Becker's Clinical Quality & Infection Control

16 QUALITY IMPROVEMENT & MEASUREMENT How MD Anderson enhances transfusion safety By Elizabeth Gregerson H ouston-based MD Anderson Cancer Center's hemovigilance unit was born from a blood transfusion-related event that led to a patient's death in 2019. Kimberly Klein, MD, medical director of the unit, presented operational insights from the program at the Association for the Advancement of Blood & Biotherapies annual meeting Oct. 19, according to a news release from the association. The unit monitors transfusions in real time and uses AI to predict potential adverse reactions and alert staff who can immediately respond. Dr. Klein shared more about the unit's effect on transfusion safety at MD Anderson with Becker's. Editor's note: Responses have been edited for clarity and length. Question: Can you share how MD Anderson's hemovigilance unit has transformed transfusion safety? Dr. Kimberly Klein: Since the advent of the hemovigilance unit, our detection rate ability concerning transfusion reactions has increased several fold, allowing for the proper management and expedited care of the associated event. Our real-time health system enhances patient safety by ensuring patients receive appropriate treatment in a timely manner to mitigate the severity of any possible symptoms experienced. By studying these events in a retrospective fashion, it has allowed the institution to select blood products that better suit the transfusion needs of our patients. Q: In what ways has your work in hemovigilance at MD Anderson impacted the hospital's overall approach to patient safety? KK: We have made the practice of transfusion safer across all departments for all patients. From collection done at the MD Anderson Blood Bank to the patient's room or treatment area, we are ensuring and prioritizing safety. Because transfusion is the most common procedure performed in the hospital, hemovigilance helps to ensure safety for all. Q: What best practices have emerged from MD Anderson's hemovigilance unit that could be adopted by other health systems? KK: Offering product modifications to at-risk patients is the first thing that comes to mind. But also, the fact that technology created for one intent can be harnessed and applied to solve other patient care problems, ultimately improving the overall treatment journey and experience for the patient. n 'Outdated protocols' for anaphylaxis worsening patient outcomes: 7 things to know By Mariah Taylor "O utdated protocols" and a lack of patient education around anaphylaxis treatment can result in poor patient outcomes, Medscape Medical News reported Oct. 28. Here are seven things to know: Education A survey of 96 patients and caregivers was conducted in an allergy clinic waiting room. Of these, 95% were prescribed epinephrine. 1. e majority of respondents, 73%, said they were comfortable identifying signs of anaphylaxis, but only 14% said they used epinephrine as a first-line treatment. 2. Many patients and caregivers said they do not know which anaphylaxis symptoms to treat with epinephrine. About 23% of respondents said they use antihistamines as the first treatment in cases of anaphylaxis. 3. Common reasons respondents gave for avoiding epinephrine included uncertainty over which symptoms to treat, at 40.6%, hesitancy to visit an ED (24%), hesitancy to call 911 (17.7%), uncertainty on how to use epinephrine auto-injectors (11.5%) and a fear of needles (5.2%). 4. e fear of needles is considered a significant deterrent in epinephrine use. "However, our respondents were more inclined to acknowledge a reluctance to escalate to emergency response as the major barrier to treatment," Joni Chow, DO, a physician at Baylor College of Medicine in San Antonio, told Medscape. Outdated Protocols A separate study analyzed data from 30 states with mandatory advanced cardiac life support protocols to find gaps in recognizing the treating anaphylaxis. 1. Only 15 states included gastrointestinal symptoms in their definition of anaphylaxis, and only 40% included neurologic manifestations while 47% used two-organ system definitions. 2. All 30 state protocols recommended diphenhydramine and epinephrine for anaphylactic reactions. All but one state listed epinephrine as the first-line recommendation for anaphylaxis. 3. However, researchers found that many patients do not receive epinephrine from EMS personnel when they call 911. "ey receive antihistamines, steroids, everything except epinephrine, which is incredibly concerning given that epinephrine is always the first-line treatment for anaphylaxis," Carly Gunderson, DO, a physician at Memorial Healthcare System in Pembroke Pines, Fla., told Medscape. "Because EMS providers are oen the first healthcare professionals to assess patients experiencing anaphylaxis, their ability to recognize and appropriately treat anaphylaxis is essential. We were also disappointed by how many protocols continue to recommend outdated interventions such as first-generation antihistamines and corticosteroids in the treatment of anaphylaxis." n

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