Kelly Shane, Sharpe Simon, Culliton Marie, Higgins Mary F, Fitzgerald Joan
University College Dublin School of Medicine, Dublin, Republic of Ireland.
Medical Science, National Maternity Hospital, Dublin, Republic of Ireland.
Ir J Med Sci. 2023 Apr;192(2):765-771. doi: 10.1007/s11845-022-03032-8. Epub 2022 Jun 3.
With blood products being a limited and expensive resource within the healthcare system, there is an ever-increasing emphasis on judicial and appropriate use.
To evaluate whether implementing contemporary society recommendations on restrictive transfusion policies would reduce inappropriate use of red blood cell transfusions, by evaluating the effect of a staff educational campaign.
An audit of peri-partum red cell concentrate (RCC) transfusion practice within a tertiary obstetric unit was undertaken, covering a 1-year period (2015), examining data related to transfusion prescribing practices. Subsequently, an educational programme was held for clinical and laboratory staff which aimed to bring practice in line with society guidelines. A repeat audit covering another 1-year period (2018) was undertaken.
The number of RCC units of transfused reduced by 49% between 2015 and 2018 (426 to 218). The number of patients receiving transfusion dropped from 166 in 2018 (1.8% of births) to 119 in 2015 (1.5% of births). Among stable patients who were transfused, the proportion receiving a single unit increased from 6.9 to 53.9%. (p < 0.001). Haematological reassessment between units rose from 13.8 to 80.4% (p < 0.001). Written consent documentation improved (68% in 2018 vs. 38% in 2015) (p < 0.001).
The implementation of guidelines has resulted in substantial reduction in RCC transfusions between 2015 and 2018. Fewer women received a blood transfusion, and those who did received fewer units. There is a higher proportion of patients being reassessed between units and receiving single unit transfusions. Recording of consent has improved.
血液制品在医疗保健系统中是一种有限且昂贵的资源，因此越来越强调合理且恰当的使用。
通过评估一项员工教育活动的效果，来评价实施当代社会关于限制性输血政策的建议是否会减少红细胞输血的不当使用。
对一家三级产科单位的围产期红细胞浓缩液（RCC）输血实践进行了为期1年（2015年）的审核，检查与输血处方实践相关的数据。随后，为临床和实验室工作人员举办了一个教育项目，旨在使实践符合社会指南。又进行了为期1年（2018年）的重复审核。
2015年至2018年间，输注的RCC单位数量减少了49%（从426单位降至218单位）。接受输血的患者数量从2015年的166例（占出生人数的1.5%）降至2018年的119例（占出生人数的1.8%）。在接受输血的稳定患者中，接受单单位输血的比例从6.9%增至53.9%（p<0.001）。单位间的血液学重新评估从13.8%增至80.4%（p<0.001）。书面同意文件有所改善（2018年为68%，2015年为38%）（p<0.001）。
指南的实施使2015年至2018年间RCC输血大幅减少。接受输血的女性减少，且接受输血的单位数量也减少。单位间重新评估的患者比例更高，接受单单位输血的患者更多。同意记录有所改善。
