Lack of standardization of blood donor recruitment processes: A two-center mixed-methods audit study in Ghana.

Objective: Sub-Saharan African countries perennially suffer acute donor blood shortfalls. Clinical audit is a quality improvement strategy that enables the identification of actionable points to improve healthcare delivery. This study audited the blood donor recruitment processes at two Ghanaian secondary healthcare facilities to identify areas that can be leveraged to improve donor blood stocks. Methods: This was a sequential, exploratory mixed-methods study. First, 30 real-time observations of prospective blood donor-laboratorian interactions were undertaken using checklists. Subsequently, 2 sets of semi-structured questionnaires were used to collect data on pre-donation screening, blood donor privacy, and postblood donation care from the perspectives of 135 blood donors and 134 laboratory staff. Results: The observational data collection found a general inter- and intrapractitioner variation in blood donor recruitment procedures. Overwhelmingly, prospective donors were males (91.1%), or 20-39 years old (80.7%). Also, only 5.9% of prospective donors were voluntary nonremunerated, whereas 34.8% were deferred. Overwhelmingly, laboratory staff and prospective donors indicated that neither donor information leaflet (97.0% versus 98.5%, respectively), nor medication deferral list (93.3% versus 97.8%, respectively) was employed during the blood donor screening process. Also, whereas 88.2% of successful donors indicated being unaware of any focal person to contact in the event of adverse postdonation symptoms, laboratorians indicated that there was no focal person for handling issues related to successful (94.8%) or deferred (90.0%) blood donors. Furthermore, 42.3% of laboratorians indicated that prospective donors with permanent deferral results are fully informed, compared to 58.2% who indicated uneasiness when disclosing reactive screening results. Conclusions: The adoption of standard operating procedures may help prevent interfacility and interpractitioner variability in blood donor recruitment practices. Interventional implementation research may help to improve pre- and postdonation services offered to both successful and deferred donors in the study settings.