Last year, BC Cancer – Vancouver was one of 145 care centres across Canada that participated in the Using Blood Wisely initiative in collaboration with Canadian Blood Services. The initiative challenged hospitals and care centres to track when they used blood transfusions and critically evaluate whether it was necessary in all cases. The aim was to decrease unnecessary blood transfusions to improve patient safety and conserve blood resources in case of a shortage.
Drs. Megan Tesch and Mae Alghawas, medical oncology residents at BC Cancer - Vancouver had noticed that a number of in-patients at the centre were receiving transfusions and thought the challenge was a good opportunity to review care practices and patient safety.
"It is important to ensure that we are providing blood transfusions only when needed," says Dr. Tesch. "While relatively safe, transfusions are not without some risk to patients. Patients may have an adverse reaction to the transfusion or their system could be overloaded with blood cells. Additionally, blood is a precious resource and are necessary for patients receiving specific types of chemotherapy but not all."
As part of the initiative, Dr. Tesch and Dr. Alghawas assessed transfusion practices for in-patients at the Vancouver centre.
"When we conducted our first audit, we found that providers were ordering more blood than a patient may have needed and our conservation rate was below the national benchmarks," says Dr. Alghawas. "Whether it was ordering two units of blood when one would have been enough to safely raise levels or transfusing when hemoglobin concentration was still at a safe level, there was room for us to improve."
Drs. Tesch and Alghawas presented their audit results, discussed the need for more restrictive transfusion strategies, and listened to clinician concerns. They credit Janice Dirksen, clinical nurse leader for BC Cancer – Vancouver inpatient unit, and the team of RNs, who engaged providers in discussions when they were ordering transfusions that did not adhere to guidelines. The implementation of Cerner also helped with a default order set for a single unit of blood for in-patient transfusion orders.
Another follow-up showed a 45 per cent improvement in ordering a single unit transfusion rather than two units and a 14 per cent improvement in ordering a transfusion for a patient who already had acceptable hemoglobin levels. These improvements meant that the centre was successfully meeting national benchmarks.
"Mae and I were fortunate to have advocates and providers who were eager to learn, engage, and adapt practices as part of this national challenge; a testament to the collegial environment that is BC Cancer – Vancouver."
In February, BC Cancer – Vancouver was designated a Using Blood Wisely facility. Drs. Tesch and Alghawas are now analyzing outpatient transfusion practices in order to determine if there are areas to improve with this patient population.
For more information on the Using Blood Wisely program, visit usingbloodwisely.ca.
