Rationalised premedication practice for blood product transfusions: A single-centre quality initiative.

Area of Science:

• Pediatric Oncology
• Transfusion Medicine
• Clinical Pharmacy

Background:

• Blood and platelet transfusions are vital supportive care for pediatric cancer patients.
• Acute transfusion reactions (ATRs) pose risks, often leading to routine premedication.
• Routine premedication carries its own risks and healthcare system implications.

Purpose of the Study:

• To prevent automatic prescribing of premedications for ATRs in pediatric cancer patients.
• To evaluate if eliminating routine premedication increases patient harm.
• To reduce unnecessary medication use and associated risks.

Main Methods:

• Intervention: Stopped automatic prescribing of IV corticosteroids and promethazine.
• Approach: Utilized a behavior change model and co-designed prescribing guidelines.
• Refinement: Three Plan-Do-Study-Act (PDSA) cycles optimized guidelines.
• Comparison: Trial data compared to international ATR rates.

Main Results:

• 100 patients received transfusions; 11 experienced reactions (initial or recurrent).
• All patients adhered to guidelines, receiving no premedication or oral antihistamines.
• No breakthrough reactions occurred with oral antihistamine use.
• Overall ATR rate was 1.33%, consistent with international data.

Conclusions:

• A restricted prescribing approach for transfusion premedication is feasible in pediatric cancer patients.
• This strategy can be implemented effectively without increasing patient harm.
• The findings support a move away from automatic premedication protocols.