2024 National Comparative Audit of NICE Quality Standard QS138

31 March 2025

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
  • Include an additional audit of restrictive haemoglobin thresholds to guide transfusion decisions in adults who are not actively bleeding or on a chronic transfusion programme.
  • 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
  • An organisational survey of the resources for transfusion in hospitals e.g. staff, information technology etc. was conducted alongside this audit. Analyses are being carried out to determine correlations, if any, between the availability of different types of resources for transfusion in hospitals and compliance with the Standards used in this audit.

 

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 guidance for selecting a sample for audit and four data collection forms, with ten copies of each, allowing them to audit up to 50 patients. The audit Standards were derived from the Standards in the NICE Quality Standard QS138. The audit was divided into five sections, A, B, C, D & E, and a patient’s record could be used for more than one section. Data were collected on cases seen during July, August and September 2024.

Who took part?

  • 149 sites contributed data
  • 5105 patients were analysed

What did we find?

 

Main findings 

  • 880/1337 (66%) of the patients who were known to have iron deficiency anaemia prior to being admitted for moderate blood loss surgery were treated with iron before surgery (compared to 68% in the 2023 audit)

  • 1259/1671 (75%) patients undergoing surgery with expected moderate blood loss received tranexamic acid (compared to 67.5% in the 2023 audit)

  • 1088/1600 (68%) 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 (compared to 63.6% in the 2021 audit)

  • 591/1649 (36%) of transfused patients had evidence of receiving both written and verbal information about the risks, benefits and alternatives to transfusion (compared to 35% in the 2021 audit)

  • 680/1445 (47%) of eligible patients received red cell transfusion compliant with the NICE guideline recommendation for restrictive red cell transfusion

 

Our recommendations:

  • Hospitals should examine their procedures for implementing the NICE Quality Standard for Blood Transfusion, and explore the barriers to their implementation and work to overcome them
  • Hospitals should undertake regular repeat audits of the NICE Quality Standard and consider using the QS138 Quality Insights tool as a quality improvement initiative
  • Variation in compliance with the Standards by clinical specialties needs to be explored to understand the reasons and to identify potential solutions

 

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