A quality improvement initiative to reduce inappropriate plasma transfusions across community hospitals in the Niagara region

BACKGROUND AND OBJECTIVES: Plasma transfusion is indicated for patients with coagulopathy and active bleeding or those undergoing major surgery. Appropriate use is defined by an international normalized ratio (INR) >1.7 and a dose of 3-4 units for adults. However, audits in tertiary care settings consistently revealed high rates of inappropriate plasma use. At Niagara Health, audits across three community hospitals showed that 42% of plasma transfusions in hospitalized adults were inappropriate, largely due to limited understanding of proper indications. This misuse leads to resource wastage, higher costs and unnecessary patient exposure to transfusion-related risks. The aim of this project was to improve appropriate plasma transfusion rates among hospitalized adults in three Niagara region hospitals by 25% over a 12-month period. MATERIALS AND METHODS: This non-randomized, interrupted time series quality improvement project followed the Model for Improvement (MFI) framework. Sequential Plan-Do-Study-Act cycles began in July 2024, with monthly monitoring of transfusion rates. Interventions included an awareness campaign, enhanced audit and feedback and implementation of an electronic transfusion order set in the electronic medical record (EMR). RESULTS: During the study, 253 plasma units were transfused. Median monthly appropriateness rates were 90% (INR >1.7), 89% (dose >2 units) and 78% (both criteria). Appropriateness improved, particularly in dosing. Out-of-guideline requests screened by technologists decreased by 15%, with no significant change in plasma or red cell use. CONCLUSION: Electronic order sets, technologist screening, education and audit-feedback improved adherence to plasma transfusion guidelines without increasing workload or affecting other blood product use. These strategies may be scalable to other components.