The Role of the Transfusion Safety Officer in Transfusion Medicine

Annie Newton, RN Transfusion Safety CoordinatorTransfusion and TransplantationAmerican Red Cross 8th Annual Fall SeminarOctober 6, 2016

DisclosureI have no real or apparent conflict of interest. I have no relevant financial relationship to disclose.

For the purposes of this presentation, I will be reflecting on my experience over the past year in a new TSO role within an academic level 1 trauma center with 621 acute-care beds and an average of 30,000 total blood product transfusions annually.

At the end of this presentation the learner should be able to:• Identify development and implementation strategies for a

transfusion safety officer (TSO) role—including experience and skills to consider when seeking a candidate AND training and support of the role.

• Recognize the impact and responsibilities of the transfusion safety officer role in a patient blood management program.

What is a Transfusion Safety Officer?

“The Transfusion Safety Officer/Blood Management Specialist (TSO/BMS) is a medical professional who has the specialized training to be responsible for patient safety and quality initiatives, reporting, processes and procedures, regulatory compliance, education and support related to blood transfusions.”1

What is a TSO? (cont.)

• Relatively new position within the healthcare system

• Title of the role can vary based upon organization location/structure/need and/or job description.

• Transfusion Safety, Blood Conservation, (Patient) Blood Management, Blood Utilization (Review), Transfusion Stewardship

• Officer, Coordinator, Specialist, Director

• Concept introduced in the U.S. in 1960’s with first held position at the University of Washington Medical Center in 1962 but began its re-immergence in the United States in the 2000’s after growth throughout France, the United Kingdom and Canada in the 1990’s.2

• 2008-14 positions reported vs. 201 positions in 2011 (15% of surveyed hospitals) 2

• Where do you start?

• How do you find candidates for the role?

• What are important skills to consider when interviewing candidates?

• Training of the new TSO.

Developing the TSO Role for your Organization

• Identify what areas of your transfusion service need improvement.• What are your goals?• Can you provide data to leadership to justify your organization’s

need for this role?

• What is the structure of your organization?• How is patient care provided, direct vs. indirect?• Is your staff mainly comprised of laboratory/technical staff or

nurses/providers?• What is the size of your organization and how many total products

are transfused annually?

This will help you to determine what kind of candidate experience/credentialing will best meet your needs and shape the expectations and responsibilities for the role.

Where to Start

The professional background of the TSO can vary from that of a registered nurse, medical lab scientist/medical technologist, provider (physician, physician assistant, advanced practice nurse) or perfusionist.

The majority of TSO backgrounds range between those with either blood banking or nursing experience, depending upon the organizational structure and need.

Finding TSO Candidates

• Blood banking experience• Functionality• Specimen and compatibility testing• Transfusion reaction work-ups and protocols• Inventory management

• Knowledge related to state and federal regulations and other accrediting agencies.

• Limited knowledge and/or experience related to patient care and blood administration.

• Minimal interactions with providers and other leaders within the organization.

MLS/MT

• Clinical experience and working knowledge of blood administration practices.• Assessment/monitoring of patients during transfusions• Able to recognize and take appropriate action during a suspected transfusion

reaction.• Understanding of patients’ medical conditions that benefit from transfusions and

advocate for patient care.

• Direct interaction with providers and other members of the interdisciplinary team

• May have experience with organizational leadership committees.

• Limited Knowledge related to the blood banking process• Workflow and functionality• Specimen/compatibility testing• State/federal regulations and accreditation standards

Registered Nurse

• *Effective Communication• Time management

• Self motivation• Flexibility• Team building• Public Speaking• **Project Management• Passion• ***Leadership

• Basics of Communication• Crucial Conversations• Conflict Resolution• Managing Change• Problem Analysis and Group Decision Making

Soft Skills

• Formal TSO training programs are available

• Job shadowing other TSOs

• On the job training • Case studies, Transfusion and other scholarly/societal journal article reviews,

other literature and publications• Webinars• Organizational resources such as the Transfusion Services Medical Director

and department staff

• Attending annual blood societal conferences• AABB• SABM

Training

Get leadership involved! The role of the TSO goes far beyond that of the blood bank and an interdisciplinary approach is essential for success.

Get to know:• Leadership

• Nursing Professional Practice• Enterprise and Clinical Quality

• Other safety offices/coordinators• Department/Nurse Managers • Shared Governance councils and other committees

• Nurse Educators• Case Managers• Quality Management• Support staff

• Technical support (IT)• Analytics• HIS

• Application Analysts• Clinical Informatics• Applications Trainers

• LIS• System Analysts

Support of the TSO

Networking is KEY!

Society memberships/mentoring programs-AABB-SABM

Sub section committees-PBM-Education

List serves

LinkedIn

Resources

“Patient Blood Management (PBM) is an evidence-based, multidisciplinary approach to optimizing the care of patients who might need transfusion. PBM encompasses all aspects of patient evaluation and clinical management surrounding the transfusion decision-making process, including the application of appropriate indications, as well as minimization of blood loss and optimization of patient red cell mass.”3

“Patient Blood Management (PBM) is the timely application of evidence-based medical and surgical concepts designed to maintain hemoglobin concentration, optimize hemostasis and minimize blood loss in an effort to improve patient outcome.”4

Patient Blood Management

When looking at how best to utilize the TSO role for your organization; start by evaluating your transfusion and/or patient blood management program for what it is, then set goals for where you want it to be.

• Do you have PBM program?• How effective is your program?• How can a TSO help you to improve your program?

TSO for PBM

Scope• Blood Utilization Review

– Collect and analyze transfusion data related to provider utilization rates– Reduce blood component wastage– Tracer/compliance auditing

• Educator– Nurses, providers, laboratory personnel and patients

• Clinical Resource– Providers and nursing staff

• Project Management

• Liaison

• Hemovigilance

• Does your organization have a formally announced blood management program?

• What are your transfusion guidelines?• Are they robust enough?

• What are your providers’ blood utilization rates?• Which teams/providers are the biggest offenders for guideline outliers?

• How robust are your nursing blood administration policies and are they founded on evidenced based best practice guidelines?

• Are nursing transfusion practices safe and do they follow said policies?

• How compliant is nursing documentation?

• What is your suspected transfusion reaction reporting rate?• How educated is the nursing staff in recognizing suspected transfusion

reactions?

Get to Know Your Program

Learn your organization’s leadership and governance structure and get involved.

LET PEOPLE KNOW WHO YOUE ARE!

Join Organizational Committees as a member or ad-hoc-Transfusion Committee (x2)-Trauma PIPS Committee-Clinical Education Coordinators team-Nursing Professional Development Council

-Practice Council-Nursing Polices Review Committee

Get Involved

Important to establish positive working relationship with open communication

– Staff nurses are the eyes and ears at the bedside– Meet with individual units/departments and get to know the staff.

The TSO serves as a resource for the bedside nurse:– Educator

• Transfusion practices and guidelines, transfusion-related risks and reaction identification/reporting, P&P updates and EMR documentation requirements/changes

– Liaison• Improve relationship and communication between the bedside/clinical

environment and the blood bank/laboratory– Ally

• Empower nurses to advocate on behalf of the patient to ensure best care practices and improve patient outcomes

Build Relationships

Educate, Educate, Educate!

Remember, most providers (MD, PA, APRN) and nurses receive the bare minimum in education (2 hrs or less) during their preparatory studies related to blood administration.

A great starting point is to evaluate what are your current annual (and elective) educational resources available to staff. Can the current education be beefed up or is there room to add additional tools?

Knowledge is POWER!

It may be very tempting to want to jump in with both feet and try to “fix” the major issues straight away, but just remember: “Rome was not built in a day!”

If patient safety is truly at risk and there is an easy solution, go for it. But most of the time, this is not the case and it may take multiple small changes to see a significant shift in your program towards better practice and patient safety.

When in doubt, EDUCATE. Sound educational resources for staff are invaluable tools to have at your disposal. Keep in mind that your providers and nurses want to do what is truly best for your patients; give them the tools to be successful!

Start small……Every victory counts!

The TSO can come from varying backgrounds of expertise. One credential is not better than another nor is your program’s success dependent upon your TSO’s specific program of study. Rather, concentrate on the structure of your organization and what best will meet your needs. Ensuring that your TSO has the skills necessary to assist in leading your team towards improvement and that they are set up for success with support from all areas of leadership.

PBM is a team effort that goes far beyond the walls of the Blood Bank.

Summation

References1. Townsend, M. Transfusion Safety and Blood Management Specialists: New Roles for a New Medical Paradigm [PowerPoint Slide 31]. ASCLS, March 12, 2014. [Available at http://www.ascls-and.org/pdf/14-04-18/7_Transfusion%20Safety%20and%20Blood%20Management%20Specialists.pdf (accessed October 5, 2016).]

2. Dunbar NM, Szczepiorkowski ZM. How do we utilize a transfusion safety officer? Transfusion 2015;55:2064.

3. Patient Blood Management. Bethesda, MD: AABB, 2016. [Available at http://www.aabb.org/pbm/Pages/default.aspx (accessed September 29, 2016).]

4. What is patient blood management? Richmond, VA: SABM, 2014. [Available at https://www.sabm.org (accessed September 29, 2016).]

Contact Information

Annie Newton, RNTransfusion Safety CoordinatorTransfusion and Transplant Services

  Nebraska Medicine1325 UT981180 Nebraska Medical Center | Omaha, NE 68198-1180Office 402.559.3142 | Fax 402.559.3200 | Pager 402.888.0199 Anewton@nebraskamed.com