# Clinical Audit of Transfusion Safety and Monitoring at Al-Kareemat Specialized Complex, Sudan: A Two-Cycle Quality Improvement Study

## TL;DR

This study evaluated and improved blood transfusion safety practices at a Sudanese hospital using a two-cycle audit and quality improvement approach.

## Contribution

The study demonstrates a successful closed-loop quality improvement intervention to enhance transfusion safety and hemovigilance compliance in a clinical setting.

## Key findings

- Baseline compliance with transfusion monitoring was suboptimal, with 69.5% 15-minute observation documentation.
- A quality improvement intervention increased 15-minute observation documentation to 90.0% in the re-audit.
- Hemovigilance reporting improved from 33.3% to 100.0% for suspected transfusion reactions.

## Abstract

Background: Blood transfusion is a lifesaving intervention; however, preventable harm can occur when bedside identification, monitoring, and documentation are incomplete. We focused on these bedside steps because they are safety critical, reduce the risk of wrong patient transfusions, and support early recognition of transfusion reactions.

Objective: To assess compliance with World Health Organization (WHO)-aligned bedside transfusion safety and monitoring criteria and hemovigilance reporting at the Al-Kareemat Specialized Complex for Clinics and Inpatient Care in Sudan, and to evaluate changes after a targeted quality improvement intervention using a two-cycle closed-loop audit design. This audit evaluated compliance with WHO-aligned transfusion safety, monitoring, and hemovigilance protocols at the Al-Kareemat Specialized Complex for Clinics and Inpatient Care in Sudan.

Methods: A closed-loop, two-cycle documentation-based clinical audit was conducted. The baseline cycle retrospectively reviewed 220 transfusion episodes administered between January and June 2024 using a structured checklist assessing eight bedside safety and monitoring criteria and hemovigilance indicators; absent documentation was classified as noncompliance. Following implementation of a targeted quality improvement package, focused on staff reinforcement and standardized monitoring and reporting documentation, a one-year re-audit of 120 transfusion episodes administered between January and June 2025 was performed using the same criteria and abstraction approach.

Results: At baseline, patient identification was documented in 96.8% (n = 213/220) of episodes. Monitoring and completion documentation were suboptimal, with 15-minute observation documented in 69.5% (n = 153/220) and end-of-transfusion vital signs in 80.9% (n = 178/220). Suspected transfusion reactions were similar across cycles, occurring in 2.7% (n = 6/220) at baseline and 2.5% (n = 3/120) at re-audit; formal hemovigilance reporting improved from 33.3% (n = 2/6) of suspected reactions to 100.0% (n = 3/3). In the re-audit, 15-minute observation documentation increased to 90.0% (n = 108/120), end-of-transfusion vital signs increased to 91.7% (n = 110/120), and 100.0% (n = 3/3) of suspected reactions were officially reported.

Conclusion: While foundational pre-transfusion safety steps were strong, baseline deficits were evident in active monitoring and hemovigilance reporting. The quality improvement intervention was associated with substantial improvements sustained at one-year re-audit. Continued reinforcement of standardized documentation and periodic repeat audits are recommended to maintain progress and achieve full compliance with safety-critical standards.