Anemia Management and Audit Feedback Practices for Reducing Overuse of RBC Transfusion

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Table of Contents

Introduction
Background Information
Possible Audit Enhancements to Consider
Conclusion
Reference List

Introduction

In general terms, an audit is a process of improving the quality of certain services. Patient care is often audited because changes that have to be introduced are somewhat spontaneous despite being based on systematic reviews of existing evidence. Thus, numerous criteria have to be included in the discussion when an audit of patient care or laboratory functions has to be carried out (Getahun et al., 2019). The implementation of change is often included in the audit as well because continuous improvement efforts presuppose that clinical governance is the biggest priority for everyone involved.

When an audit has to be carried out to evaluate the qualities and strengths of a laboratory, 360-degree feedback might be necessary to assess lab efficiency in a reasonable manner (Gawade et al., 2021). The three components that have to be discussed when dwelling on laboratory audits are pre-analysis, analysis, and post-analysis. The existing evidence also suggests that the current quality cycles cannot be based on just one of the components mentioned above (Wandita et al., 2022). Consequently, auditing a haematological laboratory represents a complex process that requires the team to employ all kinds of knowledge and experience to achieve actual improvements in the field.

The current paper represents an assessment of an audit completed in a haematological laboratory.

Background Information

Prior to considering any of the potential enhancements that could improve future audits, it is crucial to discuss the significance of errors during the testing cycle. Pre- and post-analysis errors could be associated with inappropriate care solutions and the use of available instruments (Hueth, Jackson and Schmidt, 2018). For the current audit assessment, it means that further investigations have to be considered at the beginning of the audit in order to avoid care cost increases and ensure that the issues in question will be resolved. A high percentage of incomplete laboratory forms is another problem that has to be noted when discussing laboratory audits. According to Derzon et al. (2019), laboratory data should be the primary candidate for a thorough audit because of the incredibly high level of influence on diagnoses and patient outcomes. Thus, an audit could cut the cost of patient treatment when done correctly and comprehensively. This is also one of the main reasons why the analysis phase is often left untouched in order to help auditors focus more on pre- and post-analysis processes.

The inherent vulnerability of the current audits to errors makes it safe to say that the best way to improve an audit could be to focus more on pre- and post-analysis activities in order to help laboratory employees increase the transparency of their activities. The problem with this factor is that almost 70% of errors transpire during the pre-analysis stage and avert team members from recognising some of the threats (Haupt et al., 2021). For example, there can be numerous activities or variables that will never be under the control of laboratory staff due to being outsourced. Sample handling and transportation or specimen identification might turn into serious obstacles for laboratory workers. This is why request forms can get lost rather often and deprive the responsible team members of vital patient information. All of these details are crucially important because they validate the use of the audit and represent the quickest way to access all of the information relevant to the case (Grimshaw et al., 2019). Any existing audit of a haematological laboratory would have to be checked against the inclusion of primary clinical details and all of the secondary information that could enhance the treatment process.

Possible Audit Enhancements to Consider

The primary task that has to be completed during the assessment of the audit is to see how the current healthcare system is dependent on reliable laboratory services. Thus, regular evaluation activities might become the most important element of the laboratory workflow, with the staff being required to plan audits and other operations in advance (Kelly et al., 2022; Patidar and Kaur, 2018). One of the vital issues with the current audit is that relevant testing results are not presented logically. Thus, the audit does not contain any information regarding how request forms are completed and delivered to the destination. Considering the given audit, there is a high probability of pre-analysis forms remaining untouched. When having the basic patient information only, care providers might be caught up in a situation where they would not know the tests to request (Hortlund et al., 2021). Therefore, the provided audit assessment has to be extended to consider all of the request forms upon getting access to them.

Another element of audit critique that cannot be overlooked is the availability of request forms and other documentation. The lack of background information on the audit makes it safe to say that haematological laboratory workers might not gain enough insight into patient information. On a long-term scale, it could become the main reason why treatment plans would be timed and administered incorrectly (Argaw, Mavundla and Gidebo, 2019; Gay, Sikaris and Badrick, 2019). There were no clinical assessment summaries in the audit, which means that the existing documentation was not of high quality. The process of the audit was not as quick and exact as expected. The fact that the current audit highlighted the availability of patients’ demographic data also proved that the given haematological laboratory paid close attention to the individual needs of every patient. Nevertheless, there was no information regarding how patients’ specimen was treated. This finding enables a conclusion that the audit at hand was not detailed enough to satisfy the laboratory-based needs and the high standards of providing services to patients.

On the other hand, the current audit assessment might be seen as lacking interpretative comments intended to make it easier for the staff members to collect adequate clinical information. According to Chatterton and Kay (2018), it is one of the shortest paths to harmful activities and misleading care procedures. The inclusion of vital data in the request forms is the primary means of processing the available sample correctly and carrying out the necessary haematological laboratory tests. Specimen labelling was missing from the audit, and so were the reports on mistaken or missing labels. The audit process could be improved by the team assessing the recommended volume of blood samples available to the haematology laboratory (Hoenigl et al., 2018; Kulkarni et al., 2020). The high chance of exposing patients to false positives should be curbed by the changes made to the current audit intended to mediate specimen volume errors and prevent incorrect diagnoses.

The ultimate problem to be addressed when looking at how the audit was carried out is the improvement of access to request forms and informative summaries. Even though the team does not have any trouble conducting high-quality blood assessments, it would make perfect sense to provide all responsible employees with guidelines (Gordon et al., 2020). Staff members cannot ignore the importance of minimising the cost of laboratory functions, so the haematological unit should be seen as improving blood management in the nearest future. Thus, significant changes might benefit the team if they touched upon the creation of audit routines. The possibility to identify health issues proactively would contribute to the establishment of an organisational environment where audits are anticipated and appreciated (Gude et al., 2018). The recommendation here is to deploy an active forum to have staff members exchange experiences and ensure that communication between parties is facilitated reasonably. Over time, routine practice audits will be carried out to ensure that all patients and caregivers have access to educational materials and effect change triggers.

Another potential way to enhance the existing audit process would be to ensure that laboratory staff collects vital clinical detail from at least 70% of the request forms. On a long-term scale, it will help the team obtain better results in terms of patient outcomes while also helping the team acquire the necessary skills associated with the three phases of audits (Mok, Nabulsi and Chowdhury, 2020). Overall, the scope of the audit was respected, as no inappropriate investigations have been recommended or requested throughout the audit checklist. There was some misleading information included in the documentation, so it was hard to interpret the results of the audit and its effectiveness. Unnecessary or inessential tests could lead the team to losing time and money while carrying out procedures that do not lead to positive patient outcomes (Antonelli et al., 2018; Sawhney et al., 2019). The current audit overcomes this issue by including information related to demand implications and possible resource management solutions.

It can be stated that the current audit was rather detailed and touched upon a number of important questions. Nevertheless, the lack of guidelines for patients and care providers should be considered for future renditions of the audit. The haematological laboratory at hand should perform practice audits more often in order to respond to patient needs more rapidly.

Conclusion

The current paper discussed in rich detail the possible ways of improving the existing auditing procedures related to a haematological laboratory. Additional accreditations will help the facility cope with the need to improve constantly and update relevant documentation. This should also be supposed to contribute to the strength of quality management techniques and their outcomes. The inherent level of competence and access to certain resources is critical when it comes down to improvements intended to enhance a haematological laboratory. Thus, tests have to be carried out quickly but attentively. Future audits of the given laboratory should be subject to more well-directed planning and active support of the existing staff. The management should provide all the technical requisites while making sure that all the relevant knowledge is accessible and eventually enhances the quality of services provided to patients. Most importantly, it has to be hypothesised that haematological audits should not be treated as a one-time procedure.

Overall, the biggest issue with the audit at hand is that there are actions missing from the agenda, and certain documentation does not provide the audience with the information that one might expect to see in a report. The team should be encouraged to pursue further accreditation and create an environment where audits are normalised and represent a usual part of organisational activities. The results of the current audit assessment prove that more attention has to be paid to patients and their unique needs when evaluating the benefits of directing them to a haematological laboratory.

Reference List

Antonelli, G. et al. (2018) ‘Validation model of a laboratory-developed method for the ISO15189 accreditation: the example of salivary cortisol determination’, Clinica Chimica Acta, 485, 224-228.

Argaw, M. D., Mavundla, T. R. and Gidebo, K. D. (2019) ‘Management of uncomplicated malaria in private health facilities in North-West Ethiopia: a clinical audit of current practices’, BMC Health Services Research, 19(1), 1-14.

Chatterton, F. and Kay, V. (2018) ‘An audit of Ninewells Hospital fertility preservation service’, Journal of Obstetrics and Gynaecology, 38(5), 732-732.

Derzon, J. et al. (2019) ‘Anemia management and audit feedback practices for reducing overuse of RBC transfusion: a laboratory medicine best practice systematic review and meta-analysis’, American Journal of Clinical Pathology, 151(1), 18-28.

Gawade, G. C. et al. (2021) ‘Audit of reporting errors in biochemistry section of NABL accredited laboratory in a tertiary care teaching hospital’, Avicenna Journal of Medical Biochemistry, 9(1), 37-42.

Gay, S., Sikaris, K. and Badrick, T. (2019) ‘Reporting critical pathology results-what is the current state of play in Australian laboratories? An opinion based on findings of a KIMMS audit’, Australian Journal of Medical Science, 40(4), 126-130.

Getahun, M. S. et al. (2019) ‘Medical laboratory accreditation in a resource-limited district health centre laboratory, Addis Ababa, Ethiopia’, African Journal of Laboratory Medicine, 8(1), 1-5.

Gordon, K. et al. (2020) ‘Update and audit of the St George’s classification algorithm of primary lymphatic anomalies: a clinical and molecular approach to diagnosis’, Journal of Medical Genetics, 57(10), 653-659.

Grimshaw, J. M. et al. (2019) ‘Reinvigorating stagnant science: implementation laboratories and a meta-laboratory to efficiently advance the science of audit and feedback’, BMJ Quality & Safety, 28(5), 416-423.

Gude, W. T. et al. (2018) ‘Health professionals’ perceptions about their clinical performance and the influence of audit and feedback on their intentions to improve practice: a theory-based study in Dutch intensive care units’, Implementation Science, 13(1), 1-11.

Haupt, L. et al. (2021) ‘An audit of disseminated intravascular coagulation screen requests at an academic hospital laboratory in central South Africa’, International Journal of Laboratory Hematology, 43(5), 1174-1180.

Hoenigl, M. et al. (2018) ‘Global guidelines and initiatives from the European Confederation of Medical Mycology to improve patient care and research worldwide: new leadership is about working together’, Mycoses, 61(11), 885-894.

Hortlund, M. et al. (2021) ‘Audit of laboratory sensitivity of human papillomavirus and cytology testing in a cervical screening program’, International Journal of Cancer, 149(12), 2083-2090.

Hueth, K. D., Jackson, B. R. and Schmidt, R. L. (2018) ‘An audit of repeat testing at an academic medical center: consistency of order patterns with recommendations and potential cost savings’, American Journal of Clinical Pathology, 150(1), 27-33.

Kelly, S. et al. (2022) ‘The effect of clinician education on blood transfusion practice in obstetrics: completing the audit cycle’, Irish Journal of Medical Science, 1-7.

Kulkarni, S. et al. (2020) ‘The cost of pre-analytical errors in INR testing at a tertiary-care hospital laboratory: potential for significant cost savings’, Laboratory Medicine, 51(3), 320-324.

Mok, D., Nabulsi, R. and Chowdhury, S. (2020) ‘Management review input checklist for ISO 15189: 2012 internal auditing: an optimisation guide for medical laboratories’, New Zealand Journal of Medical Laboratory Science, 74(1), 17-21.

Patidar, G. K. and Kaur, D. (2018) ‘Audit and education: role in safe transfusion practice’, Asian Journal of Transfusion Science, 12(2), 141.

Sawhney, V. et al. (2019) ‘Impact of attributed audit on procedural performance in cardiac electrophysiology catheter laboratory’, Journal of Interventional Cardiac Electrophysiology, 56(2), 199-203.

Wandita, S. et al. (2022) ‘Development of neonatal death clinical audit instrument’, Indonesian Journal of Perinatology, 3(1), 16-20.

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