Challenge 5

Anemia and Transfusion: A Patient Safety Concern

Executive Summary Checklist

Errors in the use of blood products are a significant cause of hospital patient morbidity and mortality. To eliminate these errors, we must implement an effective Patient Blood Management program, including the following actionable steps:

  • A Commitment from hospital leadership to support a Patient Blood Management program that closes the performance gap by reducing unnecessary transfusions while speeding up needed blood transfusion and care for patients who truly need it.
  • Clinical and safety leadership endorse the plan and drive implementation across all providers and systems.
  • Establish the Patient Blood Management Committee, which replaces the traditional hospital transfusion committee, and appoint an MD chairperson to be responsible and accountable for leading this group.
  • On a monthly basis, distribute the blood product usage report by clinicians across the hospital to hospital leaders.
  • Develop a Patient Blood Management education program for emergency and elective hospital admissions, targeting medical students, physicians, nurses, pharmacists and other healthcare staff.
  • Implement interdisciplinary blood conservation modalities, including:
    • Reductions of unnecessary laboratory tests, frequency of blood sampling, and “discard” volumes.
    • A consistent protocol for preoperative management of platelet inhibitors and other anticoagulants.
    • Technology that has been shown to improve patient care, such as continuous non-invasive hemoglobin monitoring and red cell recovery technology in the operating room (OR).
  • Establish protocols for anemia management, including:
    • Screen, diagnose and appropriately treat anemia prior to surgery, allowing adequate lead time to correct the anemia before surgery.
      • Identify patients at risk for needing transfusion.
      • Increase hemoglobin levels before surgery.
      • Minimize the risk of hitting levels that require blood transfusions.
    • When appropriate, establish single unit transfusion policy and advocate for restrictive transfusion practices.
    • Document hemoglobin levels before the transfusion of each RBC unit.
    • Consider alternative therapies to RBC transfusions, such as intravenous iron or erythropoietin stimulation agents (ESAs).
  • Continuously monitor the effectiveness of the Patient Blood Management program, and use the results of this monitoring in medical staff educational sessions as a part of Continuous Quality Improvement (CQI).

Between the 2017 World Patient Safety, Science & Technology Summit and the 2017 Midyear Planning Meeting a workgroup comprised of experts representing administrators, clinicians, technologists and patient advocates will meet to update this APSS. If you are interested in joining this workgroup, please email us.