Appropriate clinical use of blood in Uganda

Abstract

The Uganda Blood Transfusion Services, in line with the requirements for the minimum health care package of Uganda, has made tremendous strides in improving the adequacy and quality on blood supply to hospitals and health center that administer blood. This is mainly due to the extensive technical and financial support to the procurement and processing components of the transfusion chain. Unfortunately these efforts have not been reciprocated at the in‐hospital setting. This is characterized by underdeveloped administrative structures catering for blood transfusion like lack of a hospital transfusion policy which has lead to paucity of instructive procedures, monitoring and evaluation as well as defined persons responsible for in‐hospital transfusion quality assurance. Additionally, documentation of what is to be or what has been done is still under‐developed.As a way of improvement, a step‐by‐step quality improvement strategy should be developed. First, a small working group of clinicians, laboratory technicians and administrators should be created to design the policy and strategies (blood transfusion plan) for clinical use of blood. Second, start creating Hospital Transfusion Committees with appropriate terms of reference. These should be supported by the hospital high authority. Third, design simple education materials for the three major in‐hospital transfusion processes and identified procedures, with their respective standard operating procedures (SOPs) and related outcome documents like a Blood Request Form (ordering, component selection and administration). Disseminate these materials through continuous professional trainings for in‐service staff and curriculum reviews for medical and paramedical schools. Fifth, embark on updating the National Transfusion Policy to embrace and support the development of National clinical standards and guidelines. These steps will be achieved when the concept of quality assurance is formally and philosophically incorporated into the structure and functioning of Uganda's health systems, consistently implemented, and supported by a culture of quality, as reflected in organizational values and policies that advocate quality of care.