Decreasing Premedication for Blood Transfusions: A Quality Improvement Project

Background:Premedication administration to patients who are to receive blood transfusions continues despite evidence of a lack of benefit when given to prevent febrile nonhemolytic or mild allergic transfusion reactions. Reviews of ordering practices and staff surveys on an adult inpatient hematology-oncology unit in our multisite oncology medical center indicated a lack of standardization and overuse of premedication in blood transfusions and a lack of knowledge of when it was appropriate to use premedication.Methods:A literature search was performed, and the evidence led to a proposal for a quality improvement (QI) project focused on development of an evidence-based algorithm to guide clinicians in when to administer which premedication, development of clear documentation for premedication plans, integration of the documented premedication plans into electronic orders for blood products, and staff education. Interventions included a hospital-wide algorithm and an electronic order to be integrated with a premedication plan for each patient on the adult hematology-oncology unit.Results:Seven months after implementation of the intervention, premedication use among patients decreased by 57.6%, and the transfusion reaction rate decreased from 1% to 0.8%. Staff knowledge as measured by responses to pre- and postintervention surveys on the appropriate use of premedication also improved.Conclusion:Evidence-based interventions can reduce the incidence of premedication use in patients receiving blood transfusions. To address premedication overuse in blood transfusions at their institution, the authors developed and implemented an evidence-based algorithm to guide clinicians in when to administer premedication and an electronic order to be integrated with a premedication plan for each patient on an adult hematology-oncology unit.