P25 Overnight Transfusions Expose Patients to Unnecessary Risk and Seldom Facilitate Next Day Discharge

Aims and Objectives  The Serious Hazards of Transfusion (SHOT) Committee has highlighted the increased risk of overnight transfusion in its annual reports. The risk arises from the paucity of staff (compared to daytime) to monitor patients and manage complications. The darkness on the ward can also obscure early clinical detection of clinical problems. Additionally, patients receiving the transfusion are prevented from sleeping and others in their bay are disturbed throughout the night. The commonest reason offered for overnight transfusion was to enable patient discharge the following day. After seeking approval from the Hospital Transfusion Committee, we performed two ‘snapshot’ studies to investigate the proportion of all transfusions given overnight. Having established that this was a significant number, fifty sequential overnight transfusions were further examined to see whether they were clinically appropriate and whether the recipients were actually discharged the following day. Evidence base/standards. ‘Overnight’ was defined as between 8  pm and 6  am as these are the times between which nursing and medical staffing levels are at their lowest. Transfusions were judged to be appropriate if they were for patients who: • were actively bleeding • admitted symptomatically anaemic during the night • peri‐operative Methodology  Each morning the Transfusion Practitioner examined the laboratory copies of the transfusion compatibility reports to identify the overnight transfusions. The medical notes for the transfused patients were then consulted for documented evidence as to the appropriateness of each episode according to the criteria above. Results  From the two snapshot studies (each of a month), it transpired that, 43% of units of red cells were given to 40% of the patients and 26% of the units to 42% of the patients. This established that the project would be worthwhile. Of the 50 transfusion episodes, there was documentation in the notes of 30 patients (60%) of the need for transfusion. Seven patients (14%) were noted to be symptomatically anaemic and 3 (6%) bleeding. In total 20% of the overnight transfusions were appropriate by our criteria. Next day discharge occurred in five of the 50 patients. Further work was done to investigate possible delays in commencing the transfusions. Recommendations and actions  The main action taken was to educate staff that inappropriate overnight transfusions compromised their patients’ care and rarely allowed earlier discharge. This was done through re‐enforcement at induction lectures, the Blood Transfusion Policy and a sign on the blood fridge.