IMPACT OF MONITORING QUALITY INDICATORS ON TRANSFUSION … · on transfusion services dr.prasanna n...
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IMPACT OF MONITORING QUALITY INDICATORS ON TRANSFUSION SERVICES DR.PRASANNA N KUMAR Professor & Head - Pathology PSG INSTITUTE OF MEDICAL SCIENCES & RESEARCH COIMBATORE
Transcript of IMPACT OF MONITORING QUALITY INDICATORS ON TRANSFUSION … · on transfusion services dr.prasanna n...
IMPACT OF MONITORING QUALITY INDICATORS ON TRANSFUSION SERVICES
DR.PRASANNA N KUMARProfessor & Head - Pathology
PSG INSTITUTE OF MEDICAL SCIENCES & RESEARCHCOIMBATORE
WE’VE HAD A ROMANCE WITH QUALITY!
• 1960s – all about ‘Quality Control’ (QC)
• 1970s and 1980s - this relationship bloomed into
‘Proficiency Testing’ (PT) and ‘Quality Assurance’ (QA).
• 1990s- in-road of Quality Management System (QMS) into TM.
• NOW - QMS has become a very important means for achieving
quality in TM. Tool of QMS - Quality indicators
• QIs - measurable, objective indicators of efficiency of the QMS
QIs – WHAT ARE THEY?
• Quantitative proof of a qualitative activity
• Many QIs for heathcare quality – few for TM
• 2010 - International Society of Blood Transfusion (ISBT)
• instituted its Working Party on Quality Management
(WPQM) 36 QIs defined
• To provide robust and valid quality indicators to
monitor quality of key processes and outcomes in TM
practice, globally.
Vuk T. Quality indicators in blood establishments:ISBT WBQM; Transfusion Today 2013;96:10-11.
HOW DO WE DEVELOP A QI?Objective What are we trying to measure?
Methodology 1. How do we capture the data2. Who will / what to capture the data3. How often to capture the data
Limits Acceptable, Concern, Unacceptable, Critical
Presentation Graphic or Text
Interpretation What does it mean?Does it reflect on OUR quality?
Limitations Unintended variables
Action Plan What will we do if it indicates acceptable performance?
What will we do if it does not – corrective measures, CQI
Exit Plan When can I stop measuring?
Pre-preanalyticalClinical question
Post-postanalyticaleffectiveness, Follow -up
QI BUILDING – knowing
the terrain – TM operational systems
User related – physician awareness
Donor related –promotion and selection
Blood collection, preparationstorage
The transfusion service
Clinical practice - blood componentadministration Assessment of effect
HOW DO THE OPERATION SYSTEMS
WORK?
• Critical control points - are those major processes of the operating systems that have to function properly if quality outcomes must be obtained
• Key elements - are operational steps that lead to CCPs.
• Identification of CCPs and KEs for TM operational system - fundamental pre-requisite for determining where quality indicators placements are desirable
C.C. Anyaegbu; ISBT Science Series (2011) 6, 35–45
BLOOD COLLECTION
CRITICAL CONTROL POINTS
Equipment&suppliesDonorphlebotomyPost-donationevents and care
KEY ELEMENTS
Blood component container inspection and documentation; recording bag lot #, expiry
Positive identification of donor
Arms selection •Arms preparation (cleansing) for phlebotomy
Collect & label donor unit & pilot sample tubes
Document time of phlebotomy
Observe for donor reactions •Manage any reaction
Post donation advice
Transport blood to processing unitTransport pilot samples to testing labs.
POTENTIAL QI
Percentage of voluntary blood donors
Rate of bacterial contamination of component
due to poor arms cleansing
Rate of donor phlebotomy failures
Percentage of labelling errors for donor unit
and/or specimen
Donor satisfaction survey (donor feedback)
Elective surgeries deferment rate due to
inventory shortage
PRODUCT -QUALITY
Need for a uniform and
strictly controlled process
TRANSFUSION THERAPY - SAFETY
Justifiable and correct
utilisation
BLOOD COMPONENT ADMINISTRATION
CRITICAL CONTROL POINTS• Blood components release & delivery for
transfusion • Recipient pre-transfusion bedside positive ID • Recipient transfusion & monitoring • Detecting, reporting & work-up of suspected
adverse events • Appropriateness of component request and use • Component disposition tracing
PRE TRANSFUSION
KEY ELEMENTS
KE 2015 2016
Indication 100% 100%
Consent 76% 90%
Correct written order
97% 100%
Correct component issue 100% 100%
PATIENT & COMPONENT INDICATORS
KEY ELEMENTS
KE 2015 2016
Patient verification 100% 100%
Verification by twopersons
57% 60%
First verifier doctor 100% 100%
Cross checking of ID numbers of pt. & component
100% 100%
Component appearance
57% 60%
Component expiry date
4% 55%
ADMINISTRATION TECHNIQUES & MONITORING
KEY ELEMENTS
KE 2015 2016
Transfusion started in first half hour
80% 98%
Pre transfusion vitals 84% 95%
Proper blood set 100% 100%
Rate of infusion 98% 100%
Observation during first 15”
37% 100%
Notification of adverse reactions
100% 100%
Hourly vitals 44% 43%
POST TRANSFUSION
KEY ELEMENTS
KE 2015 2016
Recording of stop time 90% 98%
Transfusion completion in 4 hours
84% 90%
Vitals at end of transfusion 88% 87%
Proper blood bag disposal 95% 100%
Post-postanalytical – platelet counts within one hour of transfusion – 10%
POTENTIAL QI
Wrong component selection ⁄ release
Patient ID at collection and administration
Correct transfusion rate
Correct observations and monitoring
Traceability
Rate of inability to track disposition of component
Component wastage rate
Circulars, EducationTransfusion committee and quality meetings
IDENTIFY PROBLEMS, RCA AND ------
QIs and CQIs
Continuous quality improvement - one of the main goals of the QMS
Regular documentation of results of QIs and CQIs
Any optimistic impacts?
21.1 19.315.2
11.58.63 6.68 7.54
78.9 80.784.8
88.591.44 93.4 92.47
0
10
20
30
40
50
60
70
80
90
100
2010 2011 2012 2013 2014 2015 2016 (tillOCT)
PER
CEN
TAG
EUSAGE OF BLOOD & BLOOD PRODUCTS
FROM 2010 – 2016 OCT
WHOLE BLOOD
COMPONENTS
0 0 0 0 0 0 0
0.28
0.17
0.1
0.15
0.19
0.28
0.36
0
0.05
0.1
0.15
0.2
0.25
0.3
0.35
0.4
2010 2011 2012 2013 2014 2015 2016 (tillOCT)
PER
CEN
TAG
ETRANSFUSION REACTIONS TO BLOOD & BLOOD PRODUCTS
FROM 2010 – 2016 OCT
WHOLE BLOOD
COMPONENTS
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT
TOTAL T.F. RECD. 93.45 87.46 96.95 96.98 95.94 94.74 96.1 94.86 94.57 95.78
93.45
87.46
96.95 96.98
95.94
94.74
96.1
94.86 94.57
95.78
82
84
86
88
90
92
94
96
98
PER
CEN
TATE
TOTAL TRANSFUSION REACTION FORMS RECEIVED FROM THE WARDFROM JAN 2016 – OCT 2016
3.3
2.07
2.65 3.05
1.97
2.47
1.59
5.19
2.23 2.56
1.57
3.84
3.25-4723.43 - 368
0.27-40 0.29-31
0
1
2
3
4
5
6
2010 2011 2012 2013 2014 2015 2016(tillOCT)
PER
CEN
TAG
EWASTAGE OF BLOOD & BLOOD PRODUCTS
FROM 2010-2016 OCT
WHOLE BLOOD
COMPONENTS
WARD WASTAGECOMPONENTS
0
1
2
3
4
5
6
7
8
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT
4
8
2
7
5
1
3
2
4
1
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT
No. of Transfusions beyond 30minutes after issue
4 8 2 7 5 1 3 2 4 1
AUDIT OF TRANSFUSIONS BEYOND 30 MINUTES AFTER ISSUEJAN 2016 TO OCT 2016
REASONS FOR WARDSIDE WASTAGE
• Inappropriate requests
• Patient issues – fever, “declared”
• Inappropriate storage in wards and OT (corrective –
BB fridges)
• Inability to get veins/wrong handling of the product
• Wastage associated with reactions
• Paediatric wastage (sterile connecting device)
CROSS MATCH TRANSFUSION RATIO FROM JAN 2016 – OCT 2016
0
200
400
600
800
1000
1200
1400
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT
12491214
1306
1135
1239 12231276
1339
1111 1123
522487
533
517470 492 520
452415 458
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT
CROSS MATCHING 1249 1214 1306 1135 1239 1223 1276 1339 1111 1123
ISSUE 522 487 533 517 470 492 520 452 415 458
Ideal CM:TR ratio<1.5
Our ratio = 2.52%
RATIO 2.39 2.49 2.45 2.20 2.64 2.48 2.45 2.96 2.67 2.45
THE FUTURE
SIX SIGMA RATING FOR TRANSFUSION SERVICES
0
100
200
300
400
500
600
700
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT
56 63 59
6761 71
60 6335 36
603
482
608
555
505
630
563
698
457
413
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT
Total no. of donor deferrals 56 63 59 67 61 71 60 63 35 36
Total no. of donation+
Total no. of donors603 482 608 555 505 630 563 698 457 413
DONOR DEFERRAL RATE% (JAN 2016 TO OCT 2016)
10.75%
0
100
200
300
400
500
600
700
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT
0 2 2
1 2 1 2 3 41
547
419
549
488
444
559
503
635
422
377
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT
No. of Donors adverse reaction 0 2 2 1 2 1 2 3 4 1
Total No. of Donors 547 419 549 488 444 559 503 635 422 377
ADVERSE DONOR REACTION RATE% (JAN 2016 TO OCT 2016)
RATE = 0.37%
0
100
200
300
400
500
600
700
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT
3 3 34 8 5 8 5 2 1
547
419
549
488
444
559
503
635
422
377
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT
COMBINED TTI CASES 3 3 3 4 8 5 8 5 2 1
TOTAL NO. OF DONORS 547 419 549 488 444 559 503 635 422 377
TTI % (JAN 2016 TO OCT 2016 )
0.84%
