How appropriately is blood ordered in a rural hospital?.

Abstract

Background: Blood products are a limited resource particularly in a rural setting and their appropriate use is important to maintain patient safety and minimise costs. Objective(s): To assess the appropriateness of transfusion practices in a rural hospital. Design/Data Sources: A retrospective medical record audit of packed red blood cell (PRBC) use. Setting(s): A rural hospital 300. km northwest of Melbourne. Participant(s): All patients in Wimmera Base Hospital who had a PRBC crossmatch request from October 2010 to March 2011 inclusive. Main Outcome Measure(s): Proportion of appropriate transfusions and crossmatch to transfusion ratios. Result(s): A total of 257 patients and 657 PRBC units were cross-matched during the study period. Of these patients, 28.4% had pre-procedure (elective) cross-matches. Of the elective cross-matches, 27.4% were inappropriate, compared with 16.1% of emergency cross-matches. The cross-match to transfusion ratio (C:T) was 1.59 for emergency requests and 5.96 for elective requests. The C:T ratio was high in the surgical and obstetrics and gynaecology departments. 16.3% of all transfusions were single-unit transfusions. Conclusion(s): Emergency requests were predominantly appropriate but a significant proportion of elective requests were inappropriate, suggesting changes in elective crossmatch request protocols, and increased education regarding ordering blood in a rural setting. © 2012 Elsevier Ltd.