Evaluation of the clinical blood transfusion practice at Moi teaching and Referral Hospital Eldoret, Kenya

Abstract

Background: Blood transfusion is an essential component of modern health care. It can restore normal life expectancy and improve quality of life when used appropriately. Blood is scarce, costly and its use could be associated with complications. Adequate blood supply and good clinical practice, which includes appropriate blood use and proper documentation, ensures safe and effective transfusion practice. One of the ways of achieving appropriate blood transfusion is use of blood transfusion guidelines. Objective: To determine the appropriateness of the clinical indication of blood transfusion at Moi Teaching and Referral Hospital. Methodology: A hospital based medical chart review of 384 patients who were transfused from June 2013 to November 2013 was carried out. Systematic random sampling method was used and a data collection form was used to collect data. Data analysis was done using SPSS software version 20. Descriptive statistics, ANOVA, Pearson Chi-square and logistic regression were used to analyze the data. A p-value of <0.05 was deemed statistically significant. Data is presented in form of prose, tables, graphs and charts. Approval from Institutional Research and Ethical Committee of Moi University was obtained and the patient’s medical records were de-identified Results: The median age of the recipients was 31.5 years (IQR 13,45.8) and the range was 1 day to 89 years. Females comprised 55.2% of the patients. The majority of the patients were from surgical (30.7%) and medical (29.2%) wards. The main indication of the transfusion was anaemia with the mean pretransfusion Hb being 7.8g/dl (SD 2.9) and most of the transfused patients (6 .8%) were being treated for neoplastic, pregnancy related, injuries and infectious & parasitic conditions. The proportion of inappropriate transfusion was 49% and the associated factors were pre-transfusion haemoglobin (p < 0.001), clinical department (p=0.043 presenting condition (p= 0.01) and the cadre of the prescribing clinician (p=0.008). Whole blood was transfused to 60.2% of the recipients and most of the transfusions (71.6%) were prescribed by registrars and medical interns. The consent, blood and blood product unit number, start times, duration of transfusion and observations of vital signs were documented in the charts of 0.7%, 73.4%, 43%, 47.1% and 27.6% of all the recipients respectively. Conclusion: The proportion of patients who had inappropriate blood transfusion was 49% and the associated factors were pre-transfusion haemoglobin, clinical department, presenting condition and the cadre of clinician. The documentation of the transfusion process was inadequate. Majority of the patients, who required transfusion were young, had anaemia as the main indication and presented with neoplasms, infectious and pregnancy related conditions. Recommendations: The strategies of clinical audit and continuing medical education of health workers ought to be applied in order to improve the clinical practice of blood transfusion. In addition, studies to establish the reasons for inadequate documentation of the transfusion process and unsatisfactory compliance to the national guidelines on blood transfusion should be carried out. Finally, a separate consent form dedicated to blood transfusion need to be introduced