Original Article
Patient-Centered Approach to Ensuring Appropriateness of Care Through Blood Management
Abstract
Background: Concerns have been raised about the safety and efficacy of blood transfusions. Blood products are in demand and a decreasing supply is projected, with resource conservation a global concern. A consultant group determined that the transfusion rate at Mease Countryside Hospital was higher than an average baseline.Methods: A process-improvement project was initiated using a multidisciplinary team approach to improve blood utilization and ensure appropriateness in transfusion practice. The foundation of this project was to create new guidelines for transfusion; provide detailed education, communication, reporting, and feedback; and develop criteria to ensure compliance.
Results: The mean monthly usage of red blood cell units per 1000 inpatient discharges between April 2010 and October 2011 was 321.4 compared with 212.0 for the 5 months after implementation. The mean monthly number of patients transfused per 1000 inpatient discharges from April 2010 to October 2011 was 135.2 compared with 90.2 after implementation. In both cases, this reduction was found to be statistically significant at a 95% confidence level (P = 0.000 in both respects).
Conclusions: The success of this project was the result of careful planning and execution, administrative support, physician leadership, and teamwork. Blood management includes strategies to avoid inappropriate transfusions and proactively treat anemia. Anemia management should be based on the patient’s symptoms, laboratory values, and clinical assessment. Treatment of anemia should encompass a patient-centered approach, with the aim of promoting patient safety and minimizing the risk from exposure to blood products.
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References
1. Boucher BA, Hannon TJ. Blood management: a primer for clinicians. Pharmacotherapy. 2007; 27: 1394–1411.
2. Kumar A. Perioperative management of anemia: limits of blood transfusion and alternatives to it. Cleve Clin J Med. 2009; 76: S112–S118.
3. Carson JL, Hill S, Carless P, et al. Transfusion triggers: a systematic review of the literature. Transfus Med Rev. 2002; 16: 187–199.
4. VanderEnde DS, Dressler DD. When should a hospitalized patient be transfused?http://www.thehospitalist.org/details/article/185977/When_should_a_hospitalized_patient_be_transfused.html. Published January 2009. Accessed July 31, 2012.
5. Strategic Blood Management: BloodStat Report. Indianapolis: Strategic Healthcare Group LLC; 2010.
6. Osaro E, Charles AT. Conserving red cell use for good stewardship and patient safety. J Blood Disord Transfus. 2011; S1-003
7. Rosswurm MA, Larrabee JH. A model for change to evidenced-based practice. Image J Nurs Sch. 1999; 31: 317–322.
8. Change theory—Kurt Lewin. http://currentnursing.com/nursing_theory/change_theory.html. Published September 12, 2011. Accessed July 31, 2012.
9. Liumbruno G, Bennardello F, Lattanzio A, et al. Recommendations for the transfusion of red blood cells. Blood Transfus. 2009; 7: 49–64.
10. Hébert PC, Wells G, Blajchman MA, et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. N Engl J Med. 1999; 340: 409–417.
11. Vincent JL, Baron JF, Reinhart K, et al. Anemia and blood transfusion in critically ill patients. JAMA. 2002; 288: 1499–1507.
12. Corwin HL, Gettinger A, Pearl RG, et al. The CRIT study: anemia and blood transfusion in the critically ill—current clinical practice in the United States. Crit Care Med. 2004; 32: 39–52.
13. Corwin HL, Carson JL. Blood transfusion—when is more really less? N Engl J Med. 2007; 356: 1667–1669.
14. Carson JL, Grossman BJ, Kleinman S, et al. Red blood cell transfusion: a clinical practice guideline from the AABB. Ann Intern Med. 2012; 157: 49–58.
15. Carson J, Terrin ML, Noveck H, et al. Liberal or restrictive transfusion in high-risk patients after hip surgery. N Engl J Med. 2011; 365: 2453–2462.
16. Rivers EP, Katranji M, Jaehne KA, et al. Early interventions in severe sepsis and septic shock: a review of the evidence one decade later. Minerva Anestesiol. 2012; 78: 712–724.
17. Fuller BM, Gajera M, Schorr C, et al. The impact of packed red blood cell transfusion on clinical outcomes in patients with septic shock treated with early goal directed therapy. Indian J Crit Care Med. 2010; 14: 165–169.
18. Offner PJ, Moore EE, Biffl WL, et al. Increased rate of infection associated with transfusion of old blood after severe injury. Arch Surg. 2002; 137: 711–716.
19. Schrijvers D. Management of anemia in cancer patients: transfusions. Oncologist. 2011; 16: 12–18.
20. Lawler EV, Bradbury BD, Fonda JR, et al. Transfusion burden among patients with chronic kidney disease and anemia. Clin J Am Soc Nephrol. 2010; 5: 667–672.
21. Shander A, Javidroozi M, Ozawa S, et al. What is really dangerous: anaemia or transfusion? Br J Anaesth. 2011; 107: 141–159.
22. Goodnough LT, Maniatis A, Earnshaw P, et al. Detection, evaluation, and management of preoperative anemia in elective orthopaedic surgical patient: NATA guidelines. Br J Anaesth. 2011; 106: 13–22.
23. The nursing process and project management. http://interopnurse.com/2011/07/the-nursing-process-and-project-management. Published July 10, 2011. Accessed July 31, 2012.
