Transfusion Policies and Clinical Practice in a Tertiary Academic Medical Center: Role of Protocols and Documentation

Abstract

In the last five years several consensus guidelines for blood product usage have appeared in the literature [1–13]. The guidelines can be used to form the framework from which individual institutions can design criteria for the appropriate use of blood and blood components, while taking into account the preferences of physicians at the institution. Some aspects of these guidelines are generally accepted by most physicians. Reflecting the ever-evolving nature of transfusion practice, however, some of the guidelines which are more controversial are less widely accepted. Establishing a set of audit criteria for blood component usage should be considered as just the first step in improving the quality of care. To be truly effective, audits must be accompanied by feedback to the clinicians. Audits and guidelines should also reflect continued awareness of the changes taking place in clinical transfusion practice. We will discuss some of these published guidelines, playing particular attention to the portions which are either controversial or currently in evolution. Additionally, we will focus on the approach taken by our tertiary academic medical center and some of our experiences with audits and our attempts to control blood product utilization.