Complete the spot audit to determine your hospital’s rates of single-unit transfusions and the pre-transfusion hemoglobin levels as indicators of transfusion appropriateness.

While performing this quick audit, you may also gain insight into the practice variations that are occurring at your site. The spot audit will be used for measuring your progress should your site move forward with the campaign’s quality improvement interventions.

Data from your spot audit, and subsequent measurement audits, will be collected via the Canadian Blood Services Hospital Portal.

How to conduct a spot audit:

• Red Blood Cell Transfusion Audit Tool
• Spot Audit Webinar
• The Spot Audit- Alternative Methods

How often do I audit?

For more information, review the Spot Audit Guidelines.

Once your spot audit is complete, submit data via Canadian Blood Services Hospital Portal.

Hospitals in Québec and Manitoba can submit their data here.

Have questions about the spot audit? See our Frequently Asked Questions.

Guidelines

Achieving consensus regarding the appropriate indications for transfusion is a crucial step in the 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

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

For more information on Using Blood Wisely Interventions, Guidelines, Education and Staff Engagement, you can watch our webinar.

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.

Screensavers and Other Resources 

Get your team involved in Using Blood Wisely with the below screensavers and resources that can be posted in your hospital unit.

• Screensavers – Use or adapt the templates to highlight the importance of appropriate red blood cell transfusions.
• Blood Conservation Poster – Print and post this poster to raise awareness about the importance of conserving Canada’s blood supply.

Patient Information 

This information can be incorporated into a transfusion pamphlet or pre-operative assessment clinic package for patients undergoing high blood loss surgery such as cardiac surgery, orthopedic surgery, or cancer surgery.

Download

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. Here are some key resources in this area.

Education Module 

The below education module is designed for prescribers of blood transfusions. Learn about the risks of transfusions, blood management guidelines, and alternatives to using blood.

Alternatives to Blood Module

Regional Examples 

Below are regional resources for alternatives to blood.

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 month or every two months depending on the number of transfusions per month, while rolling out your intervention. For more information, review the Spot Audit Guidelines
• Once you achieve the benchmarks, maintain four more months (two measurement cycles) to ensure the sustainability of your intervention

Reporting Your Data

Report your data through the Canadian Blood Services Hospital Portal.

Hospitals in Québec and Manitoba can submit their data here.

Presenting your data to the Hospital Transfusion Committee

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 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.