Implementation of a neonatal platelet transfusion guideline to reduce non-indicated transfusions using a quality improvement framework

Abstract

Objective: Variation exists in neonatal platelet transfusion practices. Recent studies found potential harm in liberal platelet transfusion practices, supporting the use of lower transfusion thresholds. Our aim was to reduce non-indicated platelet transfusions through implementation of a restrictive platelet transfusion guideline.

Study design: Platelet transfusions from January 2017 to December 2019 were classified as indicated or non-indicated using the new guideline. Interventions included guideline implementation and staff education. Outcomes were evaluated using statistical process control charts. Major bleeding was the balancing measure.

Result: During study, 438 platelet transfusions were administered to 105 neonates. The mean number of non-indicated platelet transfusions/month decreased from 7.3 to 1.6. The rate of non-indicated platelet transfusions per 100 patient admissions decreased from 12.5 to 2.9. Rates of major bleeding remained stable.

Conclusions: Implementation of a restrictive neonatal platelet transfusion guideline significantly reduced potentially harmful platelet transfusions in our NICU without a change in major bleeding.

Fig. 1. Key Driver Diagram.

Diagram outlining the project-specific aim, key drivers, and change concepts.

Fig. 2. Significant decreases in non-indicated platelet transfusions after project start on SPC analysis.

Special cause variation shows significant change. A Decreased number of non-indicated platelet transfusions/month after project start from 7.3 to 1.6 on SPC C-chart analysis. B Rate of non-indicated transfusions per 100 patient admissions decreased from 12.5 to 2.9 after project start on U-chart analysis. For both A and B, the rule used to determine special cause variation was 8 or more points below the centerline.