Transfusion at the Hospital End Aleksandar Mijovic Consultant Haematologist Kings College Hospital London, UK What drives the need for quality in transfusion? Blood - a limited resource Cost of blood products and the imperative of saving Risks of transfusion Clinical governance Better Blood Transfusion 2007 Safe and Appropriate Use of Blood Ensure better blood transfusion is an integral part of NHS care Further improve the safety and effectiveness of transfusion Avoid unnecessary use of transfusion Increase patient and public involvement in blood transfusion DH HSC 2007/001 National Blood Service Hospital Liaison Hospital Transfusion Committee Trust Executive HTT Clinical Governance committee Blood Users Patients Blood Bank Regional Transfusion Committee Structure of Transfusion Service in the Hospital ROLE of the HTC Promote best practice and blood safety based on evidence and guidelines Audit blood transfusion practice focus on areas of high demand provide feedback Review blood utilisation, stocks and wastage Develop and implement strategy for education & training for all involved in transfusion Promote patient information and consult with patient groups Contribute to clinical governance Composition of the Hospital Transfusion Committee Chairman - a user Consultant Haematologist Chief of the Blood bank Transfusion Practitioner(s) Laboratory Manager Pathology Business Manager NBS Hospital liaison representative Representatives from ICU, O/G, A/E, Surgery, Pediatrics, Perfusionists... Nursing representative Ad hoc co-opted representatives (Legal, etc) = HTT Topics discussed at a recent HTC meeting Transfusion in trauma Code Red Anti-D teaching Blood fridge locks Blood delivery times Electronic blood tracking Adverse events/Near misses Role of Transfusion Practitioner Communication with hospital departments and staff, patients, relatives, external organisations : Key Aspect of the Role Negotiation skills Collaborative network within hospital, regionally, and nationally. Role of Transfusion Practitioner HSC Better Blood Transfusion recommended the appointment of hospital transfusion practitioners (TP). No nationally defined criteria for the scope of TP role. It is essential to clearly define professional identity and function of TP. Training and Experience Understanding of a range of specialist work procedures - underpinned by theoretical knowledge and practical experience in transfusion and laboratory procedures, hemovigilance, IT, and quality assurance. At senior level a higher educational degree is required. TP role 3 Analytical and Organisational role Investigation and analysis of local incidents Problem solving and making recommendations for solutions; implements corrective action Collation, analysis, and interpretation of local audits. Promotes national strategies : National comparative audits; educational programs. TP role 4 Patient care Provides clinical or technical advice related to transfusion, e.g., appropriate use of blood; optimisation of blood counts prior to surgery ; alternatives to transfusion. Assists in service planning and development (e.g., surgical pre-assessment) Analyses and reports transfusion incidents/near misses Leads in development of patient information TP role 5 Teaching, training, policies Contributes or leads on transfusion policy development and implementation. Leads transfusion-related surveys or audits at local (regional; national) level. Active role in teaching and training at all levels: staff induction TP role 6 Better Blood Transfusion 2007 Safe and Appropriate Use of Blood Ensure better blood transfusion is an integral part of NHS care Make transfusion safer Avoid unnecessary use of transfusion Increase patient and public involvement in blood transfusion DH HSC 2007/001 Safe Transfusion Chain NHS National Patient Safety Agency Right Patient, right blood (Nov 2006) Competency-based training and assessment for all staff involved in transfusion Final identity check: match the blood pack with the patients wristband (not compatibility form). Formal risk assessment and feasibility (and relevance) of Electronic patient identification Photo ID for patients on regular blood transfusions Labelling system to match samples and blood for transfusion to the patient concerned. Scan barcode on wristband Quality Assurance in the Blood Bank Facilities (buildings, environment, materials, equipment) Personnel - responsibilities and training Control of tissues, materials and services (contracts/agreements, storage, traceability) Process control (validation, release and discard of products, audits, complaints, non-conformance) Finished product control (packaging, labelling,transport) Documentation (standard operating procedures, specifications, records, incident reports) Reporting Serious Incidents SABRE (Serious Adverse Blood Reactions and Events) : Online system on MHRA website (www.mhra.gov.uk)www.mhra.gov.uk SHOT (www.shotuk.org)www.shotuk.org Better Blood Transfusion 2007 Safe and Appropriate Use of Blood Ensure better blood transfusion is an integral part of NHS care Make transfusion safer Avoid unnecessary use of transfusion Increase patient and public involvement in blood transfusion DH HSC 2007/001 Avoiding unnecessary transfusion Promotion of best transfusion practice Hospital guidelines and policies Training sessions, lectures, and forums Paper and Online educational materialis Clinical advice Availability of medical & technical advice Blood conservation methods Question inappropriate orders Hospital guidelines Administration of blood products Use of blood components Surgical blood ordering schedule Transfusion in massive trauma and obstetric bleeding KINGS COLLEGE HOSPITAL TRANSFUSION COMMITTEE Guidelines for the Use of Blood Components 1. Red blood cells 2. Plasma 3. Cryoprecipitate 4. Coagulation Factor concentrates 5. Platelets 6. Granulocytes 7. Irradiated Blood Products 8. Management of massive blood loss 9. Urgent Apheresis procedures Support to Hospitals National/Regional Blood Transfusion Committee NHSBT Patient directorate National comparative audits On Line info (BBTS toolkit), Guidelines, Handbook of Transfusion Medicine, Posters, Patient info sheets Royal College of Pathologists British Committee for Standards Haematology Patients groups Hvala na panji ! Clinical Governance Sets of Measures to ensure accountability for providing quality care Quality improvement Continued Professional Development Risk Management Evidence-based Medicine Audit Development of IT Systems