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Call for national A&E transfusion guidance

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National major trauma transfusion guidelines are needed as few A&E units have guidance in place, a study shows.

Major trauma patients often require rapid treatment plans while having complex medical needs, warn researchers at Selly Oak Hospital in Birmingham.

They surveyed 167 A&E units with attendance of more than 50,000 patients a year, asking trusts whether they used major trauma transfusion guidelines and, if so, how useful they were.

Of 109 units that responded only 17 said they had guidelines. All of these were similar in design but some were out of date, the authors said.

Guidance on the use of uncross-matched blood and recombinant factor VII was absent from more than half of the guidelines. The ordering and prescribing of blood products was largely left to junior staff, the authors said.

However, most respondents reported good adherence to the guidelines with above half rating them as ‘useful’ or ‘very useful’. Of those not using guidelines, just under half said they thought they would be ‘useful’ or ‘very useful’.

The study authors said: ‘The appropriate ordering and use of blood products has major clinical and cost implications. Few trusts currently have guidelines for major trauma despite being enthusiastic regarding their use.’

A national major trauma transfusion guideline is needed to standardise practice across the UK, they added.

Brian Dolan, former chairperson of the RCN Emergency Care Association, agreed that national transfusion guidelines would be beneficial. ‘They would reduce variation in practice, enhancing both standardisation and patient safety through commonly agreed processes,’ he said.

‘Standardising the guidelines would also reduce the additional teaching sessions needed by medical and nursing staff as they move either on rotation or as part of a new job orientation,’ he added.

Emergency Medicine Journal (2008) 25: 134–135

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