Planning Survey

Need help determining what interventions best suit your hospital? Take our planning survey to identify areas for improvement and to help direct your team to the right intervention. Once you have completed the survey, you can review your answers and suggested interventions.

Take Survey Now

Intervention Toolbox

Our intervention toolbox includes templates, education modules, webinars, and resources proven to reduce inappropriate RBC transfusions. Use the toolbox to determine the right intervention for your hospital and how to measure your progress.

Restrictive Transfusion

Ensure your organizational processes reflect best practices.

Guidelines

Achieving consensus regarding the appropriate indications for transfusion is a crucial step in development of all interventions to reduce inappropriate transfusion.

This process starts from initial discussions at your hospital’s transfusion committee to stakeholder consultation and finally to approval at the medical or interprofessional advisory committee.

Guidelines

Education

Important to any practice change is education. It is important to ensure that all clinicians involved in the transfusion chain are informed of the changes in practice and the reasons why the changes are being made. This includes prescribers (e.g. physicians, nurse practitioners), nurses and laboratory technologists. Below are video modules for each clinical group.

While education is of utmost importance when changing practice, it is not, alone, a sufficient intervention. Education will support the implementation of one (or more) of the interventions below.

Education Modules

Physician Education Module

Nursing Education Module

Medical Laboratory Technologist Module

Order Sets

The purpose of the transfusion order set is to help guide clinicians to order blood appropriately at the time of the transfusion order. The transfusion order set typically includes the quantity, the infusion rate and the indication for a blood component.

Things to consider when implementing transfusion order sets include:

  • Ensuring that transfusion order sets are used most of the time. Some acceptable exceptions include orders for transfusion in emergency situations and from the operating room where often these orders are verbal.
  • Ensuring that the information on the transfusion order sets is delivered to the transfusion medicine laboratory (blood bank) whether in paper form or electronically. This will help set up a process for implementing transfusion border screening.
Download Order Set Template

Transfusion Order Screening

Transfusion order screening is the act of screening transfusion orders by the Transfusion Medicine Laboratory to ensure the order follows the guidelines. Ideally, this can be done prospectively, as the orders arrive in the lab. However, if resources are not available, retrospective transfusion order audits can also be done. Tools to implement transfusion order screening can be found below.

It should be noted that transfusion order screening should be performed only in non-urgent situations. Typically, transfusion orders that are exempt from screening are transfusion orders from the operating room, and for bleeding patients where the clinical situation is dynamic and the need for blood is urgent. For the purpose of this initiative, outpatient transfusions will be exempt from screening.

Restrictive Transfusion

Restrictive Transfusion

Ensure your organizational processes reflect best practices.

Guidelines

Achieving consensus regarding the appropriate indications for transfusion is a crucial step in development of all interventions to reduce inappropriate transfusion.

This process starts from initial discussions at your hospital’s transfusion committee to stakeholder consultation and finally to approval at the medical or interprofessional advisory committee.

Guidelines

Education

Important to any practice change is education. It is important to ensure that all clinicians involved in the transfusion chain are informed of the changes in practice and the reasons why the changes are being made. This includes prescribers (e.g. physicians, nurse practitioners), nurses and laboratory technologists. Below are video modules for each clinical group.

While education is of utmost importance when changing practice, it is not, alone, a sufficient intervention. Education will support the implementation of one (or more) of the interventions below.

Education Modules

Physician Education Module

Nursing Education Module

Medical Laboratory Technologist Module

Order Sets

The purpose of the transfusion order set is to help guide clinicians to order blood appropriately at the time of the transfusion order. The transfusion order set typically includes the quantity, the infusion rate and the indication for a blood component.

Things to consider when implementing transfusion order sets include:

  • Ensuring that transfusion order sets are used most of the time. Some acceptable exceptions include orders for transfusion in emergency situations and from the operating room where often these orders are verbal.
  • Ensuring that the information on the transfusion order sets is delivered to the transfusion medicine laboratory (blood bank) whether in paper form or electronically. This will help set up a process for implementing transfusion border screening.
Download Order Set Template

Transfusion Order Screening

Transfusion order screening is the act of screening transfusion orders by the Transfusion Medicine Laboratory to ensure the order follows the guidelines. Ideally, this can be done prospectively, as the orders arrive in the lab. However, if resources are not available, retrospective transfusion order audits can also be done. Tools to implement transfusion order screening can be found below.

It should be noted that transfusion order screening should be performed only in non-urgent situations. Typically, transfusion orders that are exempt from screening are transfusion orders from the operating room, and for bleeding patients where the clinical situation is dynamic and the need for blood is urgent. For the purpose of this initiative, outpatient transfusions will be exempt from screening.

Alternatives to Blood

Alternatives to Blood

Ensure safer and simpler options have been considered. 

For patients undergoing surgery, optimizing anemia prior to surgery is a key pillar of patient blood management.

Not only does this reduce the need for transfusion but also improves patient outcomes. Resources to be posted here soon!

Patients

Patients

Ensure you engage in conversations about transfusion appropriateness.

Involving patients in an informed discussion about their blood transfusion (or potential for blood transfusion) is important. To support the conversation between patients and their health care providers about Using Blood Wisely, written information can be provided in a transfusion pamphlet or in a preoperative assessment clinic package.

See the example of what you may want to include in a transfusion pamphlet or a pre-operative assessment clinic package.

Information for Patients

Measurement

Measurement

Ensure your hospital routinely tracks transfusion appropriateness.  

Measuring transfusion appropriateness should be an ongoing part of your blood stewardship efforts.

Spot audits should be undertaken at the following time intervals:

  • Prior to starting your intervention
  • Every two-months while rolling out your intervention
  • Once you achieve the benchmarks, maintain four more months (two measurement cycles) to ensure sustainability of your intervention

Reporting Your Data

Report your data through the Canadian Blood Services Disposition Report.

Here is a template you can use to report your data back to your internal hospital committees.

Balancing Measures

Although we are not formally collecting balancing measures, your hospital may want to look at measures of “under transfusion” to ensure that no harm occurs as a result of implementing Using Blood Wisely.

Under-transfusion is defined as patients with a hemoglobin less than 60 g/L who are not transfused.

This can be determined by contacting the LIS team and asking for hemoglobin values less than 60 g/L in a period of time in a clinical area of interest.

  • Patients with hemoglobin less than 60 g/L who were not transfused can be reviewed to determine the reason for not transfusing.

Remember that there may be reasons for not transfusing, including patients who decline transfusion (including for religious reasons) or patients who are asymptomatic and can be safely treated with alternatives to transfusion such as iron supplementation

Met Benchmarks? Get Designated.

Have your efforts and interventions reduced unnecessary RBC transfusions? Get designated by submitting your Designation Form for Using Blood Wisely.