There’s no question, blood saves lives. Blood transfusion is one of the most common procedures performed during hospitalizations and undoubtedly helps patients who are injured, having surgery, receiving cancer treatments or are being treated for diseases that affect the blood such as sickle cell anemia.
However, there are many scenarios where the risks outweigh the benefits. Studies over the past two decades have found that liberal transfusions practices make patients more susceptible to infections and increase the risk of poor outcomes such as longer hospital stays and even death. A recent systematic review of nearly 500 studies concluded that blood transfusions improved outcomes in only11 percent of patients without trauma or active bleeding.
With that in mind, UTMB’s Patient Blood Management (PBM) Program is working to improve patient safety and outcomes by encouraging health care providers to avoid unnecessary transfusions and minimize exposure to blood components.
“We want to make certain our patients are receiving the right blood component, in the right dose, at the right time, for the right reason, every time,” said Angel Male, transfusion safety officer at UTMB. “There are additional benefits to engaging in this initiative, such as decreasing potential complications associated with unnecessary transfusion, utilizing proven pharmacological alternatives, reducing hospital and patient care cost, and ultimately conserving a precious resource.”
The PBM Program uses evidence-based guidelines to promote appropriate use and management of blood and blood components while improving patient outcomes, reducing risks and costs to both the patient and the health care system.
Blood Management Program highlights include:
• Raising and sustaining awareness about evidence-based transfusion medicine and the need to adopt conservative transfusion practices
• Revision of the UTMB Transfusion Guidelines to reflect current evidence (The Transfusion Committee generally supports the transfusion of red cells at a hemoglobin trigger of 7g/dL, when clinically indicated.)
• Optimizing pre-operative anemia management to reduce the likelihood of blood transfusion
• Hard-wiring blood ordering processes for non-bleeding patients to promote single unit orders and clinical reassessment prior to ordering additional units
• Reviews of red blood cell orders by Blood Bank physicians to promote collegial discussion and education of appropriate indication and dose
• Authorizing nurses to initiate a transfusion reaction investigation work-up without delay
• Providing a forum to plan for the implementation of barcoding technology for both pre-transfusion specimen collection and blood administration
Since the program started in 2013 in partnership with Strategic Healthcare Group LLC, UTMB has achieved a reduction in utilization of all blood components, including red blood cells (22 percent), platelets (12 percent), plasma (25 percent) and cryoprecipitate (33 percent).
As a result, potential complications associated with length of stay, deaths and nursing hours have also decreased. Lastly, a component acquisition cost savings of approximately $895,000 was attained.