As the surgical transfusion coordinator, it is my job to constantly audit the blood and blood product usage at this hospital. Although there is no doubt that transfusions can save lives, there is always the risk of a transfusion reaction. Therefore, it is important that every transfusion can be justified. Additionally, the cost of blood and blood products rises annually and we are faced with a decreasing number of donors, leading to a potential shortfall in the future. The role of the transfusion coordinator was started in April 2000, with the aim of analysing the current usage of blood and blood products in theatre and intensive care. The audit lasted for 17 weeks and included all cardiac surgical patients.
It was hoped that by examining what blood products we used, and when and why we used them, we could assess whether we were not only complying with the existing transfusion guidelines but, more importantly, whether we were providing the best standard of care for our patients.
Analysis of the data collected from the first audit showed that some 33% of all transfusions were given outside the existing hospital guidelines. Additionally, 8% of all units transfused were not recorded anywhere in the patient's notes and only 17% of post-operative transfusions were prescribed.
These findings were presented at a hospital wide meeting and accompanied by a more detailed report. The transfusion guidelines were revised by the hospital's Consultant Haematologist to reflect what is currently believed to be best practice, a second audit performed and the findings reported. This process was repeated on a further two occasions, with the current audit being continuous.
From the first to the current fourth audit, we have seen significant improvements in practice. Compliance with the newer, and more rigid, guidelines has risen to 89%, only 0.6% of transfusions are inadequately recorded and prescription has risen to 69%.
This improvement has naturally had an impact on the amount of money this hospital spends on blood and blood products. We estimate that we are saving nearly £29 for each primary coronary artery bypass graft (CABG) surgery patient. Although this doesn't seem very much, we perform over 1000 of the operations here each year and this saving is in the face of increased costs for the products. More significantly, we are spending far less on products give outside the transfusion guidelines. This has fallen from £3,412 to £1,041 per week.
Although great steps have been made, there is still further room for improvement. Additionally, it is important to maintain a constant auditing program to ensure that new staff are made aware of the guidelines and procedures so that compliance remains high.
Surgical Transfusion Coordinator
Department of Anaesthetics