Quality improvement program for transfusion reaction reporting and management

Transfusion reactions are underreported, with reported rates up to 87% lower than expected for serious reactions such as transfusion-associated circulatory overload (TACO). We implemented a multicomponent quality improvement initiative to improve recognition and reporting of transfusion reactions.

The initiative combined standardized nursing education with an electronic medical record (EMR)-integrated structured workflow, the Care Signature Transfusion Reaction Pathway, to standardize recognition, evaluation, and management of suspected reactions. We also developed an automated transfusion reaction dataset to retrospectively audit transfusion events and identify reactions not captured through routine reporting.

Transfusion reaction education was incorporated into the institutional learning management system for nursing staff. During its initial six-month rollout, the Care Signature Transfusion Reaction Pathway was accessed 258 times. Retrospective surveillance identified 36 previously unreported reactions across the health system, including 22 TACO cases. Combined with the 17 TACO reactions reported to the blood banks, these additional cases represented a 129% increase in TACO identification. Following implementation, the overall transfusion reaction reporting rate at the index site increased from 0.627% to 0.683%, and the TACO identification rate increased by 293%.

A multicomponent intervention comprising standardized nursing education, an EMR-integrated transfusion reaction pathway, and automated retrospective surveillance improved transfusion reaction recognition and reporting. The intervention identified 36 previously unreported reactions, particularly TACO, and increased TACO identification both across the health system and at the index site. This approach used existing health-system infrastructure to enhance surveillance across diverse hospital settings and may be scalable to other health systems.