Benchmarks for Quality Indicators

[cbaldwin]

I have been working with our hospital's new QA person to fine tune Quality Audits and Quality Indicators in our Transfusion Service.  The QA person asked if I could find "benchmarks" for my Quality Indicators--other facilities that are monitoring the same Quality Indicators so that I have something to compare our facility to.  It makes the data more meaningful.

 

I looked through the AABB site for such information but found none.

 

What do other facilities do regarding assessment of Quality Indicators?  Does anyone use "benchmarks" for comparison?

 

Thank you!

 

Catherine

[David Saikin]

I don't use benchmarks.

[Eoin]

We don't use benchmarks (Don't personally know of any published) but we do set targets and try to hit them every year (e.g. 5% reduction in pre-analytical non-conformances; C/T Ratio of 1.2, 10% reduction in wasted units etc), but we have set them for ourselves over the years - Continual improvement is what Joint Commission (and other regulators) loke to see, and they like targets.

I think that we have our data analysed to death, Pareto Charts - Tracking & trending, but you can definitely see trends and attack them (reminders about specimen & request completion care and talking to repeat offenders, plus targeted education on any errors that become a trend. We also have a matrix with names down one side and error types across the top. - If there is a horizontal line of numbers of errors against a person, you have a problem person and they can come in for special education sessions - similarly if you have a vertical line of errors , you well could have a system (or process) error.

 

Good luck with it anyway.

Cheers

W Eoin

[Dr. Pepper]

Ditto with David. Most quality indicators in BB cry for 100% compliance (properly labeled specimens, issuing and transfusing right unit to right patient, audits of transfusion process, etc. etc.); you don't need a national consensus to tell you that. A crossmatch/transfusion ratio of 2.0 or less was the benchmark (don't know where that came from) forever, but that can vary a lot with your individual pactices, such as crossmatching units "on call" for OR and inpatients or waiting until blood is actually called for then doing a quick electronic or immediate spin crossmatch. There are some recommendations out there for transfusion triggers for appropriateness review, but those are not always in agreement. We looked at these and reached a consensus between several hospital committees and services (but we didn't agree on all points, either). Sorry if I'm not much help.

[tbostock]

There is an extreme lack of benchmarks out there in the Blood Bank world for us to measure ourselves against.  As the other posters above do, I compare to myself and try to show improvements.  For example C/T ratio, the historic benchmark is less than 2.  But since we are doing primarily electronic crossmatching now and setting up blood "on demand", our goal for C/T is less than 1.5, but we average 1.1, so we will be lowering our goal this year to less than 1.3.

 

% fallouts (transfusions that were given outside our criteria that were not justified): Goal: <2%, last year we were at 0.2%

Outdate rate (red cells): Goal: <3%, last year we were at 0.2%

Specimen mislabel rate: Goal <1%, last year we were at 0.2%

 

So we will be lowering all of those goals as well.  Not too drastically, as Eoin stated, the regulators want to see constant improvement.  We are changing our transfusion criteria this year, so our % fallout rate will increase as physicians are going to comply with them "kicking and screaming". 

[Kitty Petershagen]

We use benchmarks from the latest National Blood Survey or from groups such as UHC.

[AMcCord]

As an organization are using National Patient Safety Goals. Is the patient correctly ID'd when specimen collected? Is the patient correctly ID'd at bedside prior to start of transfusion? Goal is 100%. In addition, we are monitoring blood product waste. I suspect we will be incorporating blood management markers within a year based on an organization wide policy for blood use.

[cbaldwin]

We use benchmarks from the latest National Blood Survey or from groups such as UHC.

 

 

Thank you!   I did not know this survey existed and I see it has useful information.  Also, now that I have started this thread I see  there have been similar threads in the past few years so I will read those.

 

As an organization are using National Patient Safety Goals. Is the patient correctly ID'd when specimen collected? Is the patient correctly ID'd at bedside prior to start of transfusion? Goal is 100%. In addition, we are monitoring blood product waste. I suspect we will be incorporating blood management markers within a year based on an organization wide policy for blood use.

 

Thank you!  How do you monitor correct patient ID?  I can only think of observing whether the phlebotomist or nurse asks the patient for name and DOB, but my presence would have an effect on this process.  Also, how do you monitor patient consent?  The patient may sign the consent, but were they fully informed and did they have a chance to ask questions?

 

And thanks to tbostock, Dr. Pepper and Eoin for your input--it is helpful. 

 

I will read the previous threads on this subject before I ask more questions!