Quality standard

Quality statement 3: Reassessment after red blood cell transfusions

Quality statement 3: Reassessment after red blood cell transfusions

Quality statement

People are clinically reassessed and have their haemoglobin levels checked after each unit of red blood cells they receive, unless they are bleeding or are on a chronic transfusion programme.

Rationale

Clinical reassessment and measurement of haemoglobin levels after each unit of red blood cells transfused helps healthcare professionals to decide whether further transfusions are needed. This helps avoid the serious risks associated with red blood cell transfusions, for example infection, fluid overload and incorrect blood transfusions being given. It may also reduce the length of hospital stays and the cost to the NHS. For children and for adults with low body weight, red blood cell transfusion volumes should be calculated based on body weight.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Process

a) Proportion of red blood cell transfusions where a clinical reassessment of the person is carried out after each unit of blood transfused, unless they are bleeding or on a chronic transfusion programme.

Numerator – the number in the denominator where a clinical reassessment is carried out after each unit of blood transfused.

Denominator – the number of red blood cell transfusions in people who are not bleeding or on a chronic transfusion programme.

Data source: NHS Blood and Transplant national comparative audit of NICE quality standard QS138.

b) Proportion of red blood cell transfusions where the haemoglobin level of the person is checked after each unit of blood transfused, unless they are bleeding or on a chronic transfusion programme.

Numerator – the number in the denominator where the haemoglobin level of the person is checked after each unit of blood transfused.

Denominator – the number of red blood cell transfusions in people who are not bleeding or on a chronic transfusion programme.

Data source: NHS Blood and Transplant national comparative audit of NICE quality standard QS138.

Outcome

Incidence of serious adverse events after red blood cell transfusion.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

What the quality statement means for different audiences

Service providers (secondary care services) ensure that systems are in place to clinically reassess people and check their haemoglobin levels after each unit of red blood cells transfused, unless they are bleeding or on a chronic transfusion programme.

Healthcare professionals (such as doctors, nurses and blood transfusion specialists) clinically reassess people and check their haemoglobin levels after each unit of red blood cells transfused, unless they are bleeding or on a chronic transfusion programme.

Commissioners commission services that clinically reassess people and check their haemoglobin levels after each unit of blood transfused, unless they are bleeding or on a chronic transfusion programme.

People who have a red blood cell transfusion have an assessment and their haemoglobin levels checked after the transfusion to see if they need another one, unless they are bleeding or need regular blood transfusions.

Source guidance

Blood transfusion. NICE guideline NG24 (2015), recommendations 1.2.1 and 1.2.6

Definitions of terms used in this quality statement

Clinical assessment

This includes:

  • asking the person if their anaemia symptoms have resolved

  • asking the person about any new symptoms that might indicate an adverse response to transfusion (such as circulatory overload)

  • reviewing the vital signs taken before, during and after the transfusion

  • any further clinical assessment that could be needed.

[Expert opinion]