ORIGINAL ARTICLE
Bali Medical Journal (Bali Med J) 2016.
Volume 5.
Number 3: 381-384 P-ISSN.
E-ISSN.
Transfusion reactions as an indicator of service quality of blood transfusion in Sanglah general hospital Denpasar Bali-Indonesia CrossMark NK Mulyantari,* AAN Subawa.
I Wayan Putu Sutirta Yasa Published by DiscoverSys ABSTRACT Background: One of the fatal side effects of transfusion is transfusion The incidence of transfusion reaction in Sanglah Hospital is still relatively high and far from national target which is 0.
To achieve the target of quality, it is necessary to set up an active program so that the number of incidence of transfusion reactions can be decreased.
Methods: Pre and posttest interventional study was conducted for 6 months in Sanglah Hospital Bali.
All nurses in wards which is blood product frequently used was involved in this study.
The intervention in this study was in the form of education and training programs on the application of the closed system and cold chain in the distribution of blood products as well as improved service system.
Results: The results showed a decline in the incidence of transfusion reactions occurred every month during the study.
The incidence of transfusion reactions occurred each month was 0.
77%, 0.
56%, 0.
49%, 0.
45% and 0.
38% respectively.
The average reduction in the incidence of transfusion reactions was 0.
08% every month.
The type of transfusion reaction that occurred was 59% urticaria, 29% fever, 7% shortness of breath, 4% fever and chills, and 1% shock.
Conclusion: Education and training programs on the application of the cold chain system and closed system in the distribution of blood products as well as the improvement of service system helped reduce the number of the incidence of transfusion reactions in Sanglah Hospital Bali.
Keywords: Transfusion reaction.
Training Program.
Cold Chain System.
Closed system distribution.
Cite This Article: Mulyantari.
Subawa.
Yasa.
Transfusion reactions as an indicator of service quality of blood transfusion in Sanglah general hospital Denpasar Bali-Indonesia.
Bali Medical Journal 5.
: 381-384.
DOI:10.
15562/bmj.
Department of Clinical Pathology Faculty of Medicine Udayana University.
Bali-Indonesia Correspondence to: Ni Kadek Mulyantari.
Department of Clinical Pathology Faculty of Medicine Udayana University.
Bali-Indonesia
INTRODUCTION
Blood transfusion is a medical procedure that usually indicated as the last resort to save patients who suffer from deficiency in certain or whole components of blood .
anemia, thrombocytopenia, bleeding, coagulopathy, etc.
The decision should be based on strong indication which involve comprehensive evaluation of patient condition including hemoglobin, platelet, blood type, as well as history of allergic reaction.
Although blood transfusions are greatly beneficial to most patients, in some cases blood transfusions also can cause various side effects which generally termed transfusion reactions.
1 There are dozens types of transfusion reactions.
Starting from transfusion reaction which appears within 24 hours .
cute transfusion reaction.
to a transfusion reaction that appears a few days to several weeks after transfusion .
elayed transfusion reaction.
The severity of transfusion reactions ranges from mild to severe or even life-threatening.
Some clinical features of transfusion reactions include fever, chills, shortness of breath, multiple organs failure, manifestations in the skin .
rticaria, rash.
Flushing, oedem.
, jaundice, hemoglobinuria.
Open access: w.
org and ojs.
id/index.
php/bmj nausea, vomiting, bleeding, oliguria, anuria, and the others.
1,2 Aside from the underlying disease, if transfusion reaction has occurred, it is mandatory to treat the disease completely before more serious sequelae develop.
Thus, transfusion reaction potentially delayed patientAos management related to underlying disease, rising medical cost, and prolong patientAos hospital admission.
In the international accreditation standards set by the Joint Commission International (JCI), each hospital is obliged to report, monitor and evaluate to reduce the incidence of transfusion reactions.
Such provisions also apply in Indonesia which stated that the incidence of transfusion reactions is one of the indicators of quality of service as the minimum service standard in hospital.
The target incidence of transfusion reaction is O 0.
01% per 3 According on this target, the incidence of transfusion reactions in Sanglah Hospital is still relatively high.
In 2014, the average incidence of transfusion reactions reached 0.
The majority of transfusion reactions occurred was fever and urticaria.
Efforts to reduce the incidence of transfusion reaction by utilizing the leukocyte-reduction technology, gamma irradiation, anti-HLA
ORIGINAL ARTICLE
examination, anti-HPA and the others, are still difficult to achieve because of limited funding and the availability of equipmentAos.
Based on the problems stated above, it is very important to make new managerial breakthroughs in order to reduce the incidence of transfusion reaction.
MATERIAL AND METHODS
Data and specimen collection An interventional research with pre and posttest design was conducted in Sanglah Hospital from September 2014 until February 2015.
All nurses in Sanglah hospital were included as study The samples were all nurses on duty on the ward with the highest number of blood product usage like Internal Medicine.
Surgery.
Obstetrics and Gynecology and Paedriatic Department.
The intervention in this study was in the form of education and training programs on the application of the closed system and cold chain in the distribution of blood products as well as improved service system.
In the first month (September 2.
education and training program was provided and all of the research subjects were gathered and procedure materials for distributing and transporting blood products was given as well as training to properly pack the blood products in the cold box.
In the following months the interventions were carried out by the dissemination of the blood service operational standards procedure to each ward in aforementioned Departments.
Improvement program of service system was conducted by strict supervision of cold chain and close system in the distribution and transportation of blood products as well as supervision of implementation of the AuA 30-minute ruleAy.
Blood products that were already taken out from blood bank should be immediately returned to the blood bank within a maximum of 30 minutes if the bloods were canceled to be used.
Officers who violated this procedure were to be immediately reprimanded and re-educated.
The program was conducted for 6 months .
nded in February 2.
and incidence of transfusion reactions that occurred was evaluated every month.
RESULTS
In the first month of the intervention (September 2.
the number of occurrences of transfusion reactions was 19 out of the total 2475 number of transfused blood units for the month.
The following month, the number of incident of transfusion reactions per total blood bags transfused was respectively 13/2323, 10/1980, 10/2030, 9/2011, 9/2327.
The incidence of transfusion reactions found was Figure 1AEIncidence of Transfusion Reaction in Sanglah General Hospital Bali mostly those of the components of Pack Red Cells (PRC) followed by the component of Thrombocyte Concentrate (TC) and only a small portion of the components of Fresh Frozen Plasma (FFP).
The results (Figure .
showed a decline in the incidence of transfusion reactions every month during the time of research.
From August 2014 until February 2015, the incidence of transfusion reactions per month was 0.
77%, 0.
56%, 0.
5% 0.
45% and 0.
38% respectively.
The mean reduction in the incidence of transfusion reactions was 0.
every month.
The type of transfusion reaction that occurred during the six-month of research is shown in the following figure:
The majority of transfusion reactions occurred were urticaria and fever.
The number of cases of transfusion reactions varied, ranging from pediatric to geriatric and the ratio of the number of transfusion reactions in pediatric patients and those in adults ranged from 1: 2-3.
Most cases of transfusion reactions occurred in the ward of the Department of Internal Medicine, but when it is compared with the proportion of blood usages, transfusion reactions percentage divided by the total number of blood units transfused was almost the same in each ward.
Of the 70 cases of transfusion reactions that occurred, 88% of cases were classified as mild, 11% were classified as moderate and 1% of case was classified as severe transfusion reactions.
DISCUSSION