Patient safety in blood transfusion depends on both the safety of blood products and the safety of the clinical transfusion process -a process that encompasses a series of inter-connected steps including the prescription and ordering of blood products; patient identification; collection and labelling of patient blood samples; pretransfusion compatibility procedures and issue of blood; collection and transportation of blood units within the hospital; handling of blood units in the clinical area; blood administration; monitoring of patients; and management of adverse transfusion events.
An appropriate and correct clinical transfusion process ensures patient safety and contributes to improved health and survival. However, transfusion carries the risk of adverse events including errors, transfusion reactions and transmission of infections. The most important cause of serious transfusion reactions and death is wrong blood transfusion due to errors during the clinical transfusion process, such as incorrect identification of patients, blood samples or blood units; sampling and labelling errors; laboratory errors; clerical errors; improper storage and handling of blood; failure to perform the final bedside check prior to blood administration; and lack of patient monitoring during transfusion.
Errors during the clinical transfusion process can be prevented by the strengthening of hospital systems and processes for clinical transfusion, the training of hospital staff and the implementation of standardized procedures throughout the clinical transfusion process.

# Clinical Transfusion Process and Patient Safety
Aide-MeMoire The failure to correctly identify patients is one of the principal causes of medical errors in hospital procedures. A system of patient identification, including the use of wristbands, should be put in place to enable staff to correctly identify patients before commencing any procedures. In each hospital, the quality system should cover the entire clinical transfusion process, including the development of documents such as standard operating procedures, standard forms, labels and records (patient, clinical, laboratory and transfusion) to ensure traceability between the patient, blood unit and blood donor.
Hospital management should establish a functioning transfusion committee which has authority and responsibility to develop, monitor and implement its transfusion policy. It should also designate a transfusion safety officer(s) to liaise between the transfusion committee, clinical disciplines and services on a day-to-day basis to promote consistency in the implementation of transfusion guidelines and protocols. Patients should be provided with sufficient information to enable them to give informed consent for blood transfusion.
There should be a suitable infrastructure for the implementation of good pretransfusion procedures in the hospital blood bank/transfusion laboratory.

# Transfusion guidelines and protocols
Each hospital should implement national transfusion guidelines to ensure uniform standards and safe practices. These should include:  Clinical and laboratory indications for the use of blood products and alternatives to transfusion  System for requesting blood for transfusion in routine and emergency situations and use of a standard blood request form and blood ordering schedules for elective surgery  Use of standard operating procedures to ensure consistency and reliability in the transfusion process.

# Transfusion in the clinical area
While responsibility for the decision to transfuse ultimately rests with the attending doctor, patient safety in blood transfusion is the responsibility of all staff involved in the clinical transfusion process. This requires:  Systematic assessment of the clinical need for blood transfusion  Avoidance of unnecessary transfusions through the use of replacement fluids, pharmaceuticals and medical devices, where possible  Rational use of blood products on the basis of patients' clinical needs  Checking patient identity at the time of sample collection and prior to blood transfusion  Collection and accurate labelling of patient blood samples  Sending blood samples to blood bank with completed blood request forms  Receipt, correct storage and handling of blood units in the clinical area  Checking the integrity of blood units before transfusion  Final bedside identification check of patient, documents and each blood unit before commencing transfusion  Timely administration of blood products, including correct use of blood warmers and filters  Recording of transfusion in patients' notes, including the identities of the prescriber and the person administering the transfusion  Careful monitoring of patients before, during and after transfusion and follow-up  Rapid management and reporting of adverse transfusion events.

# Hospital blood bank/ transfusion laboratory
The hospital blood bank/transfusion laboratory is responsible for providing compatible blood for the right patient in a timely manner.

# Monitoring and evaluation
Systems should be put in place at national and hospital levels for the monitoring and evaluation of the clinical transfusion process and patient safety.
The hospital transfusion committee should define steps to:  Establish a haemovigilance system for the monitoring, reporting and investigation of adverse transfusion events in the hospital; this should be linked with regional and national haemovigilance systems, if possible  Develop and monitor indicators, such as number of transfusion reactions and blood outdate rate, and assess trends in the quality and safety of the clinical transfusion process  Analyse haemovigilance data for corrective and preventive action, where required  Review blood use and transfusion practices, including clinical audits.