Examination of usage processes of blood and blood products in the operating room of Dokuz Eylül University Hospital and Research within the framework of quality standards

Abstract: Although many guidelines on patient blood management (PBM) have been published, including international and national recommendations, there is no agreed, enforceable, auditable and multidisciplinary guideline yet. One of the common recommendations of the published guidelines is that each unit is specific, in accordance with quality standards, planning is done and guidelines are created. We have not come across a study that aims to improve the quality standards and examine the PBM processes applied in our hospital in a multidisciplinary manner through the eyes of employees who bear the burden of the process, such as the Transfusion Committee, Hemovigilance Team, Blood Center, Data Processing Center and Quality Units. Background: In Dokuz Eylul University Hospital Operating Room, we aimed to examine the usage processes of blood and blood products and to improve their quality standards. Materials and Methods: After the approval of the Ethics Committee and the patient data usage permissions of DEU Hospital Chief Physician, based on the records of Probel, Blood Center and Hospital Information Management System, the hospital admission data of the patients between 01.01.2019 - 31.12.2019, the surgery preparation period, surgery, surgery (Recovery, PACU, Intensive Care) blood use data, blood center, hemovigilance and quality unit reports were examined. Results: It was determined that 1,066,229 patients were admitted to DEU Medical Faculty Hospital in 2019 and 290,390 of them were treated by surgical units. It was understood that 37,858 of these patients were operated and 28,501 U blood products were requested for preparation, but 60% of them were used. It was understood that the most blood product requests to the service before the operation were made by general surgery, the most usage was performed by cardiovascular surgery (CVS) and erythrocyte suspension (ES) was used the most. It was understood that the surgical and anesthesia teams did not use the pre-operative patient evaluation software, there was no maximum surgical blood component request chart, the blood center software was not used by the anesthesiologist and was insufficient in the postoperative processes. Although 50% of the patients were anemic, it was found that optimization was insufficient in the preoperative period, and blood preservation methods were not used adequately during the operation. It was understood that the blood center and hemovigilance teams worked devotedly despite their missing staff. Although the feedback on blood use results is insufficient, it has been determined that blood destruction rates have decreased in recent years. It was understood that the quality units acted together with all parties while continuing the blood center donor pool development, the completion of the calibrations of the devices, and the training activities. Discussion: The reason why all units in the hospital closely follow the international and national guidelines, and despite all the efforts of the quality systems and management, the reason for not reaching a sufficient level is that each unit cannot create its own applicable, traceable, multidisciplinary systems. Every scientific institution must closely follow international guidelines, current scientific developments, and identify their own shortcomings and create their own guidelines. As guided by the quality cycles, each unit has to "Plan, Implement, Control, Take Precautions". First of all, this study aimed to evaluate the data experienced from within by all units carrying the burden of blood management and to make a step for the improvements to be made. Conclusion: In the light of 2019 data, there are deficiencies in the pre-operative optimization of our patients, blood request programs, blood use and tracking software and the production of our own instructions. For a better quality blood management, it is necessary to increase the coordination of all units and clinics. Better quality blood management will reduce unnecessary workload usage, coordination between units, blood destruction rates and costs.