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A E R Editor‑in‑Chief :
Mohamad Said Maani Takrouri
(KSA)
Open Access
HTML Format Anesthesia: Essays and
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Researches

Original Article
Operative blood transfusion quality improvement audit
Mazen Al Sohaibani, Assaf Al Malki, Venumadhav Pogaku, Saad Al Dossary, Hanan Al Bernawi

Department of Anesthesiology and Operating Room, Staff at KFMC, King Fahad Medical City, Riyadh, KSA
Corresponding author: Mr. Venumadhav Pogaku, Department of Anesthesiology and Operating Room, King Fahad Medical City, Riyadh, KSA. E‑mail: pmadhav@kfmc.med.sa

Abstract
Context: To determine how current anesthesia team handless the identification of surgical
anaesthetized patient (right patient).And the check of blood unit before collecting and immediately
before blood administration (right blood) in operating rooms where nurses have minimal duties
and responsibility to handle blood for transfusion in anaesthetized patients.
Aims: To elicit the degree of anesthesia staff compliance with new policies and procedures for
anaesthetized surgical patient the blood transfusion administration.
Settings and Design: Setting: A large tertiary care reference and teaching hospital. Design: A
prospective quality improvement. Elaboration on steps for administration of transfusion from policies
and procedures to anaesthetized patients; and analysis of the audit forms for conducted transfusions.
Subjects and Methods: An audit form was used to get key performance indicators (KPIs)
observed in all procedures involve blood transfusion and was ticked as item was met, partially
met, not met or not applicable.
Statistical Analysis Used: Descriptive statistics as number and percentage Microsoft excel 2003.
Central quality improvement committee presented the results in number percentage and graphs.
Results: The degree of compliance in performing the phases of blood transfusion by anesthesia
staff reached high percentage which let us feel certain that the quality is assured that the internal
policy and procedures (IPP) are followed in the great majority of all types of red cells and other
blood products transfusion from the start of requesting the blood or blood product to the
prescript of checking the patient in the immediate post‑transfusion period.
Conclusions: Specific problem area of giving blood transfusion to anaesthetized patient was
checking KPI concerning the phases of blood transfusion was audited and assured the investigators
of high quality performance in procedures of transfusion.

Key words: Certified privileged anesthetic staff, operative blood transfusion, quality
improvement audit

INTRODUCTION
Access this article online
Website DOI Quick Response Code The blood transfusion is managed, in hospital setting, by
www.aeronline.org 10.4103/0259-1162.128912 nursing staff. This team works according to set policies
and procedures.[1,2] On the other hand, in certain hospital
places like operating surgical rooms; blood administration
is done by anesthesiologists and their associate anesthesia
technicians who may or may not mastering these policies
and procedures. An internal policies and procedures were

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Anesthesia: Essays and Researches; 8(1); Jan-Apr 2014 Sohaibani, et al.: Operative blood transfusion audit
introduced in author’s anesthesia department to govern
the requirements of blood transfusion
These are the key performance indicators (KPIs) to be
monitored.
REQUIREMENTS
Pre‑requesting for blood
1. Consent for blood transfusion obtained and signed by a
witness
2. Arterial blood gas (ABG)  analysis has been done
3. Blood is available and ready in blood bank
4. The required units of red blood cells ara requested
5. The requested blood product is requested
6. Patient vital signs are monitored and documented.
Requesting procedure
1. Blood products collection form is filled with all required
information
2. Blood bank was informed
3. The blood is delivered iced in blood bank box.
Checking procedure
1. All blood units in the theatre has been checked
2. The blood is checked by the anesthesiologist with the
nurse or technician
3. The blood transfusion form is filled by the
anesthesiologist
4. Patient vital signs are monitored and recorded
5. All transfused units are documented in patient in the
anesthesia operative form.
Post transfusion
1. Patient’s vital signs are documented
2. If transfusion reaction occurred the correct procedure
has been applied
3. ABG was performed
4. If additional units of blood needed the same correct
procedure was followed
5. If the blood units are no more needed for the patient
then the correct procedure has been applied.
There are many reports discussing audit of blood
transfusion in relation to complications and appropriate
indications triggered the transfusion.[2‑6] According to
our knowledge, no audit was found discussing handling
anesthesia staff administering blood transfusion to
anaesthetized patient, which would call for more
attention to verification of the right patient and right
blood before administration[3,4] and extra care to prevent
complications like transfusion reaction or giving wrong
blood to anaesthetized patient. This paper report the
result of a quality assurance audit used KPIs stemmed
from IPP governing steps to follow for administration of
blood during operation by privileged certified anesthesia
technicians and anesthesia medical staff [Figure 1].
SUBJECTS AND METHODS
The practice of blood transfusion was monitored by an
audit form since October 2011, which was distributed
to all operating rooms. These forms are filled by
qualified anesthesia technicians and counter signed by
Anesthesiologists for patients undergoing surgery who
needed blood or blood products. Completed forms were
collected by quality team, the quarterly results, evaluated
and reported. Over the period of a year, data was
collected and classified into 5 steps checking procedure
as follows:
• Pre‑requesting for blood‑set criteria
• Requesting for blood criteria
• Blood products checking procedures
• Post‑transfusion procedure.
Met Partially met Not met Not applicable
Met = 2   Partially met = 1 Not met = 0
Data collected and presented in a tabular form for each
step of checking and results were in percentages.
RESULTS
The number of procedures of blood transfusion performed
by anesthesia was summarized by tables in numbers and
percentages. Degree of compliance to proper required
action is presented as graph [Figures 1 and 2].
DISCUSSION
Blood transfusion is considered in surgical sense a form
of therapy. It aimed to enhance oxygen carriage during
surgery, it also help to reduce morbidity and save
patient’s lives.
It is sort of tissue transplant from donated by one
person or pool of persons to recipient. Also it has certain
shortcomings like transmission of diseases and major
allergic reactions. Medical and paramedical management
must be practiced. That will, hopefully, eliminate the
associated dangers.[3] Anesthesiologists and anesthesia
technicians as they manage blood transfusion in surgical
operating rooms should be like the nurses administering
blood transfusion in other area of the hospital, must
have the skills and knowledge required to care for
patients receiving blood components. As it is important
for nurses to understand the correct and safe way to
approach transfusion practice so anesthesiologists and
anesthesia technicians. Blood transfusion procedures are
constant and central component of modern health care.
The current concern that the number of people eligible
to donate blood is reducing and this blood component
is precious as it comes from willing donation given in
good faith: It is given voluntarily and expected to be
used effectively to help needy patients. Therefore at
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Anesthesia: Essays and Researches; 8(1); Jan-Apr 2014 Sohaibani, et al.: Operative blood transfusion audit

Figure 1: The result of audit report tables in number. Percentages and graphs

every stage of the transfusion process the administrator
of transfusion be the blood bank staff, anesthesia team
and nurses are responsible in their part they play into
ensure that the correct patient receives the correct blood
and also that blood components are used and handled
with care. This report monitored the key principles
and practicalities to be observed in blood transfusion
to anaesthetized surgical patient who were in need
according to acceptable practice. Areas covered include
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legal obligations like checking identity with witness,
documentation and signatures, appropriate handling of
blood components; offering checking blood group, expiry
date of the blood components available and provided by
blood bank in proper containers and storing boxes, the
different elements of the transfusion process, recognition
and management of transfusion reactions and education.
The literature is wealthy with studies, guidelines and
initiatives for safe blood transfusion safe practice.[3‑6]
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Anesthesia: Essays and Researches; 8(1); Jan-Apr 2014 Sohaibani, et al.: Operative blood transfusion audit
Figure 2: Blood audit
A key theme running throughout is that despite an array
of initiatives designed to support the delivery of safe
and appropriate transfusion practice, incidences of
patients receiving the wrong blood continue to be
reported. Nurses play a key role in delivering safe and
appropriate transfusion care and have a responsibility
to support national initiatives, such as Europian health
services, had certain initiatives and guidelines Better
Blood Transfusion programmed action and the National
Patient Safety Agency Safer Practice Notice,[4] Right
Patient, Right Blood initiatives workers tested factors
leading to best transfusion practice. They concluded
that the application of certain organizational support,
insuring leadership and improving staff education,
competency and assessment.[3‑5] Also they stressed on the
importance of the role of conducting regular periodic
audits and feedback reports, this can be handled. By
systematic assessment of transfusion procedures, the
implementation of education and guidelines and the
use of innovative approaches, such as care bundles, we
can ensure that nurses have the appropriate knowledge,
skills and understanding to provide the highest standards
of transfusion care to surgical and medical patients.[3,4]
The importance of auditing is to assure firmly that the
blood transfusion is conducted according to the highest
standards of patient safety.[4‑6] The results measuring
the compliance of doing the procedure in the operating
rooms where the patient is not awake to alert attendance
about any improper sensation and transfusion is
managed for except by anesthesiologists and anesthesia
technicians. The compliances were as near as possible
were very encouraging and promising to continue
the filling of audit forms to achieve 100% compliance
and zero error in safe administering blood and blood
products. The completion of the audit form has become
mandatory in our practice, as the missed out manual
errors are monitored through cross‑checking and review
on the check‑list audit form.
ACKNOWLEDGMENTS
The authors would like to thank all the Anesthesia Technicians
for their involvement and Ms. Rosebeth M estobo, Ms. Janette
Dadizon for their secretarial assistance in completing this study.
Also thanks to members of anesthesia quality improvement for
discussing and for the approval of IPP and KPIs approval.
REFERENCES
1. Parris E, Grant‑Casey J. Promoting safer blood transfusion practice in
hospital. Nurs Stand 2007;21:35‑8.
2. Warnet S. Quality assurance and prevention of transfusion risks. Rev Infirm
2007;127:38‑40.
3. Wilkinson J, Wilkinson C. Administration of blood transfusions to
adults in general hospital settings: A review of the literature. J Clin Nurs
2001;10:161‑70.
4. Gray A, Hart M, Dalrymple K, Davies T. Promoting safe transfusion practice:
Right blood, right patient, right time. Br J Nurs 2008;17:812, 814‑7.
5. Parris E, Grant‑Casey J. Promoting safer blood transfusion practice in
hospital. Nurs Stand 2007;21:35‑8.
6. Oldham J, Sinclair L, Hendry C. Right patient, right blood, right care: Safe
transfusion practice. Br J Nurs 2009;18:312, 314, 316‑20.
How to cite this article: Al Sohaibani M, Al Malki A, Pogaku V,
Al Dossary S, Al Bernawi H. Operative blood transfusion quality
improvement audit. Anesth Essays Res 2014;8:68-71.
Source of Support: Nil, Conflict of Interest: None declared.
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