Department of Health

Preoperative anaemia assessment and management - 2015 Blood Matters audit

Audit Report

Download the audit report: Clinical audit of preoperative anaemia assessment and management in elective surgical procedures 2015

Audit aims

In 2015 the Blood Matters Program undertook an audit of preoperative anaemia assessment and management in elective surgical procedures. The audit provided valuable information to improve practice related to the assessment and management of reversible anaemia prior to surgery, and improve outcomes for patients undergoing elective surgical procedures.

Objectives

To determine:

  • whether health services have a screening pathway for assessment of preoperative anaemia as defined in the NBA PBM guidelines Module 2, Perioperative
  • where a screening pathway is in place, it uses a preoperative haemoglobin assessment and optimisation template
  • where screening processes, +/- assessment and optimisation templates are in place, that they are being followed.

Inclusions

  • Patients undergoing major elective orthopaedic, gastrointestinal or cardiothoracic surgical procedures occurring between September 2014-August 2015.

Exclusions

  • Minor surgical procedures where there is low or no expectation of need for transfusion, that is 
    • orthopaedic surgery such as arthroscopy
    • gastrointestinal surgery such as endoscopy and laparoscopic gastric banding
    • cardiothoracic surgery such as angiogram and insertion of stent
  • Emergency procedures or surgical management of traumatic injury.

Methodology

This was a two part audit.

Part A - Gap analysis

A desktop audit of processes in place at your health service to assess and manage preoperative anaemia

These data may assist health services that are intending to introduce a preoperative anaemia assessment and optimisation template/screening pathway.

Part B - Retrospective audit

A retrospective audit of up to 30 patients who have attended for elective surgical procedures (as defined above)

These data will enable health services to assess if they are following their own processes (if preoperative anaemia assessment is in place) or highlight areas where preoperative anaemia assessment and optimisation would be beneficial.

Definitions

  • Considered anaemic if Hb is below the following values:
    Age range Sex Haemoglobin (Hb) g/L
    Adult * male <130
    Adult * female <120
    2-11 years# boys and girls <115
    6-24 months# boys and girls <105

    * Reference - NBA PBM algorithm Module 2 pg 1221
    # The Royal Children’s Hospital Melbourne Clinical Practice guidelines 2

  • Elective surgery - is planned, non-emergency surgery, which is medically necessary or beneficial to the patient but does not need be done at a particular time
  • Patient blood management (PBM) is the management and preservation of patients’ own blood to reduce or avoid the need for a blood transfusion.1
  • PAD – preoperative autologous donation
  • Preoperative period – ‘pertaining to the period before a surgical procedure. Commonly the preoperative period begins with the first preparation of the patient for surgery, such as when the surgery is scheduled’.3
  • Postoperative period – defined as within seven (7) days of surgery

Timeframe

Data entry was from 1 October 2015 to 27 November 2015.

Data entry

Data was entered electronically using the hospital name via the Blood Matters audit site.

The Department of Health and Human Services is committed to protecting privacy. Information collected during this audit is not capable of identifying any individual and names will not be provided to the department.

The Blood Matters secretariat coordinated the audit, and was responsible for the distribution of audit collection tools, data processing and analysis. Data will be validated and the report will follow. Blood Matters will disseminate individual results to the participating health services with the final report.

References

  1. National Blood Authority 2012 Patient Blood Management Guidelines: Module 2 - Perioperative
  2. The Royal Children’s Hospital Melbourne Clinical Practice guidelines: anaemia
  3. Mosby's Medical Dictionary, 8th edition. © 2009, Elsevier

More information

If more information is required please contact the Blood Matters Program.

Reviewed 17 November 2015

Health.vic

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