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Embedding best transfusion practice and blood management in neonatal intensive care
  1. Cindy J Flores1,
  2. Anil Lakkundi2,
  3. Joanne McIntosh2,
  4. Peter Freeman3,
  5. Amanda Thomson1,
  6. Ben Saxon1,4,
  7. Justine Parsons2,
  8. Tracey Spigiel1,
  9. Sarah Milton5,
  10. Bryony Ross6,7
  1. 1 Clinical Services and Research Division—Transfusion Policy and Education, Australian Red Cross Lifeblood, Adelaide, South Australia, Australia
  2. 2 Neonatal Intensive Care Unit, John Hunter Children's Hospital, Newcastle, New South Wales, Australia
  3. 3 Hunter New England Local Health District, New Lambton, New South Wales, Australia
  4. 4 Women's and Children's Hospital Adelaide, North Adelaide, South Australia, Australia
  5. 5 The Royal Children's Hospital, Melbourne, Parkville, Victoria, Australia
  6. 6 Oncology and Haematology, John Hunter Children's Hospital, Newcastle, New South Wales, Australia
  7. 7 Calvary Mater Hospital, Newcastle, New South Wales, Australia
  1. Correspondence to Dr Cindy J Flores; cflores{at}


Background Transfusion is a common procedure for neonates receiving intensive care management. Recognising a paucity of patient blood management (PBM) programmes in neonates, we aimed to embed blood management and best transfusion principles in the neonatal intensive care unit (NICU) by aligning local policies, providing targeted education and partnering with parents.

Methods Practice-based evidence for clinical practice improvement (PBE-CPI) methodology was used. Previous hospital accreditation audits were reviewed and a neonate-specific transfusion audit was developed. Audit was performed at baseline and repeated following the intervention period. NICU clinicians received targeted education in obtaining informed consent, prescription and safe administration of blood components during a ‘Blood Month’ awareness period. A neonate-specific parent handout about transfusion was developed in partnership with parents. A pilot video demonstrating a shared consent discussion was also developed to assist in the consent process. Parents’ knowledge, concerns and feedback regarding transfusion practice was sought at baseline (survey) and on project completion (experience trackers).

Results Neonate-specific baseline transfusion audit showed inconsistent consent, monitoring and documentation processes in neonatal transfusions. Post-targeted education audit showed improvement in these parameters. The targeted PBM and transfusion-related education delivered during ‘Blood Month’ was well-received by staff. Parents’ feedback about the NICU transfusion consenting process was consistently positive. NICU medical and nursing clinicians (n=25) surveyed agreed that the parent handout was well set out, easy to understand and recommended that it be used to complement practice.

Conclusion PBE-CPI tools aligned with Australian PBM guidelines for clinicians and parents were well-accepted by clinical stakeholders and were associated with practice improvement in PBM awareness and transfusion consent processes. This PBE-CPI project developed NICU-specific consent information, not previously available, by partnering with parents to ensure quality of care in transfusion practice. Adoption of this also helps to meet accreditation for Australian Blood Management Standards. These strategies and tools translate readily into other NICUs to embed and support best PBM and transfusion practice.

  • transfusion medicine
  • neonatology
  • quality improvement
  • patient blood management
  • shared-decision making

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  • Twitter @cindyfloresmd, @justinegodess

  • Contributors All authors contributed to the design, implementation and review of the PBE-CPI project. BR is the clinical lead with C Flores coordinating the whole PBE-CPI project. CJF, AL, JM, PF, AT and BR were involved in the planning and diagnostic phase of the CPI methodology. AL, PF and BR completed the snapshot clinical audits. SM, TS, CJF and BS drafted and finalised the parents’ handout. JP and JM conducted the interviews with parents. AL, JM, PF, JP, AT and BR implemented Blood Month in the NICU with resources developed and reviewed by BS, AT, CJF and TS. CJF wrote the first manuscript and is the corresponding author. CJF, BR, PF and AT collated and evaluated the data. All authors provided review of the manuscript, revised the manuscript and agreed on the final version submitted.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The project was approved by the Hunter New England Human Research Ethics Committee (AU201706-07) as low-risk research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article.

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