2023 National Comparative Audit of NICE Quality Standard QS138

7 March 2024

Key objectives

  • Provide the opportunity to evaluate local evidence of progress towards compliance with the four quality statements in the NICE Quality Standard for Blood Transfusion since the 2021 audit

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

  • Allow the transfusion community, including the National Blood Transfusion Committee, 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 use the term “sites” to describe those who contributed data. Each participating site was issued with a stationery pack that contains guidance for selecting a sample for audit and 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. An individual patient’s record could be used for more than one section. Data were collected on cases seen during January, February and March 2023.

Who took part?

  • 126 sites contributed data
  • 3730 patients were analysed

What did we find?

Main findings 

  • 617/908 (68%) of the patients who were known to have iron deficiency anaemia prior to being admitted for surgery were treated with iron before surgery (compared to 59% in the 2021 audit)

  • 900/1335 (67.5%) patients undergoing surgery with expected moderate blood loss received tranexamic acid (compared to 67% in the 2021 audit)

  • 766/1205 (63.6%) patients receiving elective red blood cell transfusions had both their haemoglobin checked and a clinical re-assessment after a unit of red cells was transfused (compared to 58% in the 2021 audit)

  • Only 475/1356 (35%) of transfused patients had evidence of receiving both written and verbal information about the risks, benefits and alternatives to transfusion (compared to 26% in the 2021 audit)

Our recommendations:

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

  • Hospitals should undertake regular repeat audits of the NICE Quality Standard using the National Comparative Audit and the QS138 Quality Insights tool as a quality improvement initiative

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