A simple automatized audit system for following and managing practices of platelet and plasma transfusions in a neonatal intensive care unit

Publisher Website
Google Scholar
Abstract
Summary.  During neonatal intensive care, blood components are often used in clinical situations where both their efficacy and safety lack solid justification. A practical system to continuously analyse actual transfusion practices is a prerequisite for improvements of quality in transfusion therapy. We hypothesized that such a system would reveal inappropriate variations in clinical decission making and offer a means for staff education and quality improvement and assurance.The study consisted of three 120–152‐day periods (P I, P II and P III) between January 2000 and October 2001 and involved 543 new patient admissions (141 patients with birth weight < 1501 g) and 6227 days of patient care at a single tertiary level NICU. P I was a control with no intervention, P II was after technically introducing the computer system and, the last period, P III was after presenting and discussing the results of P I and P II at a staff meeting. Upon an order of platelet or fresh frozen plasma (FFP) unit from the blood bank, a computer‐based audit system compared the last platelet count or prothrombin time [expressed as percentage of normal clotting activity, prothrombin time (PT‐%)] to predefined criteria. In the case of exceeding the preset thresholds, the system required additional information and recorded the pretransfusion laboratory values for later analysis.Thirty‐two per cent of platelet transfusions were given with pretransfusion platelet count >49 × 109 L−1, and 60% of these transfusions (19% of all platelet transfusions) could not be clinically justified in retrospective chart review. There was no significant change in this practice from P II to P III. FFP transfusions were given with significantly different pretransfusion PT‐% values during P II and P III. The proportions of FFP transfusions with pretransfusion PT‐% > 49% were 7·8% and 0·9% during P II and P III, respectively (P < 0·0001). In chart review, none of the FFP transfusions with pretransfusion PT‐% > 49% could be justified by clinical grounds.Inappropriate transfusions of both platelets and plasma remain a significant challenge for quality assurance of neonatal intensive care. Automated recording of pretransfusion platelet count and prothrombin time reliably identified the poorly justified transfusions and thus offered a practical resource‐saving tool for quality assurance of transfusion in the NICU. A significant shift towards more appropriate use of plasma was demonstrated after implementation of the audit system.