Marjon Borgert

179 Implementation of a transfusion bundle underpinned with evidence and/or were reported in the (inter)national transfusion guidelines. All interventions aimed to reduce unnecessary, inappropriate or unsafe transfusions. 1,2,12-14,16 The transfusion bundle was actively implemented from May to August 2014 by using educational activities and audit & feedback (A&F). A&F was given monthly to the nursing teams. Half of the nurses received additionally individual A&F after every transfusion. However, the implementation of the bundle itself was not the subject of this study. In this study, we focused on the e ect of the bundle on inappropriate transfusions. Table 1. Transfusion bundle interventions Transfusion bundle interventions 1. Veri cation of the Hb measurement reliability 2. Transfusions given according to patients’ individual Hb-threshold, i.e. transfusion trigger 3. Veri cation of obtained Informed Consent 4. Veri cation of the right patient by two persons independently 5. Veri cation of the right blood product by two persons independently Data collection Data about transfusions were collected at baseline (4 months), during the implementation period (4 months) and during the post-implementation period (4 months). Transfusions during the baseline period were collected retrospectively from the electronic Patients Data Management System (PDMS) (Metavision, Ite medical Tiel). All patient and transfusion data during the baseline period were reviewed one by one and entered into the study database. Data during the implementation and post- implementation periods were prospectively collected from the PDMS. During week days the occurrence of a RBC transfusion was audited in the PDMS three times per day by the researcher. Transfusions that had occurred during the weekends were audited on Mondays. Bundle checklists were used to track the levels of bundle compliance. Compliance with the completion of each element of the bundle was assessed by reviewing the bundle checklist. Compliance levels were calculated using the all-or-none approach. 18 This means that all ve bundle-interventions had to be completed in order to be labelled as compliant to the transfusion bundle.