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Utilization of frozen plasma in O ntario: a provincewide audit reveals a high rate of inappropriate transfusions
Author(s) -
Tinmouth Alan,
Thompson Troy,
Arnold Donald M.,
Callum Jeannie L.,
Gagliardi Kate,
Lauzon Deborah,
Owens Wendy,
Pinkerton Peter
Publication year - 2013
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/trf.12231
Subject(s) - medicine , audit , emergency medicine , transfusion medicine , fresh frozen plasma , warfarin , clinical audit , emergency department , blood transfusion , medical emergency , atrial fibrillation , psychiatry , platelet , management , economics
Background F rozen plasma ( FP ) is frequently transfused inappropriately, an intervention that results in risk without benefit for the patient. To better understand current utilization practices in our region, we undertook a provincewide prospective audit to evaluate the clinical indications and appropriateness of FP transfusion. Study Design and Methods All hospitals in the C anadian province of O ntario with transfusion medicine services were invited to participate in a 5‐day audit of FP utilization. FP dose, indication, and clinical patient data were collected for each transfusion request. Indications for FP transfusions were independently adjudicated as appropriate, inappropriate, or indeterminate based on predefined criteria. Results Seventy‐six (49%) of 155 invited hospitals participated in the audit, which included 573 requests for 2012 units of FP . A total of 559 transfusions (1909 units) were administered. Of 573 requests, 164 (28.6%) were deemed inappropriate most often because: 1) they were administered to patients with an international normalized ratio below 1.5 or 2) they were administered in absence of bleeding or emergency surgery. The most frequent indications for FP transfusions were before surgery and warfarin reversal. Overall, patients admitted to the clinical areas of surgery, internal medicine, and the emergency department represented the largest users of FP , but this varied by hospital type (community vs. academic). The most frequently requested doses of FP were 2 and 4 units. Conclusion This point‐prevalence hospital audit revealed that transfusion of FP is frequently inappropriate. Focusing on reducing the two most common reasons for inappropriate FP transfusions could lead to a significant improvement in FP utilization.