[Lack of adherence to the guidelines on the use of fresh frozen plasma]

Evaluation of transfusion practice with regard to the guidelines for fresh frozen plasma.

Prospective.

Academic Medical Centre, department of internal medicine, Amsterdam, the Netherlands.

During 4 weeks in April-May 1996 the indication of every request for fresh frozen plasma was established by an inquiry by telephone and compared with the indications defined by the National organization for quality assurance in hospitals (CBO). To objectivate the stated indication it was checked whether laboratory tests had been performed (prothrombin time (PTT) and activated partial thromboplastin time (APTT), and if so, what the results were. Moreover, the numbers of transfused units of red cells, platelets and fresh frozen plasma in the first 24 hours were checked.

During the study period there were 195 requests for 844 units of plasma. 613 units were transfused in 100 patients. If the CBO guidelines were applied strictly, the proportions of plasma units inappropriately requested and inappropriately administered were 53% and 47% respectively (in 32 patients). If the CBO indications were applied less strictly, still 25% of the units were inappropriately requested and 18% inappropriately administered (in 23 patients).

The guidelines were observed only moderately. Better compliance is important for medical, logistic and financial reasons.