Assessing Transfusion Practice at the Bedside: Key Insights from the 2023 Bedside Audit of Blood Administration

Tracy Cameron, MLT, T. (Dorien) Ruijs, MD FRCPC GenPath, Donna Berta, RN, Alison Wendt MLT – Ontario Regional Blood Coordinating Network

The provincial Bedside Audit of Blood Administration was conducted from January to April 2023 to assess compliance with current standards and best practices for pre-transfusion. The sections of the audit included, demographics, pre-transfusion checks (for transfusionist, transfusion service and transfusion), patient identification checks, blood component verification checks and post transfusion checks. The audit results were compared to the 2018 to measure improvement in compliance. The goal of this audit was to promote quality improvement and transfusion safety.

Notable Improvements: The 2023 audit revealed that compliance in pre-transfusion checks (96%) and procedure checks (94%) has steadily improved across the province

Areas for Growth:

Despite improvements, there are still gaps in patient identification and component verification procedure checks. Component Check compliance decreased by 1%, while Patient Identification Checks decreased by 3%. A new section was introduced in the 2023 audit that addressed Post Transfusion Checks, which showed the lowest compliance (89%) out of all sections.

Ward/Area Variations:

A breakdown by ward/area revealed that overall compliance levels vary significantly, with some hospital areas showing near perfect compliance while others lag. Comparison across wards/areas is limited by sample size.

Looking Ahead:

Although 100% compliance is ideal for minimizing health risks, it is rarely achieved in practice. The published report will use a “traffic light” system to assess compliance using arbitrary numerical values assigned: 100% is vibrant green (optimal), ≥95-99% is pale green (acceptable for the purposes of the report but suboptimal), 91-94% is amber (cautious observation), and ≤90% is red (alert – requires investigation). Compliance below 100%, despite a green or amber designation, may warrant further investigation and follow-up, in accordance with policies and procedures.

Data from the audit, including breakdown of compliance charts and graphs, along with a discussion on practice gaps, possible contributing factors and suggestions to address/mitigate these gaps will be made available in the full report in November 2024 on our website. Work has begun on resources to address gaps in compliance and enhance transfusion safety. These resources will be available in 2025. Look for them on our website under the Bedside Audit of Blood Transfusion (BABA) webpage.

The audit highlighted the importance for the continued need for ongoing education and process evaluation in the administration of blood components. Hospitals are encouraged to use the audit tool as a quality improvement instrument, supporting patient safety and aligning with accreditation requirements.

Ontario Hospitals: If your site is interested in performing periodic audits at the bedside and have not registered, please complete the “contact us” form on the Bedside Audit of Blood Transfusion web page.

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