|Year : 2022 | Volume
| Issue : 2 | Page : 213-216
A retrospective audit of red cell serology requisition forms received at a reference Testing Center for work-up
Prashant Pandey, Supriya Kumari, Divya Setya
Department of Transfusion Medicine, Jaypee Hospital Noida, Noida, Uttar Pradesh, India
|Date of Submission||01-Oct-2021|
|Date of Decision||29-Mar-2022|
|Date of Acceptance||06-Oct-2022|
|Date of Web Publication||5-Nov-2022|
Department of Transfusion Medicine, Jaypee Hospital Noida, Noida, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Background and Objectives: Audits identify areas of problems in immunohematology workup and transfusion practice which can be corrected by the education of medical staff, formulation of guidelines, and algorithms. An audit is a series of simple, direct questions, which when answered and reviewed, tell us whether the laboratory is performing its procedures, activities, and policies correctly. The aim of this study was to analyze immunohematology request forms sent from red cell serology laboratories to our reference testing center (RTC) to ascertain their completeness. Materials and Methods: This was a retrospective, observational study conducted in the department of transfusion medicine at a tertiary-level health-care center from November 2019 to June 2021. We ascertained whether the immunohematology workup forms details were complete, absent, or incomplete. Results: The study was conducted over a period of 20 months, with 264 forms being audited. In this overall total number, almost one-third of 1894 (34.16%) of the immunohematology workup requisition form details were complete and 716 (12.91%) of these entries were incomplete. However, almost half of the overall number of 2934 (52.92%) of the requisitions were absent. Conclusion: From our study, we concluded that an audit of all the RTC requisitions at the point of receiving can be an important tool to detect requisition errors and results of RTC workup. We received a sample for RTC advanced immunohematological testing from all over India. There is a need for the organization of CME and training of staff to increase compliance regarding sending appropriate RTC advanced immunohematological requisitions and samples.
Keywords: Audit, immunohematology, reference testing center
|How to cite this article:|
Pandey P, Kumari S, Setya D. A retrospective audit of red cell serology requisition forms received at a reference Testing Center for work-up. Glob J Transfus Med 2022;7:213-6
|How to cite this URL:|
Pandey P, Kumari S, Setya D. A retrospective audit of red cell serology requisition forms received at a reference Testing Center for work-up. Glob J Transfus Med [serial online] 2022 [cited 2022 Dec 8];7:213-6. Available from: https://www.gjtmonline.com/text.asp?2022/7/2/213/360498
| Introduction|| |
Immunohematology requisition forms provide important information to the red cell serology laboratory such as patient demographics, clinical details, hematological reports, history of transfusion, pregnancy, medication, and previous antibody (ies) which are pertinent for work-up. Often these details are considered unnecessary and laboratories receive incomplete requisition forms with samples which deprives them of certain relevant details.
An audit is a series of simple, direct questions, which when answered and reviewed, tell us whether the laboratory is performing its procedures, activities, and policies correctly. It identifies areas of problems in immunohematology workup and transfusion practice which can be corrected by the education of medical staff, formulation of guidelines, and algorithms. It is a quality improvement process to improve requisition form details, specimen collection, and handling and processing before the complete distribution of test samples to multiple workstations. Inadequate filling of request forms can limit the advice when interpreting the results. Performing audits ensures the identification of missing information that has the potential to cause delays in the treatment process, can lead to chances of errors, and can cause a transfusion reaction.
Aim and objectives
The aim of this study was to analyze advanced immunohematology request forms sent from various laboratories to reference testing center (RTC) to ascertain their completeness.
| Materials and Methods|| |
Settings and design
This was a retrospective, observational study conducted in the department of transfusion medicine (TM) which receives a sample from various parts of the country for work up at a tertiary-level health-care center from November 2019 to June 2021.
All immunohematology requests received in the department
Audit of requisition forms
We ascertained whether the entries mentioned for immunohematology workup forms details were complete, absent, or incomplete. Each workup form was divided into four sections for the purpose of evaluation. For each section, the information could either be complete, absent, or incomplete. For example, if the diagnosis of patients consisted of only anemia, it would be incomplete. However, if the diagnosis was not provided, it would be absent, if the diagnosis was mentioned as sickle cell anemia, it would be complete. Similarly, if the recipient blood group was positive, forms that mentioned only A were considered incomplete, and forms with a positive group mentioned are complete, if the entry of blood group not mentioned is absent. Assessment of incomplete information was important because it had the potential to cause harm to the recipient. Transfusion-associated errors were not studied because the aim of this study was only to assess the completeness of immunohematology request forms received. The scoring system used has been given in [Table 1]. For complete (C) information, a score of 2 was given; for incomplete information (I), a score of 1 was given, whereas for absent (A) information, a score of 0 was given. For ease of understanding the information on these forms was split into four sections each with different parameters as shown in [Table 2].
Performance evaluation of entries was performed according to a scale. If ≥ 50% of entries for a parameter were complete, performance was satisfactory. However, if < 50% of entries for a parameter were complete, the performance was unsatisfactory.
Inclusion and exclusion criteria
All immunohematology requests received at our RTC from November 2019 to June 2021 were included in the study. Request forms received with no sample or sample leakage were excluded from this study.
Ethical committee approval
Institutional review board approval was obtained for the purpose of this study.
Data were entered in an MS Excel sheet (MS Office, US). Percentage and mean were calculated.
| Results|| |
A total of 264 forms and 5544 entries were evaluated in this duration. Almost one-third (34.16%) of 1894 of these 5544 entries were found to be complete. However, more than half of (52.92%) 2934 of these 5544 were absent. Moreover, (12.91%) 716 of these 5544 of these entries were incomplete. Section-wise distribution of complete (C), incomplete (I), and absent (A) entries is illustrated in [Figure 1]a,[Figure 1]b,[Figure 1]c, respectively.
|Figure 1: Distribution of section-wise (a) complete, (b) incomplete, (c) absent entries|
Click here to view
Distribution of C, I, and A blood requisition form entries is illustrated in [Table 2]. (1) Complete (C) entries in all sections are following.
Satisfactory number of complete (C) entries (>50%) were observed for: hospital details 242 (91.67%), age 239 (90.53%), gender 241 (91.29%), hospital identification number 226 (85.61%), date of sample collection 189 (71.59%), ABO and rh typing 145 (54.92%), and patient name 116 (43.94%).
Unsatisfactory and incomplete entries details are shown in [Table 1] and [Table 2].
Section I contained patient/donor demographic data, in which all entries were satisfactory (name, hospital identification number, age, gender, and hospital details) except the room number was the unsatisfactory entry.
Section II contained clinical details, in which almost all entries were unsatisfactory (history of transfusion, transplant, pregnancy, previous history of transfusion, and history of medication) except the entry of patient diagnosis which was satisfactory.
Section III contained serological workup details, in which almost all entries were unsatisfactory (reason for workup, antibody screening, direct antiglobulin test, and previous antibody) except ABO and Rh typing which was considered satisfactory.
Section IV contained miscellaneous details, in which almost all entries were unsatisfactory (technologist name, interpretations, and comments) except the date of sample collection which was satisfactory.
| Discussion|| |
A clinical audit is a management tool for appraisal and is also an important part of quality assurance, which provides necessary information for improving TM practices. Transfusion services often receive incomplete forms without adequate patient information. A common myth among health-care providers is that a blood sample or a blood group report is all that is required for sending a request form without providing clinical details of the patient. A handful of studies have examined the frequency of incomplete blood requisition forms and highlighted the fact that there are deficits in completing requisition forms. Clinicians who counsel and advise patients about transfusion therapy are responsible for accurately describing the patient's details, as well as the component details, Pandey et al. found that 54.23% of the blood requisition forms were incomplete, whereas Jain et al. found that 19.8% of blood requisition forms were incomplete. Jegede et al. found that 18.8% of forms had incomplete patient details. In this study, we found that 12.91% of the entries had incomplete details. Oyedeji et al. found that only 1.3% of the requisition forms reviewed were fully filled. Patient's name, the referring physician's name, and gender were the most completed information on the forms evaluated, with 99.0%, 99.0%, and 90.3% completion, respectively. Patidar et al. found that the highest number of incomplete fields observed (91.42%) varied from second identification (91.03%) to medical officer's name and signature (1.48%), 51.44% of forms did not mention the urgency of requirements, and pretransfusion hematological parameters were not provided in 53.67% of the request forms. Deb et al. audited blood requisition forms and found that 56% of forms did not mention the blood group of patients and the urgency of the requirement, 3.7% did not mention the indication of transfusion, and 25.1% did not mention the history of the previous transfusion. In our study, we found that 34.16% had complete and 52.92 had completely absent entries.
The strength of this study is that there are very few reports of AIH requisition form analysis from India, especially with a unique scoring system for comparison (rewritten by editors). The limitation was that this was a retrospective study, and after the audit, we were unable to conduct training programs due to the pandemic. However, we intend to conduct a virtual session for the same in the near future.
| Conclusion|| |
RTC requisitions can be an important tool to detect requisition errors. There is a need for organizing of training modules to increase compliance in this regard. This will help minimize potential errors and strengthen safe transfusion practices. Incomplete forms lead to delays in reporting and issues of blood when needed (condensed by editors).
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2]