1. IHS XII Dubrovnik feb ‘10 Indicators for safe and appropriate use of blood components René R.P. de Vries

2. IHS XII Dubrovnik feb ‘10 Question Blood transfusion: worth the risk?

3. IHS XII Dubrovnik feb ‘10 Inappropiate Use

4. IHS XII Dubrovnik feb ‘10 How can we improve appropriate use of blood components? Autorisation by experts Monitoring of requests and feed-back Projects Audits

5. IHS XII Dubrovnik feb ‘10 How can we improve appropriate use of blood components? Autorisation by experts Monitoring of requests and feed-back Projects Audits Quality Indicators

6. IHS XII Dubrovnik feb ‘10 ( Quality )Indicator Definition: measurable element of health care that gives an indication about the quality of care Function: signaling, monitoring and adjustment Goal: improvement of quality of care

7. IHS XII Dubrovnik feb ‘10 Types of indicators 1 Structure indicator: How have I organised it? Process indicator: Am I doing it well? Outcome indicator: Do I reach the desired result?

8. IHS XII Dubrovnik feb ‘10 Types of indicators 2 Internal indicators: Goal: quality management and improvement External indicators: Goal: external account pm. Benchmarking

9. IHS XII Dubrovnik feb ‘10 Internal indicators: 3 levels 1.Hospital 2.Haemovigilance system: national 3. IHN: international

10. IHS XII Dubrovnik feb ‘10 Internal indicators: 3 levels 1.Hospital 2.Haemovigilance system: national 3. IHN: international

11. IHS XII Dubrovnik feb ‘10 Internal indicators LUMC

12. IHS XII Dubrovnik feb ‘10 Blood transfusion chain 1.Clinical decision, patient sample and request 2.Processing request by Hospital Bloodbank and delivery of blood component 3.Administration of blood component to the patient 4.Assessment of the effect

13. IHS XII Dubrovnik feb ‘10 Internal indicators LUMC 1.Clinical decision, patient sample and request 2.Processing request in Hospital Bloodbank and delivery of blood component 3.Administration of blood component to the patient 4.Assessment of the effect

14. IHS XII Dubrovnik feb ‘10 Utilisation of plasma: Dept. of Thorax surgery Requested Transfused % destroyed

15. IHS XII Dubrovnik feb ‘10 Internal indicators LUMC 1.Clinical decision, patient sample and request 2.Processing request in Hospital Bloodbank and delivery of blood component 3.Administration of blood component to the patient 4.Assessment of the effect

16. IHS XII Dubrovnik feb ‘10 Internal indicators LUMC Target2009 % of administered platelet units where the increment could be measured > 75 %76 %

17. IHS XII Dubrovnik feb ‘10 Blood use 1995-2006 Absolute numbers of transfused products per year

18. IHS XII Dubrovnik feb ‘10 Internal indicators: 3 levels 1.Hospital 2.Haemovigilance system: national 3.IHN: international

19. IHS XII Dubrovnik feb ‘10 Indicators for benchmarking safe and appropriate use Developed according to the AIRE method Internal indicators but also selected on the basis of –Validity –Reliability –Ease of registration –Discriminative capacity ( benchmarking) –Possibility for improvement

20. IHS XII Dubrovnik feb ‘10 Structure indicators Transfusion Committee Haemovigilance officer Electronic registration of process indicators Electronic pre-administration control

21. IHS XII Dubrovnik feb ‘10 Process indicators AB0-RhD blood group discrepancies Waste of blood components Indication and assessment of the effect of transfusion of –erythrocytes –platelets –plasma

22. IHS XII Dubrovnik feb ‘10 Role for TRIP ? Collect Analyse Report (anonymously) Indicators per hospital

23. IHS XII Dubrovnik feb ‘10 Internal indicators: 3 levels 1.Hospital 2.Haemovigilance system: national 3.IHN: international

24. IHS XII Dubrovnik feb ‘10 International indicators Benchmarking International standards?

25. IHS XII Dubrovnik feb ‘10 Indicators for the quality of Haemovigilance Systems? % hospitals that report Quality of reports? Not easy! Improvement of safe use appropriate use

26. IHS XII Dubrovnik feb ‘10 Conclusion 1 Quality indicators are an effective instrument to improve the quality of the blood transfusion chain

27. IHS XII Dubrovnik feb ‘10 Conclusion 2 Success factors: Electronic registration Financial stimulus Transfusion committee Haemovigilance officer

28. IHS XII Dubrovnik feb ‘10 Conclusion 3 Future: Computerisation of the whole blood transfusion chain in the hospital Electronic request +computerized clinical decision support

29. IHS XII Dubrovnik feb ‘10

30. THE END Thank you for your for your vigilance vigilance

31. IHS XII Dubrovnik feb ‘10 Indicators for safe and appropriate use of blood components Haemovigilance is part of a quality system of the blood transfusion chain

32. IHS XII Dubrovnik feb ‘10 Should we watch for more than safety of blood transfusions? Risk Blood transfusion 1:10.000 * Blood donation 1:100 Blood saving procedures ? * medication 1: 100 ?

33. IHS XII Dubrovnik feb ‘10 Internal indicators Relevant for professional Specific, detailed Less stringent requirements for validation Registration at the source Quick, funny, interactive Paradigm: good-better

34. IHS XII Dubrovnik feb ‘10 External indicators Relevant for external organisations Aspecific, global Strict validation necessary Information is public Paradigm: (often) good-bad

35. IHS XII Dubrovnik feb ‘10 Bloodtransfusion chain LUMC 1 2 34

36. IHS XII Dubrovnik feb ‘10 Utilisation of blood components (2008) PurchasedNumber and % not used Erythrocytes13.8933582,6% Plasma5.04573214,5% Platelets5.158551,1% Other25972,7% Total24.3641.1524,7%

37. IHS XII Dubrovnik feb ‘10 Safe usage PatientsProductsSevere reactions Severe reactions due to mistakes 20062.70123.99600 20072.62723.16410*0 20082.54523.212 60 20092.53120.86590 * Since 2007 also grade 2 reactions are reported as severe reactions according to EU regulations

38. IHS XII Dubrovnik feb ‘10 Blood transfusion chain LUMC 1.Clinical decision, patient sample and request 2.Processing request by Hospital Bloodbank and delivery of blood component 3.Administration of blood component to the patient 4.Assessment of the effect

39. IHS XII Dubrovnik feb ‘10 Indicators for indication and request: safety Target2009 Number of blood group discrepancies in AB0-RhD screening of patients due to identification or labeling errors outside the transfusion laboratory divided by the total number of AB0-RhD screenings in the same period < 1 ‰0.9 ‰