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The main aims of this study were to explore and identify why traceability compliance was poor at the Homerton University Hospital NHS Trust and to implement a suitable model to improve it. This study was a multi-stage exploration of the various practices of staff involved in the blood transfusion chain, both at the Trust and in some other NHS Trusts in the United Kingdom. The study explored the reasons for the Trust's poor traceability of blood products, which eventually led to poor compliance. It identified the risk factors that led to poor traceability, explored why some wards had better compliance than others and evaluated the direct costs and benefits of wastage.  The principal aim of these activities was to be able to take an informed decision on the development of a new model to improve compliance.  A quantitative approach was adopted as it made it possible to measure the frequency of actions, and this data was used to answer the research questions. Data was collected using questionnaires, observations and an audit of information extracted from the laboratory's information management systems. A questionnaire was designed, piloted and sent to all ward managers at the Trust, and survey data was analysed using the SPSS statistical package. Some of the issues that were addressed and analysed included: staff training in blood product collection and administration; knowledge of staff members of the concept of traceability compliance; laboratory staff professionalism; ward staff responsibilities for traceability compliance; and ward staff attitudes and opinions about the traceability model.  To add rigour to the study, the survey was followed by structured observations at the blood collection point and the patient's bedside. This data was also analysed using descriptive statistics and the results showed that traceability compliance was poor in some areas of the Trust. Problems included: the absence of a trainer on the ward, lack of education, few transfusion episodes on the wards, variation in the method of returning labels to the transfusion department, and poor communication between frontline staff and the transfusion laboratory.  The study resulted in the implementation of new approaches to the transfusion chain in order to improve practice. These included: the appointment of a medical laboratory assistant to assist with traceability compliance; the appointment of a clinical transfusion nurse specialist to assist with training and ensure safe practice on wards; the provision of trainers and clinical supervision on particular wards; the development of a competence programme to assess staff involved in blood collection and distribution; the development of clinical guidelines; and the administration of an annual skills checks for staff involved in the transfusion chain.  Most of the recommendations have been implemented and put into practice. A formal audit will be conducted in the future to evaluate their success but to date, 65% of staff members have passed the annual skills' assessment and the traceability compliance of the Trust has remained at 100%.

Implementation and evaluation of a blood products traceability procedure in a District General Hospital