Improving Patient Blood Management

Posted on Dec 4, 2018 in Announcements | 0 comments

IMPROVING PATIENT BLOOD MANAGEMENT

Our initial focus on a single unit RBC transfusion strategy continues to show improvement.  The % of transfuse orders for 1 RBC unit has increased from 37% to almost 60%.  The statistics exclude RBC transfusions for sickle cell disease, GI hemorrhage and post-partum hemorrhage.

Recommendation: Don’t transfuse more RBC units than absolutely necessary.  Give single unit RBC transfusions in stable, non-bleeding hospitalized patients, with reassessment of the patient after the single-unit transfusion to decide if a second unit is needed.

RBC transfusion decisions should be influenced by patient symptoms and HGB level.  AABB guidelines support a restrictive HGB transfusion threshold:

  • 0 gm/dL for stable, non-bleeding hospitalized patients
  • 0 gm/dL for stable orthopedic, cardiovascular or cardiac surgery patients

During Jan-Oct 2018, ~25% of RBC units were transfused to patients with a HGB > 8.0 gm/dL.  The Blood Utilization Committee will begin drilling down on these cases to determine if transfusion was indicated.

To achieve the single unit RBC transfusion strategy, please remember to:

  • Place Type & Crossmatch and/or Transfuse orders for 1 unit in Epic.
  • Order post-transfusion hemoglobin [LABHGB] and reassess patient to determine if a second RBC unit is needed. A post-transfusion HGB can be drawn as soon as 15 minutes after the transfusion is completed.

Annette Shaieb, MD

 

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