51 Monitoring the quality indicators of blood transfusion services as a method to improve patient safety at king abdulaziz university hospital

Background A quality indicator is measurable information gathered at the critical control points in a process or procedure for monitoring, assessment, and improvement. Quality monitoring is an important tool used to review blood transfusion practice and provide feedback on transfusion trends in blood transfusion services. Quality indicators can improve quality standards and support patient safety through setting priorities and process improvement. The aim of this study was to report 5 years’ experience of monitoring the quality indicators at KAUH and to measure its impact on the blood transfusion practice as a tool in hemovigilance system implementation for patient safety. Methods This was a retrospective study of data collected over the past 5 years (2013–2017) at KAUH, Jeddah, in which the quality indicators for certain parameters were analyzed and benchmarks were set for blood donor adverse reactions, transfusion reactions, fresh frozen plasma (FFP) in-date wastage, and cross match to transfusion (CT) ratio. Data were forwarded to the Hospital Transfusion Committee (HTC) for review. Deviations were identified and corrective actions were taken. The outcomes were used to plan for improvement. Results Among a total of 60,631 blood donors, 282 donor reactions were reported, resulting in a rate of 0.46%, mostly in the form of mild dizziness. 285 adverse transfusion reactions were reported among 99,564 total blood transfusions, resulting in a rate of 0.28%; most were allergic and febrile reactions. Monitoring of the adverse donor reactions showed a decreased incidence; however, the adverse transfusion reactions were under-reported. The FFP in-date wastage was 2205 among 22,590 requested FFP units, resulting in a high rate of 9.76%. The CT ratio was 1.24. Safety improvements were implemented by a multidisciplinary quality improvement team to determine the critical control points and to address the factors contributing to high FFP wastage. Conclusion The use of quality indicators as a tool for implementing a hemovigilance system can provide a better understanding of areas for improvement in the quality of the work and safety of patients. Establishing guidelines for appropriate clinical use of blood and proper communication between clinical transfusion staff and practitioners is expected to enhance these features along the blood transfusion chain. The use of a similar model in other institutions will facilitate the local benchmarking between hospitals, which is a feasible method to lower transfusion risk and cost and to improve quality outcomes.