Clinical guidelines, audits and hemovigilance in managing blood transfusion needs: CLINICAL GUIDELINES, AUDITS AND HEMOVIGILANCE

SUMMARY The transfusion of blood and blood components is a critical element for the delivery of a healthcare service to patients. Tools to help improve the safety of the blood supply of a country include: (i) clinical (transfusion) guidelines to direct transfusion practices; (ii) audit systems to monitor adherence to the guidelines as well as the effects of adjustments to the guidelines; and (iii) the hemovigilance program which monitors the entire blood supply value chain, develops measures and solutions to problems that threaten or might threaten the safety of blood component recipients, and monitors the implementation of these corrective actions. Establishing guidelines, implementing audit systems and hemovigilance programs are achieved more readily in developing countries with limited resources available, if a step-up approach is used. If these tools are instigated on an inappropriate level as initial programs, they will be unattainable and most initiatives would fail because the performance targets are unrealistically high. Starting with an elementary approach, acknowledging the shortcomings of it while creating a culture of continuous improvement, is the preferred option.