Transfusion safety in the hospital

From various haemovigilance and similar studies it appears that the mislabelling and miscollection of patient samples, as well as faulty patient identification, are still important causes of transfusion accidents (see Dzik, 2003 [1]). It is shameful that blood products which have been made as safe as possible, at considerable cost and effort, are still sometimes given to the wrong patient. For this Forum, we have collected information on the measures that are taken to ensure correct sampling and patient identification. To obtain this information, the questions, listed below, were sent to various experts in this field. We received 13 contributions to this Forum. Question 1. Which system is used to prevent errors in pretransfusion sample collection, i.e. mislabelling and miscollection (wrong blood in tube) of samples? Question 2. Which system is used for patient identification: barcodes, radio frequency chips (others)? If you do not use barcodes, could you explain the reason? Question 3. Is a transfusion service or haemovigilance officer employed in the hospitals who is responsible for transfusion safety? If so, could you describe her/his background (specialty, training, etc.). Question 4. Over the last decade, how many errors, caused by faulty patient identification, were reported in your centre? And how many of these errors resulted in serious transfusion accidents? From the answers to question 1, it is clear that all sorts of safety measures are taken to prevent mislabelling and miscollection of patient samples and to avoid giving blood to the wrong patient, at least in the countries/hospitals concerned. As these measures vary considerably from place to place, it does not seem sensible to produce a survey. Rather, the reader should read the individual answers to appreciate the nature of these measures. Wrist bands are generally used for patient identification, but although barcodes are usually present on the wrist band, at present only in the university hospital in Tokyo are barcodes routinely read electronically for patient identification. In most other countries/hospitals, the electronic reading of barcodes is, as yet, incidental or being evaluated. In most hospitals, barcode reading is expected to be used in the future. In the UK, a study revealed that barcode reading clearly improves patient identification, more so than merely educating those who are responsible for patient identification. In the USA, a study is being undertaken to evaluate the use of radio-frequency chips. When barcode reading is not yet used, it is for organizational and/or financial reasons. In most of the hospitals/countries, one or more special officer(s) is (are) responsible for transfusion safety. He/she is often also responsible for haemovigilance. Their qualifications range from a specialized nurse to physicians specialized in transfusion medicine. The general opinion appears to be that such transfusion safety officers are of great benefit. In all hospitals/countries, errors have been reported. In most cases the errors were made when collecting patient samples, and the vast majority of these were detected in time because of discrepancies with results of previous blood grouping. In most hospitals/countries, the wrong blood has been given to a few patients, owing to undetected errors in patient identification, e.g. because the pretransfusion bedside check was omitted. However, rather surprisingly, serious transfusion accidents occurred in only a small percentage of cases in which the wrong blood was given. However, in the UK, where a reliable haemovigilance system (Serious Hazards of Transfusion – SHOT) is currently in place, mistransfusions account for the largest proportion of all adverse events monitored. The commonest cause of error was at the final bedside check! In Austria, the administration of ABO-incompatible red cells in the two known cases led to one very serious and one fatal reaction. In conclusion, it is clear that there is general awareness of the great importance of transfusion safety in the hospital. It seems that electronic reading of barcodes or other computerized aids will soon be used on a much greater scale. However, it must be realized (see, e.g. Dzik, 2003) that even the most sophisticated measures will fail if they are not applied accurately. It will be an important task of the transfusion safety officer to see that they are.