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The effect of clinician education on blood transfusion practice in obstetrics: completing the audit cycle

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Abstract

Background

With blood products being a limited and expensive resource within the healthcare system, there is an ever-increasing emphasis on judicial and appropriate use.

AIMS

To evaluate whether implementing contemporary society recommendations on restrictive transfusion policies would reduce inappropriate use of red blood cell transfusions, by evaluating the effect of a staff educational campaign.

Methods

An audit of peri-partum red cell concentrate (RCC) transfusion practice within a tertiary obstetric unit was undertaken, covering a 1-year period (2015), examining data related to transfusion prescribing practices. Subsequently, an educational programme was held for clinical and laboratory staff which aimed to bring practice in line with society guidelines. A repeat audit covering another 1-year period (2018) was undertaken.

Results

The number of RCC units of transfused reduced by 49% between 2015 and 2018 (426 to 218). The number of patients receiving transfusion dropped from 166 in 2018 (1.8% of births) to 119 in 2015 (1.5% of births). Among stable patients who were transfused, the proportion receiving a single unit increased from 6.9 to 53.9%. (p < 0.001). Haematological reassessment between units rose from 13.8 to 80.4% (p < 0.001). Written consent documentation improved (68% in 2018 vs. 38% in 2015) (p < 0.001).

Conclusions

The implementation of guidelines has resulted in substantial reduction in RCC transfusions between 2015 and 2018. Fewer women received a blood transfusion, and those who did received fewer units. There is a higher proportion of patients being reassessed between units and receiving single unit transfusions. Recording of consent has improved.

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Author information

Authors and Affiliations

  1. University College Dublin School of Medicine, Dublin, Republic of Ireland

    Shane Kelly & Simon Sharpe

  2. Medical Science, National Maternity Hospital, Dublin, Republic of Ireland

    Marie Culliton

  3. UCD Peri-Natal Research Centre, University College Dublin Obstetrics and Gynecology, Dublin, Republic of Ireland

    Mary F. Higgins

  4. Haematology, National Maternity Hospital and Saint Vincent’s University Hospital, Holles Street, Dublin 2, Dublin, D02 YH21, Republic of Ireland

    Joan Fitzgerald

Authors
  1. Shane Kelly
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  2. Simon Sharpe
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  3. Marie Culliton
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  4. Mary F. Higgins
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  5. Joan Fitzgerald
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Corresponding author

Correspondence to Joan Fitzgerald.

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As an audit of routine clinical practice, this study was exempt from institutional research board/ethics review.

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The authors declare no competing interests.

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Kelly, S., Sharpe, S., Culliton, M. et al. The effect of clinician education on blood transfusion practice in obstetrics: completing the audit cycle. Ir J Med Sci 192, 765–771 (2023). https://doi.org/10.1007/s11845-022-03032-8

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  • DOI: https://doi.org/10.1007/s11845-022-03032-8

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