한 3차 병원에서 2009년 수혈가이드라인 홍보 후 수혈 적정성 변화의 평가
Evaluation of Changes in Appropriateness of Blood Transfusion in a Tertiary Care Hospital after Advertising the Transfusion Guideline Proposed in 2009
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배경: 한정된 혈액자원을 보다 안전하고 효율적으로 사용하기 위해 보건복지가족부 질병관리본부와 대한수혈학회가 2009년 수혈가이드라인을 발간하였다. 2009 수혈가이드라인에 근거한 수혈 적정성 평가를 시행하였다. 방법: 3차 병원의 임상의들을 대상으로 2009년 수혈가이드라인에대한인지도 및 필요성에 대한 설문조사를 실시하였다. 혈액제제처방 시 전산 처방 화면에 혈액 제제 별 수혈가이드라인이 요약되어 있는 팝업 창이 뜨도록 하고 온라인과 오프라인 병원 게시판에수혈가이드라인을 게시하는 홍보 활동을 1달 동안 시행하였다. 수혈 적정성은 홍보전후 각 1달 동안 수혈 받은 환자의 진료정보를검토하여 평가하였다. 또한 혈액 반납률과 폐기율을 조사하였다. 결과: 혈액 제제 별 준수율을 조사한 결과, 적혈구 제제는 홍보 전29.4%에서 홍보 후 33.1%로, 혈소판 제제도 16.9%에서 68.9%로 증가하였으나 신선동결혈장은 54.8%에서 33.3%로 감소한 결과를 보였다. 신선동결혈장의 감소한 준수율은 짧은 기간 동안의 수혈 만을 조사하여 그 건수가 적어서 생긴 결과로 생각된다. 혈액 제제의반납률은 3.91%에서 3.00%로, 폐기율은 1.77%에서 1.21%로 감소하였다. 결론: 새로운 수혈가이드라인을 홍보함으로써 부적정한 수혈이감소되었다. 수혈가이드라인에 대한 지속적인 홍보가 필요하며, 각병원의 상황에 맞춰 수혈가이드라인을 정립하고 수정해 나아가야할 것이다.
Abstract
Background: In support of safe and appropriate utilization of blood products, the Korean Ministry of Health and Welfare and the Korean Society of Blood Transfusion developed transfusion guidelines in 2009. We evaluated the appropriateness of blood transfusions on the basis of these proposed guidelines. Methods: We investigated the awareness of the 2009 proposed guidelines and the transfusion guidelines currently in use through a questionnaire administered to the physicians of a tertiary care hospital. We provided the 2009 proposed transfusion guidelines through summarized popups for each blood product that appeared in the hospital information system whenever a physician ordered blood products, and promoted the guidelines by posting it on the bulletin board and the hospital information system for one month. Evaluation of the appropriateness of blood transfusion was conducted by reviewing the medical records of patients who were transfused within one month before and one month after the promotion. Further, we also examined the rates of blood wastage and return. Results: Rates of appropriately transfused blood products changed from 29.4% to 33.1% for red blood cells, from 16.9% to 68.9% for platelets,and from 54.8% to 33.3% for fresh frozen plasma. The decreased appropriate transfusion rate of fresh frozen plasma might be due to the small number of transfusions performed during the short study period. The rates of blood wastage and return decreased from 1.77% to 1.21%and from 3.91% to 3.00%, respectively. Conclusions: Promotion of the new transfusion guidelines lowered the incidence of inappropriate transfusions. Continuous promotion and establishment of these guidelines after adjustments according to the status of each hospital are necessary.
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