Marjon Borgert

177 Implementation of a transfusion bundle INTRODUCTION In the past decades randomized trials have shown that a restrictive red blood cell (RBC) transfusion policy is safe for most critically ill patients and even results in improved survival in speci c critically ill patients. 1,2 A restrictive (7g/dL -1 ) RBC transfusion policy has now been widely implemented in transfusion guidelines for critically ill patients. Unfortunately, compliance with these guidelines is poor. 3,4 It is important to improve compliance as this reduces mortality in critically ill patients and reduces waste of scarce as well as expensive RBC products. To improve adherence to guidelines, the Institute for Healthcare Improvement (IHI) developed the concept of care bundles. 5,6 Care bundles consist of a small set of evidence-based key interventions. 6-8 These interventions should be performed together for every patient. 7.8 The idea behind bundling evidence-based interventions is that bundles improve the reliability of care so that all patients receive the care they need. 6- 8 The rst designed care bundles were the ventilator bundle and central line bundle. They aimed to reduce the incidence of ventilator-associated pneumonia (VAP) and catheter-related bloodstream infections respectively. 6-8 Both bundles are nowadays widely used in intensive care units (ICUs), showing signi cant improvements in clinical outcomes and in reducing costs. 5,9-11 Care bundles might also be e ective in transfusion medicine. Therefore, we have developed a care bundle for the transfusion of RBCs in the ICU. We have selected those interventions that have proven to have a great impact on RBC transfusion safety or on decision making regarding RBC transfusion 1,2,12-15 , which will subsequently lead to a reduction in costs and in improved clinical outcomes. For instance, adequate pre-transfusion ‘bedside’ checks should be carried out and decisions for transfusion should be made on reliable haemoglobin (Hb) results. 12,13,16 Moreover RBCs should only be transfused when the preset Hb threshold is reached. 1,2 Nurses play a signi cant role in transfusion decision making. 4 Vlaar et al. showed that the need for transfusion is often pointed out by nurses. 4 Greater involvement of nurses in reviewing the appropriateness of a transfusion order before blood is given might be e ective in reducing inappropriate transfusions. In this study, we quanti ed the true e ect of the transfusion bundle by assessing, per transfusion, whether the decision to transfuse was based on a lower pre-transfusion Hb-level than the patients’ individual preset Hb threshold. The objective of this study was to investigate whether application of the transfusion bundle would reduce the number of inappropriate red blood cell transfusions in an ICU setting.