Original Articles Interventions to Reduce Wrong Blood in Tube Errors in Transfusion: A Systematic Review Susan Cottrell a , Douglas Watson b , Toby A. Eyre c , Susan J. Brunskill d, ⁎, Carolyn Dorée d , Michael F. Murphy e a NHS Dumfries & Galloway, Dumfries & Galloway Royal Infirmary, Dumfries, UK b Better Blood Transfusion, Scottish National Blood Transfusion Service, Gartnavel, Glasgow, UK c Oxford University Hospitals NHS Trust, Oxford, UK d Systematic Review Initiative, NHS Blood and Transplant, John Radcliffe Hospital, Oxford, UK e NHS Blood and Transplant and National Institute for Health Research (NIHR) Oxford Biomedical Research Centre at Oxford University Hospitals NHS Trust and University of Oxford, Oxford, UK abstract article info Article history: Available online 25 September 2013 This systematic review addresses the issue of wrong blood in tube (WBIT). The objective was to identify interventions that have been implemented and the effectiveness of these interventions to reduce WBIT incidence in red blood cell transfusion. Eligible articles were identified through a comprehensive search of The Cochrane Library, MEDLINE, EMBASE, Cinahl, BNID, and the Transfusion Evidence Library to April 2013. Initial search criteria were wide including primary intervention or observational studies, case reports, expert opinion, and guidelines. There was no restriction by study type, language, or status. Publications before 1995, reviews or reports of a secondary nature, studies of sampling errors outwith transfusion, and articles involving animals were excluded. The primary outcome was a reduction in errors. Study characteristics, outcomes measured, and methodological quality were extracted by 2 authors independently. The principal method of analysis was descriptive. A total of 12,703 references were initially identified. Preliminary secondary screening by 2 reviewers reduced articles for detailed screening to 128 articles. Eleven articles were eventually identified as eligible, resulting in 9 independent studies being included in the review. The overall finding was that all the identified interventions reduced WBIT incidence. Five studies measured the effect of a single intervention, for example, changes to blood sample labeling, weekly feedback, handwritten transfusion requests, and an electronic transfusion system. Four studies reported multiple interventions including education, second check of ID at sampling, and confirmatory sampling. It was not clear which intervention was the most effective. Sustainability of the effectiveness of interventions was also unclear. Targeted interventions, either single or multiple, can lead to a reduction in WBIT; but the sustainability of effectiveness is uncertain. Data on the pre- and postimplementation of interventions need to be collected in future trials to demonstrate effectiveness, and comparative studies are needed of different interventions. © 2013 Elsevier Inc. All rights reserved. Contents Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198 Eligibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198 Search Strategy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198 Data Extraction and Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198 Data Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199 Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199 Search Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199 Characteristics of the Included Articles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199 Effects of Intervention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199 Studies Measuring 1 Intervention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199 Studies Measuring Multiple Interventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199 Transfusion Medicine Reviews 27 (2013) 197–205 Sources of support: NHS Blood and Transplant Research and Development, UK, for Susan Brunskill and Carolyn Dorée. Conflict of Interest: MFM has worked and published on electronic transfusion systems for many years but has no financial conflicts to declare. SC, DW, TAE, SJB, and CD have no conflicts of interest to declare. ⁎ Corresponding author. Susan J. Brunskill, Senior Information Scientist, Systematic Review Initiative, NHS Blood and Transplant, John Radcliffe Hospital, Oxford, UK, OX3 9BQ. E-mail address: susan.brunskill@nhsbt.nhs.uk (S.J. Brunskill). 0887-7963/$ – see front matter © 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.tmrv.2013.08.003 Contents lists available at ScienceDirect Transfusion Medicine Reviews journal homepage: www.tmreviews.com