Less plasma, less drama: A quality improvement initiative to reduce inappropriate plasmatransfusions across community hospitals in the niagara region. Free

Background Plasma transfusion has limited clinical indications, primarily 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 transfusion dose of 3–4 units in adults. However, audits in tertiary care settings have

consistently revealed high rates of inappropriate plasma use.

Local Problem At Niagara Health, recent audits across three community hospitals identified that 42% of plasma

transfusions in hospitalized adults were inappropriate. This misuse contributes to resource wastage,

increased healthcare costs, and unnecessary patient exposure to transfusion-related risks.

Aim This study aimed to improve the rates of appropriate plasma transfusions (as set by appropriate metrics of

INR and dose) amongst hospitalized adult patients of three major community hospitals in the Niagara

Region by 25% by June 30, 2025. This will be achieved through awareness campaign, enhanced audit and

feedback, as well as incorporation of electronic Transfusion Medicine order set in hospitals EMR.

Methods This is a nonrandomized, interrupted time series quality improvement project (QIP) following the Model

for Improvement framework (MFI). The QIP is designed to develop, test, and implement change ideas

following sequential Play-Do-Study-Act cycles starting July 2024, monitoring rates of plasma transfusions

monthly.

Results Over the study period, 253 plasma units were transfused. Median monthly rates of appropriate transfusions

were 90% (INR >1.7), 89% (dose >2 units), and 78% (meeting both criteria). A positive trend in

appropriateness was observed, particularly in dosing. Additionally, the proportion of out-of-guideline

plasma requests screened by transfusion medicine technologists decreased by 15%. Importantly, there were

no significant changes in the overall use of plasma or red cell products.

Conclusions The implementation of an electronic order set, supported by technologist screening, targeted education, and

audit-feedback loops, led to improved adherence to plasma transfusion guidelines without increasing

laboratory workload or affecting the use of other blood products. These interventions demonstrate potential

for broader application to other blood components. Ongoing evaluation will assess the sustainability of

these improvements.