NICE issues new guideline to preserve national stocks of blood
NICE – the National Institute for Health and Care Excellence – has issued its first guideline on the use of transfusions in adults, children and young people to ensure they are used only when necessary.
National audits on the use of blood in England have consistently shown that a fifth or more of transfusions are unnecessary. The new guideline gives clear recommendations on when a transfusion should be used for a patient and when alternatives should be considered.
The guideline also includes recommendations to help hospitals provide better care for patients by reducing the need for transfusions wherever possible. This includes encouraging clinicians to prescribe tranexamic acid to patients undergoing surgery to stop them losing too much blood. Tranexamic acid costs as little as 60 pence and can save hospitals hundreds of pounds per patient.1
With improvements in clinical practice, getting a transfusion in the UK is safer than ever before. In the small number of instances where a problem was reported to the national blood safety watchdog (SHOT) in 2014, the main cause has been a mistake that could easily have been avoided, such as improper labelling of samples or misidentification of patients.2
The guideline also calls for hospitals to consider using a system that electronically identifies patients to make the transfusion process safer and more efficient. Electronic patient identification systems prompt staff to carry out key steps in the correct order, and ensure that transfusions are given to the right patients through scanning of barcodes on patient wristbands and blood component containers.
Mike Murphy, consultant haematologist at Oxford University Hospitals and chair of the committee that developed the guideline, said: “‘Electronic systems make it easy for staff to do the right thing every time, and avoid errors. They can also provide ‘decision support’ for doctors when they are ordering blood and promote the restrictive use of blood. The guideline also importantly highlights the benefits of the routine use of tranexamic acid in patients undergoing surgery.
“Routine implementation of these measures in the NHS will make best use of a valuable resource, be safer for patients and save money for hospitals.”
Lorna Williamson, NHS blood and transplant medical and research director, said: “NHS Blood and Transplant welcomes this new transfusion guideline and the emphasis on putting patients at the heart of decision making. Audits show inappropriate or excessive use of blood components in more than 20 per cent of transfusions.
“Our Patient Blood Management initiatives have already significantly reduced the inappropriate use of blood products. This new guideline will help to do even more to ensure clinicians use consistent evidence-based approaches that deliver the best outcomes for patients.”
References:
1 Tranexamic acid is estimated to cost £0.60 for surgical procedures with a moderate risk of bleeding and £1.19 for surgical procedures with a high risk of bleeding. Potential savings per transfusion avoided are estimated as £688.59 for procedures with a high risk of bleeding, £299.76 for procedures with a medium risk of bleeding and £145.81 for procedures with a high and medium risk of bleeding. Full details are in the NICE costing statement.
2 Analysis of reports made to the UK haemovigilance scheme, Serious Hazards of Transfusion (SHOT), in 2014 shows that 2346 out of 3017 (77.8 per cent) were caused by error. www.shotuk.org
