Striving to improve transfusion safety: The 2021 SHOT Report

Serious Hazards of Transfusion (SHOT) works collaboratively with the Medicines and Healthcare products Regulatory Agency (MHRA) to oversee haemovigilance in the UK, collecting and analysing anonymised reports relating to serious adverse reactions (SAR) and serious adverse events (SAE) following blood transfusion. This is done via an integrated electronic reporting portal. SHOT also accepts reports of near miss (NM) events and acknowledging continuing excellence (ACE) which recognises exceptional practice. Reviewing these events on a national scale helps identify trends in reports received, make annual recommendations, and provide key learning points to proactively improve patient and transfusion safety, as outlined in the Annual SHOT Report (ASR). 

              Haemovigilance is instrumental in improving transfusion safety, both for donors and patients. Haemovigilance data helps assess risks associated with transfusions, provide assurance about safety, and helps identify areas for improvement. This also facilitates dissemination of knowledge amongst professionals to minimise the risk of adverse events.

              SHOT is celebrating 25 years of haemovigilance reporting in the UK this year. During its first year SHOT received only 169 reports, which has now grown to 4088 reports submitted in 2021. 2021 was the first year that 100% of UK NHS Trusts/Health Boards involved in transfusion submitted reports to SHOT. This is commendable in what has been another difficult year for NHS staff and indicates an open and fair reporting culture, where staff learn from things that go wrong.