Fresh frozen plasma utilization pattern in tertiary care hospital of North Western India

Background: Fresh Frozen Plasma (FFP) is mainly used in treatment of coagulation derangements; trauma emergencies. It is the most inappropriately used blood component. Since the guidelines for FFP use in a clinical setting are not well defined, this study aims at defining the appropriateness of use of FFP in the light of its risks and adverse effect. Audit of institute FFP usage with specific aim of assessing appropriate use, based on clinical indications and laboratory parameters in requisition form.Methods: Retrospective analysis of 10,753 FFP supplied in 3072 patients from June 2016 to December 2016 in SMS Hospital, Jaipur, Rajasthan, India was done in Department of Immunohaematology and Transfusion Medicine, SMS Hospital, Jaipur, Rajasthan, India. Detailed analysis of clinical indication, INR value, specialty, age, gender of patient was done.Results: 10,753 FFP was supplied to 3072 Patients. 6990 FFP was supplied to 1995 males. 3763 FFP was supplied to 1077 females. Clinical use of FFP for medical and surgical conditions was highest seen in Blood Cancers (13%) and Cardiosurgery (22.3%). 15.2% was available from Emergency Department. 1.9% of FFP was returned back. Patients with Deranged Coagulation Profile (DCP) require maximum transfusion (49.3), Bleeding patients (37.6%), DIC (3.3%). FFP used for plasmapheresis (2.6%). No information available about diagnosis (7.2%) was available from Emergency Department.Conclusions: FFP is most inappropriately used blood component (39.57%) and should be used judiciously. Regular audit of blood components serves as tool for accomplishment of quality tools and to understand clinical transfusion practices

Prospective audit of blood transfusion practices among nurses and role of education and intervention at a tertiary care hospital

Background and Objectives: Periodical internal audits evaluate the process flow of transfusion which arrests the spectrum of adverse events .The objective of the study was to provide evidence that blood is being ordered, handled, and administered according to transfusion guidelines and to highlight the deviations with the secondary objective of improving knowledge and practices in nursing officers. Methods: Nursing officers were audited on 50 patients each in P1 and P2 phase. Training of 243 nursing staff was done after P1 phase. Training comprised education and interventions over 45 days – 18 didactic lectures and 36 bedside classes. Nurses were audited both before and after the completion of the training. Results: One hundred and forty-five nurses had knowledge and practice score in between 11 and 15 in P1 which improved to 243 (100%) in P2. Transfusion order for one patient was not written in P1, whereas 100% compliance was seen in P2. Noncompliance in taking consent for transfusion improved from 5 to 1 in P2. Blood request error and sample labeling error reduced from 8% to 0% and 4% to 0%, respectively, in P2. Sample labeling was inappropriate in 2 patients in P1 which improved to nil in P2. Checking of vital signs check and intravenous cannula patency improved from 96% to 98%. Crosscheck of packed red blood cell nursing officers before transfusion reduced from 8% to 0% and from 30% to 2% among medical officer (P < 0.05). Delay in the initiation of transfusion, reduced from 7 to 2 patients. Conclusion: Timely audit of transfusion practices reduces mistakes and errors hence improved patient care