease the inappropriate use of blood products, reduce the cost of care, and optimize the use of the voluntary donor’s gift.
Collapse
Affiliation(s)
- Serena Valsami
- Aretaieio Hospital, Kapodistrian University of Athens Medical School, Department of Blood Transfusion, Athens, Greece Phone: +306944602629 E-mail:
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Baron D, Metnitz P, Fellinger T, Metnitz B, Rhodes A, Kozek-Langenecker S. Evaluation of clinical practice in perioperative patient blood management. Br J Anaesth 2016; 117:610-616. [DOI: 10.1093/bja/aew308] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2016] [Indexed: 01/07/2023] Open
|
24
|
Patient blood management equals patient safety. Best Pract Res Clin Anaesthesiol 2016; 30:159-69. [DOI: 10.1016/j.bpa.2016.04.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 04/29/2016] [Indexed: 01/28/2023]
|
25
|
Patient Blood Management Bundles to Facilitate Implementation. Transfus Med Rev 2016; 31:62-71. [PMID: 27317382 DOI: 10.1016/j.tmrv.2016.05.012] [Citation(s) in RCA: 140] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 05/25/2016] [Accepted: 05/25/2016] [Indexed: 12/22/2022]
Abstract
More than 30% of the world's population are anemic with serious economic consequences including reduced work capacity and other obstacles to national welfare and development. Red blood cell transfusion is the mainstay to correct anemia, but it is also 1 of the top 5 overused procedures. Patient blood management (PBM) is a proactive, patient-centered, and multidisciplinary approach to manage anemia, optimize hemostasis, minimize iatrogenic blood loss, and harness tolerance to anemia. Although the World Health Organization has endorsed PBM in 2010, many hospitals still seek guidance with the implementation of PBM in clinical routine. Given the use of proven change management principles, we propose simple, cost-effective measures enabling any hospital to reduce both anemia and red blood cell transfusions in surgical and medical patients. This article provides comprehensive bundles of PBM components encompassing 107 different PBM measures, divided into 6 bundle blocks acting as a working template to develop institutions' individual PBM practices for hospitals beginning a program or trying to improve an already existing program. A stepwise selection of the most feasible measures will facilitate the implementation of PBM. In this manner, PBM represents a new quality and safety standard.
Collapse
|
26
|
Moog R. Lessons learned from transfusion audits. Transfus Apher Sci 2016; 54:377-9. [PMID: 26928918 DOI: 10.1016/j.transci.2015.11.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 11/10/2015] [Accepted: 11/16/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND In times of patient blood management, studies focus on appropriate transfusion strategies to improve patient's outcome. Little is known about the quality assurance in preparation of blood transfusion and thereafter. In the present study, the indication, informed consent, mandatory immunohematology tests and documentation of blood transfusions were evaluated using assessed self-inspection forms approved by the hospital transfusion committee. MATERIALS AND METHODS 47 medical records of transfused patients were retrospectively reviewed by a clinical transfusion audit team in six hospital facilities from 2012 to 2015. Self-inspection forms were used to classify the physicians' documentation of transfusion into 3 groups: adequately, intermediately, and inadequately documented. RESULTS Adequate documented records were only found in 5 cases (10.6%), followed by intermediate (51.1%) and inadequate documentation (38.3%). Informed consent was identified most often as inappropriate, and this was a critical point with respect to medico legal aspects. CONCLUSION Continuous education of physicians defining parameters to be documented is almost essential in daily transfusion medicine routine. The use of a check list with physician's documentation of transfusion is strongly recommended.
Collapse
Affiliation(s)
- Rainer Moog
- German Red Cross Blood Donor Service North-East, Institute Cottbus, 03050 Cottbus, Germany.
| |
Collapse
|
27
|
Abstract
PURPOSE OF REVIEW In recent years, the view changed from 'product orientated' to 'patient orientated' and a new concept, named 'patient blood management' (PBM), was created with the aim to improve patient care and safety. However, changing long lasting work practice is more than challenging but the outcomes of several recently published studies confirm the concept and warrant the effort. This review will exemplify the need of patient centered treatments and highlight recent findings in the field of PBM. RECENT FINDINGS Anemia is the biggest predictor for red blood cell transfusion that may by itself be associated with adverse outcome. PBM is a multiprofessional and multidisciplinary composition addressing a patient-centered prevention and treatment of both preoperative and hospital-acquired anemia. Thereby, red blood cell utilization can be reduced and patient perioperative outcome improved. SUMMARY During recent years, a tremendous movement has been observed in respect of patient safety and patient blood use. However, the majority of hospitals hazard with the implementation of PBM practice mostly because the awareness about recent findings and current recommendations regarding PBM is lacking.
Collapse
|
28
|
Mehra T, Seifert B, Bravo-Reiter S, Wanner G, Dutkowski P, Holubec T, Moos RM, Volbracht J, Manz MG, Spahn DR. Implementation of a patient blood management monitoring and feedback program significantly reduces transfusions and costs. Transfusion 2015; 55:2807-15. [DOI: 10.1111/trf.13260] [Citation(s) in RCA: 150] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 06/25/2015] [Accepted: 06/26/2015] [Indexed: 12/21/2022]
Affiliation(s)
- Tarun Mehra
- Medical Directorate; University Hospital of Zurich
| | - Burkhardt Seifert
- Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute; University of Zurich
| | | | - Guido Wanner
- Division of Trauma Surgery, Department of Surgery
| | | | | | | | | | | | - Donat R. Spahn
- Institute of Anesthesiology; University and University Hospital of Zurich; Zurich Switzerland
| |
Collapse
|