QI Project in Paediatrics: What can we do to reduce the number of pre-transfusion bloods samples that are rejected?

Camille Roberts ST1

Why did we initiate the project?

​In paediatrics, as in other specialties, a large number of pre transfusion blood samples are rejected as a result of labelling and sampling errors. Over 200 paediatric pre-transfusion blood samples were rejected in UHW in 2018. We wanted to find out where errors were occurring and whether we could make any improvements.

What did we discover?

​Questionnaires were completed by 43 staff members across paediatrics including senior and junior doctors and nurses. 49% had never received training or none within the last 3 years. 26% were ‘somewhat’ or ‘not at all’ confident with pre-transfusion sampling, and 79% admitted to having a sample rejected previously.
 
We also undertook an audit of rejected Paediatric samples between March to May 2018. 45 pre-transfusion samples were rejected, of which 75% were due to labelling errors. The most common labelling errors were a lack of signature, date of birth, first line of address, and no declaration completed.

What did we do?

​We have put together an informative poster with key points for pre-transfusion sampling, focussing on accurate labelling. This is located in treatment rooms and doctors’ offices across the children’s hospital, including theatres and paediatric A&E. It will also be provided to new doctors at induction. We are working on improving staff competency training rates and have had doctors trained as assessors to facilitate this.
 
We will subsequently re-audit and repeat questionnaires to assess whether rates of sample rejection have improved.

How is this relevant to paediatrics & elsewhere?

​Having to repeat blood samples following errors can be particularly emotive in Paediatrics. However, it is of relevance across all specialties as incorrectly labelled samples are more likely to lead to ‘wrong blood in tube’ errors, necessitate additional procedures for the patient, lead to delays in treatment, and add to staff workload.

Any suggestions?

​If you have any suggestions or if you are interested in expanding the project to your area please get in touch, we would love to hear from you.
Dr Camille Roberts (ST1 in Paediatrics)
Camille.Roberts@wales.nhs.uk

Contributors to the project...

​Ann Patterson, Dr Sally Richards, Dr Ifeoma Ujomu, Samantha Mcwilliam