9.10 Transfusion threshold in the intensive care unit

Published 11/06/2024

Quality improvement methodology

  • A quality improvement approach should be used to develop a blood conservation bundle for patients in the intensive care unit, with the aim of decreasing blood transfusions.6 This approach could include regular review of anticoagulant medications and stress ulcer prophylaxis, guidance on the frequency of blood sampling for individual patients and review of blood volumes being removed during sampling.
  • A multidisciplinary approach involves including medical, nursing and pharmacy staff to develop a local approach to blood conservation.
  • Improvement techniques may include a local programme of education for staff and checklists/ techniques to prompt daily consideration of the need for blood sampling and avoiding unnecessary blood tests.
  • The impact of the blood conservation bundle would require evaluation – for example, the impact on changing haemoglobin concentration and the number of blood transfusions.
  • Implementation of aspects of the bundle can be displayed to the multidisciplinary team using run charts to monitor progress over time.