1. Date started: 08/09/08 Date completed: 21/09/08 Audit Lead: Dr. Khawla Belhoul Consultant Physician Thalassemia Center

2. Dr. Sahar Habibollah Dr. Mohammed ALMarri

4. RESULTS  Improvement in compliance with the national guidelines to over 95% in six out of seven of the recommendations was seen 18 months after the initial intervention.  The study showed that education of those who prescribe and administer transfusions, can improve the safety of transfusions EDUCATION AND DEPATE Effect of a formal education programme on safety of transfusions BMJ VOLUME 323 10 NOVEMBER 2001

5. Why was the chosen topic considered to be important?  Thalassemia center staff perform at least 30 transfusions per day.  Blood transfusions involve placing the patients and staff at risk.  Complications associated with blood transfusions are easily preventable.  Education of those who prescribe and administer transfusions, can improve the safety of transfusions

6.  To improve:  Patient health outcome  Delivery of care  Patient satisfaction  Staff satisfaction  Use of resources

7.  Thalassemia center blood transfusion Guidelines  International blood transfusion Guidelines

8.  Percentage of staff that should be aware of presence of guidelines: 100%  Percentage of staff that should know exactly where it is: 80%  Percentage of staff that should have read all the guidelines: 80%  Percentage of staff that should be aware about/attended any education regarding the guidelines in the last 6 months: 80%

9.  Source of Data:  Staff Interview  Sample Size: 14 (54% of Thalassemia center nursing staff)  Sample selection: Random over 2 weeks period  Data Collection Process:  Record form & Verbal communication with Staff

10.  Is the nurse aware of the presence of Thalassemia Center Transfusion Guidelines?  Can she show you where the Thalassemia Center Transfusion Guidelines booklet is placed?  Has she read the Thalassemia Center Transfusion Guidelines at least once?  Has she received any education regarding the Thalassemia Center Transfusion Guidelines in the last 6 months?

11.  Basic statistics using Microsoft Excel  Tabulated data and charts

12.  93% of nursing staff were aware of the presence of transfusion guidelines.  Zero % of the nursing staff were able to locate the booklet correctly.  21% had read the transfusion guidelines at least once*  14% were able to recall education about the guidelines within the last 6 months.

13. QuestionYesNo Total Number Are you aware of the presence of the guidelines? 13114 Do you know where the booklet is placed? 01414 Have you read the guidelines at least once? 31114 Have you received any education about the guidelines in last 6 months? 21214

15.  The transfusion guidelines booklet was placed in one of the drawers of the Head Nurse’s office.  The reason for giving me the wrong location was because:

16. Thought it was at the Unit Desk 6 (46%) Thought that it was part of Doctor’s reading material4 (31%) Thought that Sister Lily would know2 (15%) They were too busy2 (15%)

18. Last Year JCI 5 (38%) Do not remember 3 (23%) Last one about Leucocytes depleted blood 2 (15%) Too Busy 2 (15%) Every 2 years 1 (8%) Sister Lily knows 1 (8%)

19.  Results were communicated to Dr. Khawla Belhoul verbally using statistical data.

20. Knowing the location  All staff should be informed of the location of the transfusion guidelines by Head of Nurses during the coming nursing morning report.  All new staff should be informed during their orientation.  Head of Nurses is expected to test the staff awareness of the location 6 monthly.  Head of nurses should keep the staff informed if the location happen to be changed.

21.  Have you read it ? Have you received any education?  Introduce transfusion guidelines acknowledgement form.  Head of nurses should formulate the transfusion guidelines acknowledgement form.  Each staff should sign that she has read and understood the guidelines once a year.  Head of nurses should arrange an educational session about the transfusion guidelines once a year.  All new staff should receive education about transfusion guidelines during orientation.  All new staff should sign the transfusion guideline acknowledgement form at the end of their orientation.  Include transfusion guidelines awareness in nursing competency evaluation.

23. Date started: 08/09/08 Date completed: 21/09/08 Audit Lead: Dr. Khawla Belhoul Consultant Physician Thalassemia Center

24.  Blood transfusions involve a complex sequence of activities.  To ensure the right patient receives the right blood, there must be strict checking procedures in place at each stage.  Most of error during transfusions are due to the failure of the final identity checks carried out between the patient at the patient's side and the blood to be transfused.

25.  To improve:  Patient health outcome  Delivery of care  Patient satisfaction  Staff satisfaction  Use of resources

26.  Percentage of patients in which identities are verified by two members of staff together: 100%  Percentage of patients in which identification is carried out at the patient’s bedside : 100%  Percentage of patients in which identities are confirmed verbally : 100%

27.  Thalassemia center blood transfusion Guidelines  International blood transfusion Guidelines

28.  Source of Data:  Episode observation  Patient interview  Sample Size:24 episodes of transfusions  Sample selection: Random over 2 weeks period  Data Collection Process:  Record form & Verbal communication with patients

29. Observation Before starting the blood transfusion unit at bedside:  The patient’s identity is verified by two members of staff together.  The identification is carried out at the patient’s bedside.  The patient’s identity confirmed verbally.

30.  Basic statistics using Microsoft Excel  Tabulated data and charts  Benchmarking

31.  87.5% of the patients identities were verified by two members of staff together.  100% of the patients identification was carried out at the patient’s bedside.  100% of the patients’ identity confirmed verbally.

32. Guideline being audited Done Not Done Total Number The patient’s identity is verified by two members of staff together. 21324 The identification is carried out at the patient’s bedside. 24024 The patient’s identity confirmed verbally. 24024

34. Ninewells Hospital,a large teaching hospital which houses the headquarters of the regional transfusion service Department -UK EDUCATION AND DEPATE Effect of a formal education programme on safety of transfusions BMJ VOLUME 323 10 NOVEMBER 2001

37.  The patient's identity should be verified by two members of staff together  The identification should be carried out at the patient's bedside  The identity and quality of the blood pack and the prescription should be formally verified  The patient's identity should be confirmed verbally  The patient's identity band should be formally verified  The patient's blood pressure, pulse, and temperature should be taken before transfusion  The patient's blood pressure, pulse, and temperature should be taken at regular intervals during the transfusion

38. Guideline being audited UK- teaching hospital ED=education Before ED After ED Thalassemia Center The patient’s identity is verified by two members of staff together. 100% 87.5% The identification is carried out at the patient’s bedside 63 %100% The patient's identity should be confirmed verbally 46%98%100%

39. G1-The patient’s identity is verified by two members of staff together. G2-The identification is carried out at the patient’s bedside G3-The patient's identity confirmed verbally

40. Results were communicated to Dr. Khawla Belhoul verbally using statistical data and benchmarking.

41. Well done Keep up the good work BUT Head of nurses should ensure that patient’s identity to be verified by two members of staff together all the time.

42. If you are interrupted in the bedside checking procedure what should you do? ???

43. Always restart again ---!!!