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Al Khan S, Rosinski K, Petraszko T, Dawe P, Hwang BW, Sham L, Hudoba M, Roland K, Shih AW. Reducing AB plasma utilisation through the AB plasma appropriateness index. Transfus Med 2019; 29:381-388. [PMID: 31576629 DOI: 10.1111/tme.12632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 08/17/2019] [Accepted: 08/19/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES We hypothesised that there was inappropriate group AB plasma used in our hospital, identifiable by a novel key quality indicator (KQI) and mitigable through massive transfusion protocol (MTP) modification. BACKGROUND Group AB plasma is a scarce resource strained by increasing usage worldwide when used as universal donor plasma in non-group AB patients. To reduce inappropriate use and to promote benchmarking to the best practice, we developed the AB plasma appropriateness index (ABAI). ABAI is the ratio of AB plasma transfused to group AB or unknown blood group patients to all AB plasma utilised, where values closer to 1 are better. METHODS Data collected included AB plasma disposition by blood group, indications for transfusion, total blood utilisation, patient clinical characteristics and outcomes. ABAI during a 12-month period was retrospectively assessed, which led to implementation of pre-thawed group A plasma instead of group AB plasma for trauma patients starting in July 2017. RESULTS The ABAI retrospectively showed inappropriate use in non-group AB patients in our hospital, the majority used to avoid expiry after thaw. When comparing 1-year pre- and post-implementation periods, ABAI improved from 0·464 to 0·900 (P < 0·0001). After exclusion of therapeutic plasma exchange, ABAI still improved (0·486-0·720, P < 0·0001). No differences in the length of stay or mortality associated in 32 patients receiving group A plasma for emergency release were observed. CONCLUSION The ABAI is a novel KQI to indicate inappropriate AB plasma usage for quality improvement. This led to thawed A plasma use for MTPs, reducing inappropriate AB plasma usage.
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Affiliation(s)
- S Al Khan
- Blood Bank Services, Directorate General of Specialized Medical Care, Ministry of Health, Muscat, Oman
| | - K Rosinski
- Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - T Petraszko
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Canadian Blood Services, Vancouver, British Columbia, Canada
| | - P Dawe
- Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada.,Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - B W Hwang
- Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - L Sham
- Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - M Hudoba
- Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - K Roland
- Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - A W Shih
- Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Yazer MH, Spinella PC, Allard S, Roxby D, So-Osman C, Lozano M, Gunn K, Shih AW, Stensballe J, Johansson PI, Bagge Hansen M, Maegele M, Doughty H, Crombie N, Jenkins DH, McGinity AC, Schaefer RM, Martinaud C, Shinar E, Strugo R, Chen J, Russcher H. Vox Sanguinis International Forum on the use of prehospital blood products and pharmaceuticals in the treatment of patients with traumatic hemorrhage. Vox Sang 2018; 113:816-830. [DOI: 10.1111/vox.12677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | | | | | - D. Roxby
- SA Pathology Transfusion Medicine; Flinders Medical Centre; Flinders Drive Bedford Park SA 5042 Australia
| | | | | | - K. Gunn
- Department of Anaesthesia; Auckland City Hospital; 2 Park Road Grafton, Auckland 1023 New Zealand
| | - A. W. Shih
- Vancouver General Hospital; Department of Pathology and Laboratory Medicine; 855 West 12th Avenue Vancouver BC V5Z 1M9 Canada
| | - J. Stensballe
- Rigshospitalet; Section for Transfusion Medicine; Copenhagen University Hospital; Capital Region Blood Bank; Blegdamsvej 9 Copenhagen 2100 Denmark
| | - P. I. Johansson
- Rigshospitalet; Section for Transfusion Medicine; Copenhagen University Hospital; Capital Region Blood Bank; Blegdamsvej 9 Copenhagen 2100 Denmark
| | - M. Bagge Hansen
- Klinikchef; Rigshospitalet; Klinisk Immulogisk Afd. 2034, Blegdamsvej 9 2100 København Ø Denmark
| | - M. Maegele
- Department of Traumatology and Orthopedic Surgery; Cologne-Merheim Medical Center (CMMC); Institute for Research in Operative Medicine (IFOM); University Witten/Herdecke (UW/H); Ostmerheimerstr. 200 D-51109 Köln Germany
| | - H. Doughty
- NHS Blood and Transplant; Vincent Drive Birmingham UK
- Department of Clinical Traumatology; University Hospitals Birmingham NHS Foundation Trust; Birmingham UK
| | - N. Crombie
- University Hospitals Birmingham NHS Foundation Trust; Birmingham UK
- National Institute for Health Research SRMRC
| | - D. H. Jenkins
- Department of Surgery; UT Health San Antonio; 7703 Floyd Curl Dr San Antonio TX 78229 USA
| | - A. C. McGinity
- Department of Surgery; UT Health San Antonio; 7703 Floyd Curl Dr San Antonio TX 78229 USA
| | - R. M. Schaefer
- Research; Southwest Texas Regional Advisory Council; 7500 US-90 West San Antonio TX 78227 USA
| | - C. Martinaud
- Chief of Clinical Operations; French Military Blood Institute; 1 rue du Lieutenant Raoul Batany, 92 141 Clamart Cedex France
| | - E. Shinar
- Magen David Adom; Ramat Gan 5262100 Israel
| | - R. Strugo
- Magen David Adom; Yigal Alon 60 Tel Aviv 67062 Israel
| | - J. Chen
- Trauma and Combat Medicine Branch; Surgeon General's Headquarters; Israel Defense Force; Ramat Gan Israel
| | - H. Russcher
- Specialist Laboratory Medicine; Dep. Clinical Chemistry; Blood Transfusion Laboratory Erasmus MC; University Medical Center, Rotterdam; Dr. Molewaterplein 60 3015 GD Rotterdam The Netherlands
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Shih AW, Jamula E, Diep C, Lin Y, Armali C, Heddle NM, Traore A, Doherty J, Shah N, Hillis CM. Audit of provincial IVIG Request Forms and efficacy documentation in four Ontario tertiary care centres. Transfus Med 2017; 27:122-131. [PMID: 28144996 DOI: 10.1111/tme.12391] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 12/29/2016] [Accepted: 12/30/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Retrospective audit of IVIG Request Forms in four Ontario tertiary care centres: to determine the case mix of new IVIG requests, to authenticate information provided, and to determine documentation of clinical efficacy. AIMS To understand contributors to increases in IVIG utilisation and to determine whether IVIG is being used and monitored appropriately. INTRODUCTION Intravenous immunoglobulin (IVIG) use in Canada is high compared with other developed countries. We performed a retrospective audit of new IVIG Request Forms across four tertiary care centres in Ontario, one with an active surveillance programme, to determine the case mix, authenticate information provided and assess documentation of efficacy. METHODS Consecutive adult patients with a first-time IVIG request in 2014 were included. The ordering physician specialty, form completeness, documentation of diagnostic criteria for the medical condition and indication for IVIG use and documentation of efficacy were assessed by form and chart review. RESULTS Of 178 patients, the most common indications for IVIG were immune thrombocytopenia (24.2%) and secondary immune deficiency (20.2%). The most frequent prescribers were haematologists (37.6%) and neurologists (10.7%). Other conditions not listed on the form represented 24.2% of cases, with most not indicated in current guidelines. A total of 32.6% of cases overall lacked verification of diagnostic criteria and 51.7% lacked verification for IVIG utilisation criteria, with the number of cases meeting criteria based on documentation being higher at the active surveillance site (P = 0.005). A total of 19.1% of cases had a discrepancy between the indication written on the form and the documented clinical diagnosis. A total of 18.7% of clinic notes following IVIG had no mention of efficacy. CONCLUSION Our audit demonstrates a lack of compliance with IVIG Request Form requirements, a lack of documentation of diagnostic criteria and efficacy, and suggests inappropriate use of IVIG. Current implementation of the form may not be sufficient as a strategy for improving appropriate IVIG use.
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Affiliation(s)
- A W Shih
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - E Jamula
- McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - C Diep
- McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - Y Lin
- Department of Clinical Pathology, Sunnybrook Health Sciences Centre and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - C Armali
- Department of Clinical Pathology, Sunnybrook Health Sciences Centre and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - N M Heddle
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada.,Centre for Innovation, Canadian Blood Services, Ottawa, Ontario, Canada
| | - A Traore
- McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - J Doherty
- McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - N Shah
- McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - C M Hillis
- McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada.,Department of Oncology, McMaster University, Hamilton, Ontario, Canada
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Shih AW, Kolesar E, Ning S, Manning N, Arnold DM, Crowther MA. Evaluation of the appropriateness of frozen plasma usage after introduction of prothrombin complex concentrates: a retrospective study. Vox Sang 2014; 108:274-80. [PMID: 25556889 DOI: 10.1111/vox.12226] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 10/26/2014] [Accepted: 10/30/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Prothrombin complex concentrates (PCCs) can be used instead of frozen plasma (FP) transfusion to reverse the effect of warfarin. Audits have demonstrated over usage of FP transfusions even before the introduction of PCC. The objective of this study was to determine the appropriateness of current FP transfusion practice in the current era since the introduction of PCCs. METHODS A retrospective cohort study of consecutive patients receiving FP over 3 months was carried out. Each episode of FP use over a 24-h period was adjudicated independently by two reviewers as appropriate (consistent with Canadian/AABB guidelines), appropriate but inconsistent with guidelines or inappropriate. Discrepancies were resolved by a third reviewer. Use of FP to reverse warfarin was considered inappropriate. FP usage from previous years was assessed as baseline. RESULTS During the study period, 111 FP transfusions were administered. 74.8% of FP usage occurred in the ICU. The proportion of FP transfusions that were deemed appropriate, inconsistent yet appropriate or inappropriate were 33/89 (37.1%), 16/89 (18.0%) and 40/89 (44.9%), respectively, when use of FP for therapeutic plasma exchange was excluded. The most common reasons for inappropriate use were the absence of bleeding with an increased INR or warfarin reversal. CONCLUSION Our study is the first to audit FP transfusions in the post-PCC era in Canada. FP usage remains inappropriately high in INR prolongation without another indication or to reverse warfarin. Targeted interventions to reduce FP usage in the future should focus on the ICU and on education about warfarin reversal.
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Affiliation(s)
- A W Shih
- Department of Medicine, McMaster University, Hamilton, ON, Canada
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