SLIDE 1
DON'T US E T WO WHE N ONE WIL L DO
L OP AG AUDIT OF DOUB L E
- DOS
E P L AT E L E T S
Dr Megan R
- wley, Haem
26.5%
DON'T US E T WO WHE N ONE WIL L DO L OP AG AUDIT OF - - PowerPoint PPT Presentation
DON'T US E T WO WHE N ONE WIL L DO L OP AG AUDIT OF - - PowerPoint PPT Presentation
DON'T US E T WO WHE N ONE WIL L DO L OP AG AUDIT OF DOUB L E -DOS E P L AT E L E T S Dr Megan R owley, Haem atologis t NHS B T and ICHNT P latelet us age in E ngland has ris en by 26.5% over 7 years 26.5%
SLIDE 2
SLIDE 3
Do we us e too m any platelets ?
Generally, a s ingle unit or 1 adult therapeutic dos e (AT D) typically gives an im m ediate ris e in platelet count of 20-40 x109/ l in throm bocytopenic patients without platelet antibodies
1
A random is ed controlled trial s howed no difference in the num ber of patients who had s ignificant bleeding (WHO grade 2 or above) when they received s ingle
- r double-dos
e platelet trans fus ions
2
1Norfolk D (Ed) (2013) Handbook
- f Transfusion Medicine 5th Edition,
The Stationary Office.
1Norfolk D (Ed) (2013) Handbook
- f Transfusion Medicine 5th Edition,
The Stationary Office.
2Slichter SJ et al (2010). Dose of prophylactic
platelet transfusions and prevention of haemorrhage. New England Journal of Medicine;362:600-13
2Slichter SJ et al (2010). Dose of prophylactic
platelet transfusions and prevention of haemorrhage. New England Journal of Medicine;362:600-13
SLIDE 4
2010 NCA P latelet Us e in Haem atology P atients
139 Hos pitals s ubm itted 3296 platelet trans fus ion epis
- des 40 s
equential trans fus ions
- ver 3 m
- nths
T he reas
- n for trans
fus ion was prophylactic in 69%, pre-procedure in 15%, therapeutic in 13% and unclear in 3% 10% (220/ 2277) of prophylactic platelet trans fus ions were double-dos e trans fus ions T he m ajority, 73% (161/ 220) of double-dos e trans fus ions , were adm inis tered to inpatients
Clinical Leads: Drs Lise Estcourt and Janet Birchall
R E COMME NDAT ION Double-dos e prophylactic platelet trans fus ions s hould not be us ed routinely R E COMME NDAT ION Double-dos e prophylactic platelet trans fus ions s hould not be us ed routinely
SLIDE 5
A s urvey of platelet trans fus ion practice in the North of E ngland
Where did platelets go in 2012?
- A. Charlton, J. Wallis, J. Robertson, D. Watson, A. Iqbal & H. Tinegate
Transfusion Medicine, 2014, 24, 213 218
24% s urgery 75% m edicine*
[*54% haematology]
24% s urgery 75% m edicine*
[*54% haematology]
153 doses (8% of total) 57 double-dose 9 triple dose 3 quadruple
47% of the m ultiple dos es
were given to patients with haematological disease. 153 doses (8% of total) 57 double-dose 9 triple dose 3 quadruple
47% of the m ultiple dos es
were given to patients with haematological disease.
SLIDE 6
SLIDE 7
L
- P
AG Double-Dos e P latelet Audit
AUDIT AIMS
1.T
- determ
ine how com m
- n reques
ts for double-dos e (or m ultiple-dos e) platelets are
2.T
- determ
ine the reas
- n for double-dos
e platelets and the clinical s pecialty m aking thos e reques ts
3.T
- determ
ine how often review by a haem atologis t m
- difies
the reques t for double-dos e platelets S T ANDAR D T he dos e of platelets in adults s hould not exceed one unit (1 AT D)
SLIDE 8
Collect all double-dos e reques ts for one week (Monday 9am to Monday 9am )
SLIDE 9
Us e thes e indication codes to record the reas
- n
for trans fus ion
SLIDE 10
S end back the data with s
- m
e overall us age and was tage data for the s am e week
This badly worded questions
- n the data
collection form meant we did not get denominator
data
This badly worded questions
- n the data
collection form meant we did not get denominator
data
SLIDE 11
R es ults
29/ 50 (58%) hos pitals in the L
- ndon R
T C At leas t 1 m ultiple dos e platelet reques t was received by 26/ 29 (90%) hos pitals (3 nil returns) 205 s eparate m ultiple trans fus ion reques ts for 431 units
- f platelets
4/ 29 (14%) did not s upply data for the total num ber of platelets fated as trans fus ed during the audit period (no denom inator) 6/ 29 (21%) did not s upply data for the num ber of units fated as was ted during the audit period
SLIDE 12
Num ber of m ultiple-dos e platelet reques ts
SLIDE 13
Clinical S pecialty R eques ting Multiple Dos e P latelets
Clinical S
peciality
No of Cases
Haematology 62
Cardiac
30 L iver 23
Oncology
19 ITU 10 S urgical 12
Theatres
8
A&E
6
Total
170
36% of multiple
dose requests were in haematology patients
Only 2 of the 30
multiple dose requests in
cardiac/cardiac
surgery were
referred for
haematological advice
SLIDE 14
Indication and appropriate trans fus ion
Indication Code Threshold Pl count
(x109/L)
Cases
% requested
- utside
threshold P1: Prophylaxis in BMF
10 17 53%
P2: Prophylaxis in BMF + risk
20 15 73%
P3: Prophylaxis for invasive procedures
50 8 35%
P4: Massive transfusion
75 3 50%
P6: DIC
5
- P10: NAIT**
30 15 73%
Other
12
- Not recorded
73
Total
205
** one hospital ? correct indication code used
SLIDE 15
Advice of a haem atologis t
Haem atological advice was s
- ught in 111/ 205
(54%) of cas es 86% (96) double platelet dos e was is s ued 6% (7) the dos e was reduced 3% (3) reques ts were cancelled 5% (5) the outcom e was not docum ented
SLIDE 16
S um m ary
Hopefully this audit highlighted the extent of m ultiple dos e platelet us e to the trans fus ion team s who undertook the data collection and triggered local dis cus s ion Haem atology and Cardiac S urgery account for the larges t num ber of double-dos e platelets and m any were given above the thres hold for that indication code As king a haem atologis t to clarify if the double-dos e was indicated did not m ake a difference in the m ajority
- f cas
es
SLIDE 17
Dis cus s ion
Can we us e audit to im prove platelet pres cribing? If s
- , what do we do next?
SLIDE 18
Dis cus s ion what do you want?
You can choos e which week you do and, if there are no double dos e reques ts then it would be helpful to have a nil return Get your haem atologis ts
- n board with the indication
codes and vetting of reques ts m ay need s
- m