Marjon Borgert

157 Implementation of the transfusion bundle INTRODUCTION Transfusion of blood products is a frequently used life-saving therapy in critically ill patients. Besides the positive treatment e ects, it can cause serious complications such as pulmonary oedema, infections and transfusion-related acute lung injury (TRALI). 1,2 Although reported incidences of these complications are low, they are an important cause of transfusion-related morbidity and mortality. 3,4 Results from the UK have shown that risks of morbidity from transfusion is 1 in 322 580 components transfused. 3 In the last decade, changes have been made in transfusion practice to further reduce these complications. For instance, screening of donors to reduce infections 5 or excluding female donors to reduce the incidence of TRALI. 6 However, it is known that most transfusion-related incidents are caused by human errors. 3 The blood transfusion process is complex and involves multiple disciplines. 7 This results in multiple moments in which errors could occur. 7 Estimates of the risks of transfusions were calculated in the UK. 7 The risk of an error during blood transfusion is estimated at 1:16 500 units transfused, transfusion a wrong blood product at 1:100 000 and the risks of death in case a wrong blood product was transfused at 1:1 500 000. 7,8 However, the true incidence may be higher since not every error is reported. Most errors are made during the collection and labelling of blood samples or at the nal bedside checks. 3,4 For instance, identifying the wrong blood product patient combination could lead to transfusion of incompatible blood. 7 To improve transfusion practice and to reduce errors, guidelines should be used. 9 However, despite intensive implementation programs, it is known that guidelines are not followed consistently. 10,11 In order to improve guidelines adherence, the Institute for Healthcare Improvement (IHI) has developed the concept of care bundles. 12 They consist of three to ve evidence-based interventions for a prede ned patient population or clinical process. 12 The strength of bundling interventions in care bundles is to ensure that evidence-based care will be uniformly applied and improve clinical outcomes. 12 Care bundles have already proven to be e ective in improving clinical outcomes. 13,14 In order to improve transfusion practice, we have developed a care bundle for the transfusion of red blood cells (RBCs). We used the IHI process steps to design the transfusion bundle and included ve evidence-based interventions (Supplementary File 1). 12,15,16 All interventions are aimed to reduce unnecessary, incorrect or unsafe transfusions.