UK Issues National Patient Safety Alert on Reducing TACO Risk

The United Kingdom’s Medicines and Healthcare Products Regulatory Agency (MHRA) issued a national patient safety alert on Thursday focused on reducing the risk of transfusion-associated circulatory overload​ ​(TACO). TACO is one of the most common causes of transfusion-related deaths in the U.K., and cases have increased substantially in recent years.

The safety alert outlines three actions that the National Health Service (NHS) and independent (acute and specialist) organizations where transfusions occur must complete as soon as possible and no later than Oct. 4.

Stakeholders must first review and update their policies, procedures, and processes to align with recommendations from the British Society for Hematology, Serious Hazards of Transfusion (SHOT), and the National Institute for Health and Care Excellence. This includes conducting TACO risk assessments using the SHOT risk assessment tool, implementing mitigation measures for at-risk individuals and ensuring clear communication with patients regarding TACO risk and complications. Additionally, stakeholders should incorporate guidance on timely management of TACO cases and use SHOT’s structured incident investigation tool.

Second, stakeholders must review, update and implement training programs to include TACO pre-transfusion risk assessment tools, appropriate mitigation measures, the management of severe chronic anemia in non-bleeding patients, and recognition and management of TACO.  In addition, staff should be empowered to question blood transfusion practices and understand the importance of reporting TACO cases to regulatory bodies. Furthermore, stakeholders should establish record-keeping mechanisms to track staff participation in relevant trainings and re-trainings.

Finally, stakeholders should undertake regular audits to monitor the implementation of the TACO risk assessment tool, consent practices, management of chronic severe anemia, transfusion rates and discharge communications. These audits should involve relevant teams along the care pathway, including patients, and help identify areas to improve transfusion safety and patient care.

Additional information is available in an accompanying FAQ document.