(P-PB-10) Effects of Updating Transfusion Indications on Transfusion Ordering Practices at a Children’s Hospital

 In recent years, several expert guidelines, and a large, randomized control trial (RCT) have been published that address transfusion thresholds and indications in the pediatric population.  Those publications provided a good foundation to create more specific transfusion indications for infants and children.

Study

Design/Methods:

Review of the literature was completed and followed by several interdisciplinary discussions to determine the applicability of new thresholds and guidelines in the clinical practice.  Finally, the updated transfusion indications were reviewed and approved by the transfusion committee.  

At our institution, a clinician must choose the appropriate transfusion indication at the time of entering a transfusion order.  Entered transfusion indications are screened by the blood bank technologists who are trained to compare entered indications with expected indications and patient’s laboratory markers.  Inappropriate transfusion indications and transfusion indications entered as a free text are submitted to the Medical Director for review.

Study was undertaken to evaluate how many transfusion orders were submitted for the review in five months prior to use of updated transfusion indications and how many transfusion orders were submitted for the review in five months after initiating the use of updated transfusion indications.

The aim of the study was to observe the effect of updated transfusion indications on the review process (internal transfusion order audits) and whether those updates, with focus on pediatric population, improved their use in the institutional clinical practice.

Results/Findings:

There were 120 transfusion orders submitted for review out of 4646 transfusions (2.5%) in five months prior to the use of updated transfusion indications.  The number of transfusion orders submitted for review decreased to 68 out of 4346 transfusions (1.5%), in the five months period after the updated transfusion indications were available for clinical use.  Number of orders with an inappropriate transfusion indication in both time periods remained similar.  See table 1.

Conclusions:

Transfusion indications updates, based on recent, evidence-based guidelines and RCTs in a pediatric population, led to a decrease in number of transfusion orders requiring review.

Number of inappropriate indications was not affected by the updates.  This could be because some health care providers do not understand or do not pay attention to transfusion indications at the time of ordering blood products.  Education regarding transfusion indications and thresholds is warranted.

 Periodic review and updates of the institutional transfusion indications is an important element of transfusion medicine process in the hospital.