Rationalised premedication practice for blood product transfusions: A single-centre quality initiative.

Grant, AM; Wright, FA; O'Brien, TA

Rationalised premedication practice for blood product transfusions: A single-centre quality initiative.

Grant, AM Wright, FA O'Brien, TA

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Publisher:: Wiley
Publication Type:: Journal Article
Citation:: Journal of paediatrics and child health, 2021
Issue Date:: 2021-08-16

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Field	Value	Language
dc.contributor.author	Grant, AM
dc.contributor.author	Wright, FA
dc.contributor.author	O'Brien, TA
dc.date.accessioned	2021-12-06T04:07:35Z
dc.date.available	2021-07-30
dc.date.available	2021-12-06T04:07:35Z
dc.date.issued	2021-08-16
dc.identifier.citation	Journal of paediatrics and child health, 2021
dc.identifier.issn	1034-4810
dc.identifier.issn	1440-1754
dc.identifier.uri	http://hdl.handle.net/10453/152140
dc.description.abstract	<h4>Aim</h4>Blood and platelets are scarce resources that are an essential part of the supportive care for paediatric cancer patients. There are many inherent risks involved with transfusions including acute transfusion reactions (ATRs). Following an initial ATR, prophylactic medications are commonly given prior to subsequent transfusions. However, there are risks with medication administration as well as negative implications for the health system. Our aim was to prevent the automatic prescribing of premedications prior to blood and platelet transfusions for ATRs. We hypothesised this would not increase the risk of harm.<h4>Methods</h4>Our intervention was to eliminate automatic prescribing of intravenous corticosteroids and intravenous promethazine prior to a transfusion. This was approached through a behaviour change model and the implementation of recommended prescribing guidelines. Three Plan Do Study Act (PDSA) cycles refined the guidelines to align with clinicians' needs and build support through co-design. Data gathered on individual patients receiving transfusions and reaction rates during the trial were compared to international data.<h4>Results</h4>A total of 100 patients received a transfusion during the trial. Eleven patients either had a previous reaction or experienced their first reaction during this time. All patients followed the guidelines and had either no premedication or an oral antihistamine premedication. There were no breakthrough reactions using oral antihistamines. The overall reaction rate was 1.33%, which aligns with the reported data on ATRs internationally.<h4>Conclusion</h4>A restricted prescribing approach to pharmaceutical cover prior to blood and platelet transfusions can be implemented effectively in a paediatric cancer population, without an increase in the risk of harm to the patients.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	Wiley
dc.relation.ispartof	Journal of paediatrics and child health
dc.relation.isbasedon	10.1111/jpc.15698
dc.rights	info:eu-repo/semantics/closedAccess
dc.subject	1103 Clinical Sciences, 1114 Paediatrics and Reproductive Medicine, 1117 Public Health and Health Services
dc.subject.classification	Pediatrics
dc.title	Rationalised premedication practice for blood product transfusions: A single-centre quality initiative.
dc.type	Journal Article
utslib.location.activity	Australia
utslib.for	1103 Clinical Sciences
utslib.for	1114 Paediatrics and Reproductive Medicine
utslib.for	1117 Public Health and Health Services
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
utslib.copyright.status	closed_access	*
dc.date.updated	2021-12-06T04:07:34Z
pubs.publication-status	Published

Abstract:

Aim

Blood and platelets are scarce resources that are an essential part of the supportive care for paediatric cancer patients. There are many inherent risks involved with transfusions including acute transfusion reactions (ATRs). Following an initial ATR, prophylactic medications are commonly given prior to subsequent transfusions. However, there are risks with medication administration as well as negative implications for the health system. Our aim was to prevent the automatic prescribing of premedications prior to blood and platelet transfusions for ATRs. We hypothesised this would not increase the risk of harm.

Methods

Our intervention was to eliminate automatic prescribing of intravenous corticosteroids and intravenous promethazine prior to a transfusion. This was approached through a behaviour change model and the implementation of recommended prescribing guidelines. Three Plan Do Study Act (PDSA) cycles refined the guidelines to align with clinicians' needs and build support through co-design. Data gathered on individual patients receiving transfusions and reaction rates during the trial were compared to international data.

Results

A total of 100 patients received a transfusion during the trial. Eleven patients either had a previous reaction or experienced their first reaction during this time. All patients followed the guidelines and had either no premedication or an oral antihistamine premedication. There were no breakthrough reactions using oral antihistamines. The overall reaction rate was 1.33%, which aligns with the reported data on ATRs internationally.

Conclusion

A restricted prescribing approach to pharmaceutical cover prior to blood and platelet transfusions can be implemented effectively in a paediatric cancer population, without an increase in the risk of harm to the patients.

Please use this identifier to cite or link to this item:

http://hdl.handle.net/10453/152140