Abstract:
Background: Home or residential care facility based blood transfusion is beneficial for individuals requiring transfusion due to reduced disruption to daily life and the comfort of a familiar environment. However, blood transfusion may result in serious adverse events. There is a lack of research in this area and there is a need to identify rates of adverse events and evaluate the system used for this service.
Objective: To determine the rate of individual and system adverse events associated with blood transfusion at home DESIGN: Retrospective cohort study SETTING: Home or residential care facilities in Adelaide, South Australia.
Participants: Medically stable adults with a chronic disease who underwent blood transfusion in a home setting provided by a Nurse-led service METHODS: Existing data routinely collected for clinical care was used to determine client and system adverse events. A STROBE EQUATOR checklist was used for this study (see File S1).
Results: There were 1790 episodes of care involving 533 participants, with 13 cases of transfusion reaction (incident rate (IR) 0.7% ; 95% CI 0.43-1.25%). Only five of these were severe, resulting in the cessation of the blood transfusion and further medical review or hospital admission (IR 0.28%; 95% CI 0.12-0.68). There were no cases of tampered blood packaging, expired or visually damaged blood products. There were 10 cases of incorrect paperwork (0.6%) and nine cases of incorrect temperature (0.5%). There were 153 cases of vascular access device adverse events (IR 8.5% 95 % CI 7.3-9.9%), most commonly, difficulty cannulating the individual (n= 82, 54%).
Conclusions: A Nurse-led home blood transfusion service was associated with low rates of both individual and system adverse events. Further research is needed to explore the perception of those using this service and supports required to improve the experience.
Clinical relevance: Blood transfusions may be associated with increased risk of morbidity and mortality. This risk may be increased in a home setting due to the distance from an acute care facility. This study has demonstrated that a Nurse-led home blood transfusion service is safe (<1% adverse event rate) for those with a medically stable, chronic condition. There were few failures in the system used to provide this service. Adverse events associated with the vascular access device were the most common complication and the reason for most blood product wastage. Mainly this was due to difficulty inserting the short-term peripheral intravenous catheter (PIVC). RNs should consider ultrasound to aid PIVC insertion to facilitate treatment provision and enhance the experience of the individual.
Reference:
Sharp R, Turner L, Altschwager J, Corsini N, Esterman A. Adverse events associated with home blood transfusion: a retrospective cohort study. J Clin Nurs. 2021 Mar 3. doi: 10.1111/jocn.15734. Epub ahead of print. PMID: 33656751.