Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 
  • Users Online:231
  • Home
  • Print this page
  • Email this page


 
 Table of Contents  
SHORT ARTICLE
Year : 2022  |  Volume : 7  |  Issue : 2  |  Page : 213-216

A retrospective audit of red cell serology requisition forms received at a reference Testing Center for work-up


Department of Transfusion Medicine, Jaypee Hospital Noida, Noida, Uttar Pradesh, India

Date of Submission01-Oct-2021
Date of Decision29-Mar-2022
Date of Acceptance06-Oct-2022
Date of Web Publication5-Nov-2022

Correspondence Address:
Prashant Pandey
Department of Transfusion Medicine, Jaypee Hospital Noida, Noida, Uttar Pradesh
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/gjtm.gjtm_90_21

Rights and Permissions
  Abstract 


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 Top


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.[1]

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.[1] 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.[2] 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.[3] 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.[4]

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 Top


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.

Sample size

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].
Table 1: Scoring criteria for entries used in the study

Click here to view
Table 2: Section-wise score for various entries

Click here to view


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.

Statistical analysis

Data were entered in an MS Excel sheet (MS Office, US). Percentage and mean were calculated.


  Results Top


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 Top


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.[4] 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,[3] Pandey et al. found that 54.23% of the blood requisition forms were incomplete,[1] whereas Jain et al. found that 19.8% of blood requisition forms were incomplete.[5] Jegede et al. found that 18.8% of forms had incomplete patient details.[6] 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.[7] 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.[8] 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.[9] 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 Top


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

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Pandey P, Setya D, Mirza SM, Singh MK. Prospective audit of blood transfusion request forms and continuing medical education to optimise compliance of clinicians in a hospital setting. Transfus Med 2021;31:16-23.  Back to cited text no. 1
    
2.
Joshi GP, Landers DF. Audit in transfusion practice. J Eval Clin Pract 1998;4:141-6.  Back to cited text no. 2
    
3.
Alving B, Alcorn K. How to improve transfusion medicine. A treating physician's perspective. Arch Pathol Lab Med 1999;123:492-5.  Back to cited text no. 3
    
4.
Gharehbaghian A, Javadzadeh Shahshahani H, Attar M, Rahbari Bonab M, Mehran M, Tabrizi Namini M. Assessment of physicians knowledge in transfusion medicine, Iran, 2007. Transfus Med 2009;19:132-8.  Back to cited text no. 4
    
5.
Jain A, Kumari S, Marwaha N, Sharma RR. The role of comprehensive check at the blood bank reception on blood requisitions in detecting potential transfusion errors. Indian J Hematol Blood Transfus 2015;31:269-74.  Back to cited text no. 5
    
6.
Jegede F, Mbah HA, Dakata A, Gwarzo DH, Abdulrahman SA, Kuliya-Gwarzo A. Evaluating laboratory request forms submitted to haematology and blood transfusion departments at a hospital in Northwest Nigeria. Afr J Lab Med 2016;5:381.  Back to cited text no. 6
    
7.
Oyedeji OA, Ogbenna AA, Iwuala SO. An audit of request forms submitted in a multidisciplinary diagnostic center in Lagos. Pan Afr Med J 2015;20:423.  Back to cited text no. 7
    
8.
Patidar GK, Kaur D. Audit and education: Role in safe transfusion practice. Asian J Transfus Sci 2018;12:141-5.  Back to cited text no. 8
[PUBMED]  [Full text]  
9.
Deb P, Swarup D, Singh MM. Audit of blood requisition. Med J Armed Forces India 2001;57:35-8.  Back to cited text no. 9
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Materials and Me...
Results
Discussion
Conclusion
References
Article Figures
Article Tables

 Article Access Statistics
    Viewed178    
    Printed4    
    Emailed0    
    PDF Downloaded17    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]