A novel objective structured clinical examination for the assessment of transfusion practice in anaesthesia

Background: In 2008 there were 262 episodes of incorrect blood component transfusion. Safer Practice Notice 14, Right patient, right blood, introduced a mandatory requirement for all clinical staff involved in the blood transfusion process to be assessed against competencies developed on a national basis. It was recommended that the assessment should be an observed, formalised process. The National Patient Safety Agency (NPSA) produced an assessment framework, but this has never been validated. We developed the Nottingham Anaesthesia Transfusion OSCE (NATO). This consists of an interactive clinical scenario that examines the key aspects of transfusion medicine. Methods: After gaining informed consent, the NATO assessments of 12 anaesthetists were filmed. Three experienced assessors independently viewed the recorded material and scored the candidates. Cronbach's alpha was subsequently calculated. All participants were asked to complete a feedback form. Results: The pass rate during the study was 58 per cent (7/12). Cronbach's alpha for NATO was 0.929. Seventy-five per cent of candidates judged NATO to be a fair assessment of transfusion competency. Discussion: NATO allows the objectives detailed by the NPSA to be assessed formally in a format that is pertinent to anaesthetic practice. Internal reliability and face validity evaluation are the first steps in utility assurance of this assessment tool.