Background Blood transfusion is a common practice in palliative care despite a dearth of evidence supporting its routine use in this setting.

Objectives

1. To review patient blood management at Milford Hospice.

2. To explore potential for prospective research in this area.

Methods Data pertaining to a purposive sample of transfusion events at Milford Care Centre that occurred in 2016 and 2017 was collected retrospectively from patient records and laboratory results. Data included demographic information, primary diagnosis, cause of anaemia, indication for transfusion, performance status, investigations such as haemoglobin and iron studies, and outcomes including 30-day outcomes and length of stay.

Results Of these 52 transfusion episodes included, 29 were regarding female patients and 34 were over the age of 65. All patients had a diagnosis of malignancy, with bone metastases reported in 13 (25%). Average Haemoglobin pre-transfusion was 7.21 g/dl. Iron studies were checked in ten cases.

2 or more units were transfused in all but 1 instance.

A beneficial response to transfusion was documented in 15 cases.

3 patients had haemoglobin checks after individual units of blood. 18 patients had haemoglobin checks within a week of the transfusion episode.

30-Day Outcome Post Transfusion: 46% of patients had returned home; 33% of patients had died; 13% of patients remained in hospice; 8% other (long term care, missing data).

Conclusions The lack of full investigation prior to transfusion demonstrates non-compliance with NICE standards and allows for potential overuse of blood products. Routine prescription of two units of blood without interval symptom reassessment or haemoglobin measurement may also contribute. These results were disseminated among clinical staff and an action plan was developed. An algorithm was developed for use in the inpatient palliative care setting and this is being implemented currently. Accompanying guideline development is also underway.