Audit of the clinical use of fresh-frozen plasma in umbria: study design and results
Abstract number: PP-WE-688
Basileo1 M., Marchesi2 M., Marchesini1 E., Materazzi3 M., Germani2 A., Rocchetti2 L., Silvani2 C., Iorio1 A.
11Internal and Vascular Medicine, University of Perugia 22Transfusional unit, Hospital of Perugia, Perugia 33Transfusional unit, Hospital of Terni, Terni, Italy
How-to-cite Basileo M, Marchesi M, Marchesini E, Materazzi M, Germani A, Rocchetti L, Silvani C, Iorio A. Audit of the clinical use of fresh-frozen plasma in umbria: study design and results. Journal of Thrombosis and Haemostasis 2009; Volume 7, Supplement 2: Abstract PP-WE-688
Background: Fresh frozen plasma (FFP) is the elective treatment for acute hemorrhage in patients with abnormal clotting tests, disseminated intravascular coagulation or rare bleeding disorders, all when specific concentrates are not available, and thrombotic thrombocytopenic purpura. However, several reports in the literature point out a high rate of inappropriate prescriptions, and potential benefit from guideline issuing and audit activity. We describe the empirical identification and evaluation of a set of indicators to be used to set up a clinical audit program for FFP usage.
Designed and Methods: The requests for FFP issued from January to June 2007 to the 4 partecipating blood banks were collected and analyzed. The clinical record forms (CRF) of the transfused patients were also evaluated. The following indicators were selected and analysed: request completeness, appropriateness for indication and dosage, CRF completeness, adverse events, mortality, efficacy and the agreement between electronic database and paper request forms. The indicators were analysed to identify those relevant to be controlled for appropriate plasma usage.
Results: A total of 1300 requests referring to 556 patients were collected. 63.9% of the requests was scored as 3–4/4 for completeness (65–80% of fields filled-in). Appropriateness for indication was found to be 42.6% of evaluable requests (74.1% of the total), with a significant difference among issuing entity (medical, surgical or intensive care units). Appropriateness for dosage was found to be 40.7% of evaluable requests (58.5% of the total). The overall completeness of CRF reporting was around 70%. Finally, we showed that only in a minority of cases (45%) FPP administration lead to normalization of previously abnormal coagulation tests.
Conclusions: The more relevant indicators to manage and optimize the use of FFP were found to be appropriateness for indication, completeness of request filling and CRF reporting.
Disclosure of interest: none declared.
