Background/Case Studies: Early identification and diagnosis of transfusion reactions (TR) are critical to improving patient outcomes. This project aims to develop an evidence-based, multi-step approach for detecting transfusion reactions and to implement a healthcare quality review and improvement program. The initiative seeks to enhance the accuracy of reporting and diagnosis of TR, ultimately contributing to safer transfusion practices and improved patient care.
Study
Design/Methods: A retrospective review of Bridgeport Hospital (BH) medical records from fiscal year 2024 (FY24) was done to identify gaps in recognizing and reporting transfusion reactions with a comparison to national trends. A multistep approach quality improvement program was implemented to close the gaps. Here we present this multistep approach: (1) baseline assessment of nurses’ knowledge and practices via a survey prepared by subject matter experts; (2) training sessions at selected nursing units who were identified to have gaps (3) post training knowledge assessment. These training sessions and questions were eventually developed into a Learning Management System (LMS) module on early recognition and response to transfusion reactions. Pre- and post-intervention data were compared to assess changes in nurse knowledge and pathway adherence. Additionally, as a fourth step a Transfusion Reaction Signature Care Pathway was developed.
Results/Findings: BH exceeded the national trend in the FY24 in reporting of TR (0.6% vs 0.2%), However, reporting of serious TR at BH was lower when compared to a study that evaluated a number of transfusion episodes audited by trained subject matter experts. For example the TACO (Transfusion Associated Circulatory Overload) reporting rate at BH during FY24 was 0.05% (4/7518 components transfused) compared to 0.8% (39/4857 transfusion episodes) mentioned in the study and the confirmed TRALI rate was 0% (0/7518 components) at BH, compared to 0.08% (4/4857 transfusion episodes) mentioned in the Hendrickson's study. Keeping in mind one TR usually has 2 components transfused on average, with our total transfusions, we would anticipate a higher number of TACO and TRALI reported yearly.
In terms of the outcomes of the initial phase of our QI initiative, post-intervention, nurses demonstrated improvement in awareness and knowledge of early transfusion reaction indicators (87% vs. 83%). While the overall rate of reported reactions remained unchanged, no missed events were identified post-intervention (0% vs. 0.4%). The Signature Care pathway supported better recognition of reactions and appropriate sample/lab ordering. Even in the short term, nurse awareness increased, with more inquiries to the blood bank. Additional data from the 6–12 month follow-up will further inform outcomes. Conclusions: Our QI initiative increased awareness and facilitated the communication between the blood bank and the clinical staff.
