ihs xii dubrovnik feb ‘10 indicators for safe and appropriate use of blood components rené r.p....

IHS XII Dubrovnik feb ‘10

Indicators for safe and appropriate use of blood components

René R.P. de Vries


Question

Blood transfusion: worth the risk?


Inappropiate Use


How can we improve appropriate use of blood components?

• Autorisation by experts• Monitoring of requests

and feed-back• Projects• Audits


How can we improve appropriate use of blood components?

• Autorisation by experts• Monitoring of requests

and feed-back• Projects• Audits

•Quality Indicators


( Quality )Indicator

• Definition: measurable element of health care that gives an indication about the quality of care

• Function: signaling, monitoring and adjustment

• Goal: improvement of quality of care


Types of indicators 1

Structure indicator: How have I organised it?

Process indicator: Am I doing it well?

Outcome indicator: Do I reach the desired

result?


Types of indicators 2

Internal indicators:Goal: quality management and

improvement

External indicators:Goal: external account

pm. Benchmarking


Internal indicators: 3 levels

1. Hospital

2. Haemovigilance system: national

3. IHN: international


Internal indicators LUMC


Blood transfusion chain

1. Clinical decision, patient sample and request

2. Processing request by Hospital Bloodbank and delivery of blood component

3. Administration of blood component to the patient

4. Assessment of the effect




2. Processing request in Hospital Bloodbank and delivery of blood component




Utilisation of plasma: Dept. of Thorax surgery

Plasma verbruik afd. thoraxheelkunde

500

1000

1500

2000

2500

3000

1997 1998 1999 2000 2001 2002 2003 2004 2005

0%

5%

10%

15%

20%

25%

30%

35%

aangevraagd

getransfundeerd

% vernietigd

Plasma verbruik afd. thoraxheelkunde

500

1000

1500

2000

2500

3000

1997 1998 1999 2000 2001 2002 2003 2004 2005

0%

5%

10%

15%

20%

25%

30%

35%

aangevraagd

getransfundeerd

% vernietigd

RequestedTransfused% destroyed




2. Processing request in Hospital Bloodbank and delivery of blood component





Target 2009

% of administered platelet units where the increment could be measured

> 75 % 76 %


Blood use 1995-2006

Absolute numbers of transfused products per year



1. Hospital



http://www.cbo.nl/


Indicators for benchmarking safe and appropriate use

• Developed according to the AIRE method

• Internal indicators but also selected on the basis of– Validity– Reliability– Ease of registration– Discriminative capacity ( benchmarking)– Possibility for improvement

http://www.cbo.nl/


Structure indicators

• Transfusion Committee• Haemovigilance officer• Electronic registration of

process indicators• Electronic pre-administration

control

http://www.cbo.nl/


Process indicators

• AB0-RhD blood group discrepancies• Waste of blood components • Indication and assessment of the effect

of transfusion of –erythrocytes–platelets–plasma

http://www.cbo.nl/


Role for TRIP ?

• Collect • Analyse • Report (anonymously)

Indicators per hospital

http://www.tripnet.nl/



1. Hospital




International indicators

Benchmarking

International standards?


Indicators for the quality of Haemovigilance Systems?

• % hospitals that report• Quality of reports? Not easy!• Improvement of

safe use

appropriate use


Conclusion 1

Quality indicators are an effective instrument to improve the quality of the

blood transfusion chain


Conclusion 2

Success factors:• Electronic registration• Financial stimulus• Transfusion committee• Haemovigilance officer


Conclusion 3

Future:• Computerisation of the whole

blood transfusion chain in the hospital

• Electronic request +computerized clinical decision support


THE END

Thank you

for your vigilance


Indicators for safe and appropriate use of blood components

Haemovigilance is part of a quality system of the blood transfusion chain


Should we watch for more than safety of blood transfusions?

RiskBlood transfusion 1:10.000 *Blood donation 1:100

Blood saving procedures ?

* medication 1: 100 ?


Internal indicators

• Relevant for professional• Specific, detailed• Less stringent requirements for

validation• Registration at the source• Quick, funny, interactive• Paradigm: good-better


External indicators

• Relevant for external organisations• Aspecific, global• Strict validation necessary• Information is public• Paradigm: (often) good-bad


Bloodtransfusion chain LUMC

1

2

3 4


Utilisation of blood components (2008)

Purchased Number and % not used

Erythrocytes 13.893 358 2,6%

Plasma 5.045 732 14,5%

Platelets 5.158 55 1,1%

Other 259 7 2,7%

Total 24.364 1.152 4,7%


Safe usage

Patients Products Severe reactions

Severe reactions due to mistakes

2006 2.701 23.996 0 0

2007 2.627 23.164 10* 0

2008 2.545 23.212 6 0

2009 2.531 20.865 9 0

* Since 2007 also grade 2 reactions are reported as severe reactions according to EU regulations


Blood transfusion chain LUMC


2. Processing request by Hospital Bloodbank and delivery of blood component




Indicators for indication and request: safety

Target 2009

Number of blood group discrepancies in AB0-RhD screening of patients due to identification or labeling errors outside the transfusion laboratory divided by the total number of AB0-RhD screenings in the same period

< 1 ‰ 0.9 ‰

ihs xii dubrovnik feb ‘10 indicators for safe and appropriate use of blood components rené r.p....

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