NHRMC Updates Blood Transfusion Standards

July 02, 2019
Blood Management Graphic

Based on new scientific studies and accumulating evidence, the NHRMC Clinical Excellence Blood Utilization team has updated new blood transfusion standards for patient care across the NHRMC system and redesigned blood transfusion orders to assist compliance with these new standards.

Blood transfusions save many lives, but also have the potential to cause harm. Blood is a limited resource with a short shelf life and should be conserved when possible, yet transfusion has been identified as one of the most overused medical procedures.  New studies have shown that restrictive transfusion practices are as clinically effective as liberal transfusion practices while significantly reducing harm to the patient.

Furthermore, current standards advise transfusion of only one unit of PRBCs (Packed Red Blood Cells) at a time rather than multiple units, unless the patient is experiencing severe blood loss.

NHRMC and the Transfusion Committee have actively encouraged single-unit transfusions since 2014 and studying best practices to ensure that our physicians are consistently providing the safest experience for our patients.

In 2019, the Clinical Excellence Blood Utilization Team was established to engage the blood experts at NHRMC to improve transfusion practices.

The multispecialty team reviewed recent literature around transfusion guidelines, endorsed the American Association of Blood Banks recommendations as the standard for appropriate blood transfusions at NHRMC, and modified the Order Set to comply with these standards.

The transfusion standard order set (Med Blood Product Administration Orders 114) for RBCs should default to a single unit option with restrictions based on the following hemoglobin thresholds:

Condition

Hemoglobin Threshold for Transfusion

Hospitalized Adult Patient

 

Preexisting CAD

8 g/dL

Cardiac surgery

7.5 g/dL

Acute Coronary Syndromes

8-10 g/dL

Hemodynamically stable patients including ICU patients, gastrointestinal bleeding

7 g/dL

“Following guidelines and ordering transfusions appropriately are essential to improving blood utilization and preventing harm to patients. A system-wide change must be made,” said Dr. Jeff Turner, Blood Bank Medical Director.

A subset order will be available for multi-unit transfusions within the same order set when clinically appropriate.  A multidisciplinary physician review group will review the orders that deviate from the guidelines and serve as a resource to educate providers about current transfusion standards.

Blood Utilization Team Members:

  • Jeff Turner, MD, Blood Bank Medical Director
  • Charmaine Lewis, MD, Quality Director, New Hanover Hospitalists
  • William Powers, MD, General Surgery
  • Stephen Olsen, MD, Pathology
  • Luis Arce, MD, Anesthesia
  • Brian Collins, MD, Emergency Medicine
  • Jeffrey Stinson, MD, Medical Director OB Department
  • Clyde Harris, MD, Vice President of Clinical Excellence
  • Claire Corbett, Director of Clinical Excellence
  • Kevin Briggs, Administrator Lab and Respiratory Care Services
  • Abby Roetger, MS, Programs Manager Clinical Excellence
  • Lisa Anderson, MT(ASCP), Laboratory Manager
  • Kelly Dyer, RN, BSN, Transfusion Safety Coordinator
  • Karen Hines, RN, MSN, CCRN, NE-BC, Manager ASU and PACU
  • Colleen Printy, MSN, CRNA, Anesthesia
  • Celeste Stephens, BSN RN
  • Sandy Mitchell, MBA, MLIS, Clinical Excellence Analyst

Transfusion recommendations have been endorsed by the Clinical Excellence Council.