University of Tennessee Medical Center, Tennessee, United States
Background/Case Studies: At our institution, the transfusion reaction rate was low, compared to the current national average. Transfusion reactions were identified by the transfusionist using a list of signs and symptoms (SS). After review by a regulatory body, the list of transfusion reaction SS was identified as an improvement opportunity, including structure and criteria.
Study
Design/Methods: Data was collected on transfusion rate and number/type of transfusion reaction reviews (TRR) completed from a previous 12-month period by the Blood Bank (BB). Once opportunities for improvement were identified, an action plan was created to include specific criteria, suggested clinical actions, and educational material. For the nursing team, education was accomplished using online modules, huddle topics, verbal, and email communications. Education, including the use of the CDC Hemovigilance Module Surveillance classification system (HMS), was sent to the medical staff by the Chief Medical Officer. The policy was updated to reflect changes. Additional information is provided by the BB with non-emergent transfusions via a “Resource for the Transfusionist” card, with the purpose of placing the SS of a reaction and procedure in the hands of the transfusionist at the time of transfusion. Post-implementation data was collected on transfusion rates and number/type of TRR for a 12-month period.
Results/Findings: A retrospective review was conducted on TRR from BB documentation. For a 12-month period, 19,757 products were transfused with a TRR rate of 0.32% (64 cases). A confirmed reaction rate (CRR) of 0.15% (30 cases) with four types of reactions noted (Febrile: 43.3%, Allergic: 40.0%, TACO: 13.3%, TRALI: 3.3%). Post-implementation of the action plan, for a 12-month period, 20,321 products were transfused with a TRR rate of 0.96% (195 cases). A CRR of 0.38% (78 cases) with reactions classified using the HMS (TACO: 12.8%, TRALI: 1.3%, Allergic: 28.2%, Hypotension: 10.3%, FNHTR (febrile): 46.2%, DHTR: 1.3%). The data shows a 305% increase in the number of possible reported reactions reviewed. Conclusions: After adding specific criteria for a potential transfusion reaction, the TRR rate increased significantly. TRR revealed many were not related to the transfusion as evidenced by clinical situation and expert review. However, there was an increase in confirmed transfusion reactions, which may be due to more specific criteria and increased knowledge of nursing and providers related to transfusion reactions. Providing specific criteria, specifically using the resource card, offered structure and support for the transfusionist. Even with an increase in TRR, providing more specific criteria allowed for improved recognition, reporting, and review of potential transfusion reactions.
Importance of research: Data shows that transfusion reactions on a whole are typically underreported and perhaps under-detected. We are presenting the methods taken by our institution to increase surveillance and detection of transfusion reactions. With this increased awareness and reporting resulting in more effective hemovigilance and increased patient safety.
