Pp-297 Blood Transfusion And Documentation

Levent Bayam,J. Hanison,S K. Sureen, M Ismail
Royal Bolton Hospital
Aim: Documentation is an important part of daily practice in all branches of medicine, in the clinics, GP surgeries and hospitals. The use of allogeneic blood is expensive and associated with many complications such as infection, fluid balance problems, reaction, bedside mistakes.
Our aim was to assess blood transfusion practise and to detect who decided to transfuse, at what Hb level, how clear was documentation Method: It was a retrospective study with 30 patients who admitted under Orthopaedic (both elective and trauma) and had blood transfusion between September 2005 and June 2006 (in a nine-month period) were included. Multitrauma patients who had the other system problems were excluded from the study
Results: There were 16 female and 14 male patients with mean age of 73.8 and 65.5 respectively. 7 of the patients had DHS, 6 had TKR and 9 of them had THR. There were 2 patients in each group of hip hemiarthroplasty, IM nailing of femur, hip resurfacing in addition to 1 Periprosthetic THR fracture and 1 Bipolar hemiarthroplasty. The level of Hb to decide transfusion was between 7 and 8 for 19 patients(63.3%), 6 and 7 for 4 patients (13.3%), 8 and 9 for 2 patients as well as 9 and 10. Decision of transfusion was made by mostly junior doctors; 13 out of 30(43.3%), 5 of them by middle grade doctors (16.6%), 1 by a nurse but for 10 of the patients(33.3%), there was not any documentation about who decided. In total, 14 notes ( 46.5% ), documentation was not clear.
Conclusion: Although the decision of blood transfusion was made by mostly junior doctors, the level was correct according to guidelines. But most important result of the study was lack of documentation, which could have potentially serious and dangerous implication on practice. This should be addressed at every level of practice in health.