NICE issues new guideline to preserve national stocks of blood
Blood transfusions are commonly used as a treatment, from managing the symptoms of cancer and arthritis, to helping people recover after major surgery. However, national audits on the use of blood in England have consistently shown that a fifth or more of transfusions are unnecessary. The guideline gives clear recommendations on when a transfusion should be used for a patient and when alternatives should be considered.
The guideline also includes recommendations to help hospitals provide better care for patients by reducing the need for transfusions wherever possible. This includes encouraging clinicians to prescribe a drug known as tranexamic acid which can be given to patients undergoing surgery to stop them losing too much blood. Tranexamic acid costs as little as 60 pence and can save hospitals hundreds of pounds per patient1.
With improvements in clinical practice, getting a transfusion in the UK is safer than ever before. In the small number of instances where a problem was reported to the national blood safety watchdog (SHOT) in 2014, the main cause has been a mistake that could be easily avoided2.
Mistakes are often due to human error, such as improper labelling of samples or misidentification of patients. If a patient is given the wrong type of transfusion or the wrong patient is given a transfusion, it can lead to serious illness2.
The guideline calls for hospitals to consider using a system that electronically identifies patients to make the transfusion process safer and more efficient. Electronic patient identification systems prompt staff to carry out key steps in the correct order, and ensure that transfusions are given to the right patients through scanning of barcodes on patient wristbands and blood component containers.
Professor Mike Murphy, consultant haematologist at Oxford University Hospitals and chair of the committee that developed the guideline said: “’Electronic systems make it easy for staff to do the right thing every time, and avoid errors. They can also provide ‘decision support’ for doctors when they are ordering blood and promote the restrictive use of blood. The guideline also importantly highlights the benefits of the routine use of tranexamic acid in patients undergoing surgery.
“Routine implementation of these measures in the NHS will make best use of a valuable resource, be safer for patients and save money for hospitals.”
Professor Mark Baker, director of clinical practice at NICE, said: “This guideline will ensure blood products are used safely and efficiently. Hundreds of thousands of people receive blood transfusions every year in England and Wales, we must do all we can to ensure that their experience is a safe one. We know that practice is improving and with this guideline we want to drive things even further so we get closer to transfusions being completely risk-free and people are spared from avoidable harm.”
Lorna Williamson, NHS Blood and Transplant Medical and Research Director, said: “NHS Blood and Transplant welcomes this new transfusion guideline and the emphasis on putting patients at the heart of decision making. Audits show inappropriate or excessive use of blood components in more than 20% of transfusions.
“As the organisation responsible for collecting, testing, manufacturing and supplying blood products to the NHS across England and North Wales, we care passionately about appropriate blood use and patient safety.
“Our Patient Blood Management initiatives have already significantly reduced the inappropriate use of blood products. This new guideline will help to do even more to ensure clinicians use consistent evidence based approaches that deliver the best outcomes for patients.”
- Tranexamic acid is estimated to cost £0.60 for surgical procedures with a moderate risk of bleeding and £1.19 for surgical procedures with a high risk of bleeding. Potential savings per transfusion avoided are estimated as £688.59 for procedures with a high risk of bleeding, £299.76 for procedures with a medium risk of bleeding and £145.81 for procedures with a high and medium risk of bleeding. Full details are in the NICE costing statement.
- Analysis of reports made to the UK haemovigilance scheme, Serious Hazards of Transfusion (SHOT), in 2014 shows that 2346 out of 3017 (77.8%) were caused by error. Annual Serious Hazard of Transfusion (SHOT) Report 2014.
- The guidance is available at /guidance/ng24.
- NICE has also published a guide for members of the public, so they know what care they should expect to receive.