3. Quality systems

Patients’ questions:

One way of introducing the concept of quality management in clinical transfusion is to consider some questions that any patient might ask if they believe that a transfusion may be given.

Here are some examples:

  • Do I really need to have a blood transfusion?
  • Will it help me?
  • Could a transfusion do me harm?
  • Will they give me the right blood?
  • Will I feel unwell during the transfusion?
  • If I start to feel bad during the transfusion will someone come to help me?
  • If I need blood in an emergency will they get it to me in time?
  • Will someone knowledgeable take the time to explain all this to me?
  • Is the hospital staff properly trained to give me the transfusion?
  • How do I know that the hospital does these things well?

With these questions, the patient is seeking some evidence that the hospital does a good job in providing blood transfusions.

One way that the hospital can give reassurance is by providing evidence that things are done correctly. This could be information about training, documentation of procedures, or results of checks of performance or comparisons of results between one hospital and others. All these are important parts of a quality system. (11234582)

This Manual provides practical guidance that can help to provide answers to questions of this type, whether they are asked by patients or, in different ways, by quality inspectors, auditors or regulators.

A quality system (QS) for the clinical transfusion process should:

  • Provide assurance to patients, the community and clinicians that treatment is safe, effective and efficient, the people who carry out each step of the process know what they are doing, how to do it and why they are doing it
  • Provide evidence that tasks are carried out correctly and consistently using the right procedures
  • Lead to improvement in quality by providing evidence about performance and by encouraging everyone concerned to learn from both mistakes and successes

Successful introduction of a QS depends on strong management support to make sure that:

  • Responsibility for developing and maintaining the QS is clearly assigned
  • Sufficient staff, proper working conditions, facilities and training are provided
  • An effective programme of evaluation or audit is in place

Why transfusion should be part of a hospital’s wider quality system

Many studies show that patients suffer avoidable harm due to errors and accidents (quality failures) in hospitals. These occur in many aspects of the process of care. For most patients and their clinicians, transfusion is only one element of the whole process of care and transfusion risks are only a small proportion of all the risks to which patients are exposed. For these reasons a quality management system for transfusion should be planned as part of a hospital’s wider quality system. This was a key conclusion of the 2009 Wildbad-Kreuth Symposium.