2021 National Comparative Audit of NICE Quality Standard QS138

Key objectives

  • Provide the opportunity to evaluate local evidence of compliance with the four quality statements in the NICE Quality Standard for Blood Transfusion

  • Provide data to hospital teams to allow their understanding of what steps they can take to implement Patient Blood Managment (PBM) and to measure their effectiveness in improving patient care

  • Allow the transfusion community, for example, the NBTC to benchmark the progress of PBM and its effect on improving patient outcomes

What did we audit?

  • All NHS Trusts in the UK were invited to take part in the audit. Trusts were allowed to enrol as whole Trusts or as hospitals within a Trust, so we used the term “sites” to describe those who contributed data. Each participating site was issued with a stationery pack that contains four data collection forms, with ten copies of each, allowing them to audit up to 40 patients. The audit standards were derived from the statements in the NICE Quality Standard QS138. The audit was divided into four sections, A, B, C & D, and a patient’s record could be used for more than one section. Data were collected on cases seen during October, November and December 2021, on transfusions that occurred during August to December 2021.

Who took part?

  • 153 sites contributed data
  • 4679 patients were analysed

What did we find?

Main findings 

  • 665/1131 (59%) of the patients who were known to have iron deficiency anaemia prior to being admitted for surgery were treated with iron before surgery

  • 1079/1599 (67.5%) patients undergoing surgery with expected moderate blood loss received tranexamic acid

  • 893/1534 (58%) patients receiving elective red blood cell transfusions had both their Hb checked and a clinical re-assessment after a unit of red cells was transfused

  • 1032/1622 (64%) of transfused patients had evidence of receiving written or verbal information about the risks, benefits and alternatives to transfusion

  • Only 422/1622 (26%) received both written and verbal information

Our recommendations:

  • Hospitals should examine their procedures for implementing the NICE Quality Statements for Blood Transfusion. They should explore the barriers to their implementation and work to overcome them

  • Hospitals should take advantage of regular repeats of this audit to monitor effectiveness of interventions

To support hospitals to meet these recommendations and implement the Quality Standards, the following information and guidance is provided: