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| Document | Author Nicola Swarbrick, Debbi Poles & Shruthi Narayan |
| Abstract Serious Hazards of Transfusion (SHOT) is the UK’s independent, professionally led haemovigilance system, collecting and analysing anonymised information on adverse events and reactions in blood transfusion. Where risks and problems are identified, SHOT produces annual recommendations to improve patient safety. Transfusion laboratory errors reported to SHOT help highlight gaps in practices and policies paving the way for improvement actions to enhance safety. SHOT data shows that transfusion laboratory errors occur at a disproportionate rate when staff are lone working. A detailed analysis was undertaken of all laboratory errors reported to SHOT between 2020-2023 where staff working alone in laboratories was identified as a contributory factor (Narayan, 2023). |