[Blood transfusion in adults: description of a quality assurance program]

In 1995, a fatal transfusion complication led to the development of a quality-assurance programme (QAP). Initial analysis showed important deficiencies in practice patterns for both nurses and physicians. No written guidelines had been previously produced.

Evaluation of practice patterns and quality-assurance programme.

A QAP was prepared and implemented, a booklet describing completely the transfusion process and institutional policies and providing practical information was edited and the medical and non-medical personnel was informed and trained on a regular basis. Implementation was evaluated during a three-year period by measuring previously defined surrogate endpoints of the quality of the transfusion process.

Implementation became rapidly close to 100% either for well-accepted requirements (i.e. patient's identity reporting on transfusion forms) or when physicians were highly motivated (i.e. autologous blood transfusion). For other indicators, implementation progressed more slowly (i.e. traceability of labile blood products) although significant efforts were made to improve the computerised system of data collection and although hospital administration showed a very positive behaviour. Finally, other indicators showed only partial implementation. Several practical barriers (perceived lack of time, excessive increase in writing requirements) were described for transfusion checklist or transfusion prescription form but more in-depth insufficiencies (patients'information) were also observed.

The success of a change of practice patterns relies on hospital administration positive role, education and feedback, written and immediately available guidelines, employment of specially trained personnel, long-standing actions. Future accreditation of hospitals based on well-defined and well-implemented procedures will also be a major help to increase the quality of the transfusion process.