Transfusion at the Hospital End

Aleksandar Mijovic

Consultant Haematologist

King’s 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 ServiceHospital Liaison

Hospital Transfusion

Committee

Trust Executive

HTT

Clinical Governancecommittee

Blood UsersPatients

Blood Bank Regional TransfusionCommittee

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 AgencyRight 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

patient’s 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)

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

• KING’S 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 pažnji !