Emily Cooley Lecture 2002: transfusion safety in the hospital
Emily Cooley Lecture 2002: transfusion safety in the hospital
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Emily Cooley 讲座 2002：医院的输血安全
作者：
W. Dzik
rimum non beneficere（“第一，不伤害”）是一个古老的提醒，病人不应该受到不安全或有害的医疗做法。近年来，对患者伤害的担忧再次受到关注。1999年医学研究所的报告《人皆有错》强调了由于医疗保健中不安全的过程造成的错误而导致的患者受伤和死亡。1重申患者安全是医疗保健所有分支的首要任务，包括输血医学。本文总结了2002年艾米丽库利讲座，其中呼吁重新调整的优先事项，在输血医学领域远离过度关注的组成部分，对病人的利益。输血安全与向患者提供输血护理的整个过程有关。在过去的三十年中，用于血液成分质量的资源使血液安全得到了令人印象深刻的改善。然而，整体输血安全，主要是医院的省，受到的关注要少得多。因此，严重的问题存在于医院输液护理过程的每一个步骤。已经记录了高比例的错误标记和完全错误收集的患者样本。由于缺乏对照临床试验和缺乏输血疗法的正规培训，医生的输血决定受到阻碍。为了确保该单位是为接受者准备的，最后的床边检查通常不完全或不正确地进行，导致每年数百万次不安全的输血事件。输血错误仍然是输血最常见的严重危害，是输血导致死亡的最可能原因，其发生率比输血传播的HCV和HIV总和高数千倍。当前医院输血安全问题的解决方案可分为三类：第一，应探索旨在提高患者安全的新技术。机器可读的患者识别腕带、智能泵和射频智能标签可以减少输血错误。纳米技术在改善输血临床决策方面具有很大的潜力，计算机化血液利用审查（CBUR）可以为处方医生提供及时和有用的教育反馈。第二，在美国应该设立一个新的职位--输血安全官员（TSO），负责改进实验室外的输血护理过程。TSO已经在几个国家部署，以识别和解决导致不安全输血实践的潜在组织弱点。第三，专业协会应该成为患者福利的倡导者，在输血过程的关键领域制定绩效标准，包括患者样本的收集，床边血液管理和直接负责患者血液支持的实验室人员配备水平。迫切需要临床研究来更好地定义输血的适应症，并明确评估拟议的新安全干预措施。医院输血安全是输血医学工作的重中之重。
rimum non nocere (“First, do no harm”) is an ancient reminder that patients should not be subjected to unsafe or harmful medical practices. In recent years, concern over harm to patients has gained renewed attention. Patient injury and death due to errors resulting from unsafe processes in healthcare was highlighted by the 1999 Institute of Medicine’s report “To err is human.” 1 The need to reassert patient safety as a top priority cuts across all branches of healthcare and includes transfusion medicine. This paper summarizes the 2002 Emily Cooley lecture, which called for a realignment of priorities in the field of transfusion medicine away from excess attention to the component and toward the interests of the patient. Transfusion safety is concerned with the overall process of delivering transfusion care to the patient. During the past three decades, resources devoted to the quality of the blood component have resulted in impressive improvements in blood safety. However, overall transfusion safety, largely the province of hospitals, has received far less attention. As a result, serious problems exist at each step of the hospital process of transfusion care. High rates of mislabeled and completely miscollected patient samples have been documented. The physician’s decision to transfuse is hampered by the absence of controlled clinical trials and the absence of formal training in transfusion therapies. The final bedside check required to insure that the unit is intended for the recipient is often performed either incompletely or incorrectly, resulting in millions of unsafe transfusion episodes each year. Mistransfusion of blood remains the single most common serious hazard of transfusion, is the most likely cause of death attributed to transfusion, and occurs at a rate thousands of times higher than transfusion-transmitted HCV and HIV combined. Solutions to current problems in hospital transfusion safety can be grouped into three categories: First, new technology designed to improve patient safety should be explored. Machine-readable patient identification wristP bands, smart pumps, and radio-frequency smart labels may reduce transfusion errors. Nanotechnology holds great promise to improve clinical decision-making regarding transfusion, and computerized blood utilization review (CBUR) can provide timely and useful educational feedback to prescribing physicians. Second, a new position—the transfusion safety officer (TSO)—charged with the responsibility for improving the process of transfusion care outside the laboratory should be developed in the US. TSOs have already been deployed in several nations to identify and resolve latent organizational weakness leading to unsafe transfusion practice. Third, professional societies should become advocates for patient welfare by setting performance standards in key areas of the transfusion process including the collection of patient samples, bedside blood administration, and staffing levels in laboratories directly responsible for blood support of patients. Clinical research is urgently needed to define better the indications for transfusion and to explicitly evaluate proposed new safety interventions. Hospital transfusion safety represents a top priority for the profession of transfusion medicine.