At Sunnybrook Health Sciences Centre in Toronto, 78% of inpatient transfusions are single unit compared to 25-37% in a recent provincial transfusion audit. How did they get there? Institutional guidelines were adopted by the Medical Advisory Committee recommending transfusing one unit at a time in non-bleeding patients. Pre-printed transfusion orders were implemented to remind prescribers of the guidelines at the time of the order. Transfusion orders in non-bleeding patients are prospectively screened by the blood bank medical laboratory technologist to ensure that the transfusion order is appropriate. Finally, transfusion medicine physicians are available for further consultation and provide education. This multifaceted approach has resulted in a sustained practice of single unit transfusions in non-bleeding patients.
Between July 2014 and June 2015 the approach was implemented at Lakeridge Health, a large community hospital in Southern Ontario. Over this period, the hospital achieved an average rate of red blood cell transfusion per 100 acute inpatient days of 3.71, a 31% decrease compared to the previous year.
The Why Give Two When One Will Do toolkit contains the key ingredients of their approach.