24 November 2015

Reduce Waste by Carrying Out Blood Transfusions Only When Necessary 

Blood transfusions should only be carried out when necessary to help avoid waste in the NHS and prevent risk to patients, says NICE.

In new guidance, NICE makes a number of recommendations to help reduce variation in practice, increase patient safety, and prevent needless use of resources.

Blood transfusions are common procedures that tend to be safe and result in a small likelihood of harm. Yet recent studies have highlighted variation in their use and that at least a fifth of transfusions are unnecessary.

NICE’s latest guideline on blood transfusion aims to address these concerns through recommendations that help standardise practice and improve patient safety.

Alternatives to blood transfusion are clinically and cost effective

The guideline includes an algorithm to help healthcare professionals determine whether a blood transfusion is necessary.

NICE says that if a patient is having surgery, then alternatives for blood transfusion should be considered.

Among these is tranexamic acid, which is a clinically effective drug that is currently not being prescribed consistently across the country. Costing as little as 60p for surgical procedures, use of this drug can save hospitals substantial sums of money.

NICE recommends that tranexamic acid should be offered to adults undergoing surgery who are expected to have at least moderate blood loss that is greater than 500ml.

The drug should also be considered for children who are undergoing surgery and that are expected to have at least moderate blood loss – which is greater than 10% blood volume.

Electronic patient ID systems can help reduce human error

Despite their relative safety, blood transfusions carry potential risks. In 2014, 3668 reports of adverse events relating to transfusion were submitted Serious Hazards of Transfusion (SHOT). Of these, 77.8% had errors as an underlying cause.

Reasons for errors include patients receiving the wrong blood components, the choice of blood component not always being based on clinical findings and lab test values, patients not being monitored for adverse effects, and some patients being transfused unnecessarily.

As a result, NICE recommends that hospitals should consider using a system that electronically identifies patients to improve the safety and efficiency of the blood transfusion process.

Electronic patient identification systems prompt staff to carry out key steps in the correct order, and ensure that transfusions are given to the right patients through scanning of compatible wristbands and blood component containers.

While there will be an initial cost to implementing these systems, NICE says the systems will provide sufficient efficiency gains in areas such as:

  • nursing and laboratory staff time
  • reduced blood product wastage

The guideline also includes advice on making the case for investment in electronic systems.

Safer for patients, saving money for hospitals

Professor Mark Baker, director of clinical practice at NICE, said: “This guideline will ensure blood products are used safely and efficiently. Hundreds of thousands of people receive blood transfusions every year in England and Wales, we must do all we can to ensure that their experience is a safe one.

“We know that practice is improving and with this guideline we want to drive things even further so we get closer to transfusions being completely risk-free and people are spared from avoidable harm.”

Professor Mike Murphy, consultant haematologist at Oxford University Hospitals and chair of the committee that developed the guideline said: “'Electronic systems make it easy for staff to do the right thing every time, and avoid errors. They can also provide 'decision support' for doctors when they are ordering blood and promote the restrictive use of blood. The guideline also importantly highlights the benefits of the routine use of tranexamic acid in patients undergoing surgery.

“Routine implementation of these measures in the NHS will make best use of a valuable resource, be safer for patients and save money for hospitals.”