2025 National Comparative Audit of NICE Quality Standard QS138

Provide the opportunity to evaluate local evidence of progress towards compliance with the NICE Quality Standard for Blood Transfusion since the 2024 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 patient blood management (PBM) and to measure their effectiveness in improving patient care
Allow the transfusion community and national blood transfusion committees to benchmark the progress of PBM

All NHS Trusts in the UK were automatically enrolled in the audit, aiming to optimise follow-up data in light of the Infected Blood Inquiry. Each participating site was issued with a stationery pack that contained guidance for selecting a sample for audit and five data collection forms, with ten copies of each, allowing them to audit up to 50 patients. Audit standards 1 to 4 were derived from NICE Quality Standard QS138 and standard 5 from NICE Guidance NG24. The audit was divided into five sections, A, B, C, D & E, with each section reviewing compliance with a standard, and a patient’s record could be used for more than one section where applicable. Data were collected on cases seen during July, August and September 2025.

954/1251 (76%) 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 66% in the 2024 audit)
1207/1568 (77%) patients undergoing surgery with expected moderate blood loss received tranexamic acid (compared to 75% in the 2024 audit)
1018/1576 (65%) 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 68% in the 2024 audit)
608/1627 (37%) of transfused patients had evidence of receiving both written and verbal information about the risks, benefits and alternatives to transfusion (compared to 36% in the 2024 audit)
710/1582 (45%) of eligible patients received red cell transfusion compliant with the NICE guideline recommendation for restrictive red cell transfusion (compared to 47% in the 2024 audit)

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:

QS138 Quality Insights tool
Appropriate use of blood component toolkits
Blood Assist app for blood component administration, for mobile download on Android and IOS, or as a web app
Blood Components Indication Codes app, available for mobile download on Android and IOS, or as a web app
Blood Essentials is an interactive PDF book; it supports a transfusion knowledge base, assists all healthcare professionals involved in blood transfusion. There is also a section on major haemorrhage (MH) to support laboratory and clinical staff
Patient information leaflets
Preoperative anaemia guidance (toolkits with information about patients with anaemia, and iron in diet; quality improvement; Blooducation; research)