Transfusion-associated circulatory overload: A retrospective audit of risk assessment practices in a large teaching hospital

Abstract

Introduction

Transfusion-associated circulatory overload (TACO) is a serious transfusion reaction and a leading cause of transfusion-related mortality. It is recommended that all patients requiring blood transfusion should be assessed for the risk of TACO. The 2022 Serious Hazards of Transfusion (SHOT) report indicated a TACO risk assessment compliance rate of 35.6 % across the United Kingdom. This retrospective audit evaluated the TACO risk assessment compliance of a large teaching hospital in Northwest England.

Methodology

TACO risk assessments were reviewed from November 2022 to December 2023. Data was collected from paper and electronic patient records. The accuracy of the completed risk assessments was assessed against the 2022 SHOT guidance and patient medical records.

Results

44 transfusion pathways were reviewed. 59 % (26/44) had a TACO risk assessment completed, and 41 % (18/44) lacked any risk assessment. 12 % (3/26) ofthe completed risk assessments were incorrect. 50 % (9/18) of the pathways without a risk assessment were at risk of TACO. Despite the identified inaccuracies, no TACO cases were recorded. 43 % (19/26) of completed risk assessments were performed in outpatient, compared to 16 % (7/26) completed in inpatient areas; this may be

attributable to varying workloads in these clinical areas.

Conclusion

The proportion of patients without a TACO risk assessment pretransfusion was significant. A small percentage of the completed assessments were inaccurate, due to missed patient risks or a lack of mitigation plan. Healthcare professionals require improved training to ensure robust peri-transfusion documentation and patient safety.