Presentation on theme: "Standard 7 – Blood and blood products"— Presentation transcript:
1 Standard 7 – Blood and blood products Philippa KirkpatrickApril 2013
2 Why a blood standard?There are inherent risks associated with transfusion practiceTransfusion has been associated with increased morbidity and mortalityTransfusion is ingrained in the culture of medical practiceReports suggest a significant proportion of transfusions are inappropriateThere are high wastage rates at some health service organisationsThere is significant room for improvement in practice to improve quality and safety
3 Scope - activities The Blood Standard covers: Use of blood and blood products – the prescribing practice and clinical use of blood and blood products, and whether or not those products are prescribed and used appropriatelyManagement of blood and blood products - handling, transport, storage (including inventory management) of blood and blood productsAdministration of blood and blood products - the process used to deliver the product to the patient.
4 Scope Currently covered by Standard 7 Classes of products funded under National Blood ArrangementsFresh blood products egRed cellsPlateletsPlasmaCryoprecipitateSerum eye dropsPlasma derived products egIVIgRhD immunoglobulinClotting factorsRecombinant clotting factorsNot currently covered by Standard 7Haematopoietic progenitor cellsPlasma derived products egTisseelArtissC1-INHFibrinogenMonoclonal antibodiesVaccinesOther recombinant productsClasses of products not funded under National Blood ArrangementsBlood Biological Medicine
5 Three main areas of concern Decision-making regarding the clinical use of blood componentsPatient identification and labelling of pre-transfusion specimensBedside verification that the correct blood is given to the intended recipient*Source: Haemovigilance Report 2010Talk about near misses (wrong blood in tube)
7 Transfusion quality improvement system (Action 7.4.1) Improve quality and use of policies (7.1.3)Improve documentation of transfusion(7.5.3)Reduce wastage(7.8.2)Reduce adverse event risks(7.3.1)Reduce management risks(7.7.2)Improve documentation of consent(7.11.1)Reduce systems risks(7.2.2)Reduce administration risks(7.6.2)Improve provision of information to patients(7.10.1)
8 Policies, procedures and protocols (Action 7.1.1) You should have policies, procedures and protocols that reflect best practice, and national evidence based guidelines where they are available.Your policies, procedures and protocols should cover the spectrum of:Use of blood and blood productsManagement of blood and blood productsAdministration of blood and blood products
9 Quality improvement cycle Identify what you will do - develop or identify policies, procedures or protocolsTransfusion Quality Improvement SystemPlanDoCheckActTake action to improve uptake and improve their qualityImplement the policiesMonitor their use AND monitor their quality
10 Transfusion governance group (Action 7.4.1) What about small organisations?Oversight of the programReview reportsIdentify recurring issuesRoot cause analysis of incidentsDevelop or agree action planEvaluate effectiveness of actionsConsider alignment and linkages with Standard One
12 The patient clinical record (Action 7.5.1) A best possible history of blood product usage and relevant clinical and product information is documented in the patient clinical recordThis action builds on Action by identifying the information relevant to transfusion of blood and blood products that should be documented
13 Patient documentation case study What actions are required to demonstrate compliance with the Standard?
14 Case Study Hospital One Transfusion governance group has reviewed findings and developed and implemented an action plan, for example:Reviewed policyImplemented training of all staffIdentified staff associated with non-compliance and communicated directly with themMade changes to the IT system to facilitate inclusion of all information (prompts)Increased frequency of audit on the hospital audit planInitiated more regular spot checks of fate of product against patient recordsOutcome: the action plan is matched with the level of compliance. This would be likely be assessed as meeting the requirement, but the health service organisation should also demonstrate improvement in next cycle.
15 Case Study Hospital One Audit report does not have a management response or action planThey posted on the intranet a reminder to document transfusion in the patient clinical recordThey have not undertaken any other follow up and the next audit is scheduled for one year awayOutcome: the action plan is not matched with the level of compliance. The health service organisation needs to demonstrate additional work prior to accreditation.
16 Case Study Hospital Two They posted on the intranet a reminder to document transfusion in the patient clinical recordThey have not undertaken any other follow up and the next audit is scheduled for one year awayOutcome: the action plan is matched with the level of compliance. This would be likely to be assessed as meeting the requirement.
17 Managing adverse events Recognise and respond to adverse eventsDocument adverse events in the patient clinical recordTake action to reduce the risk of adverse events as part of your transfusion quality improvement system
18 Complexities of incident monitoring and reporting 7.6.1 – Document in patient clinical recordPatient recordReport to pathology service provider, Blood Service or product manufacturer whenever appropriateExternal reportReport in local incident system and review by Transfusion Governance GroupLocal reportReview by highest governance level of incident summary and analysisExec review– Participate in state haemovigilance reportingIn some cases will be extracted from local system or, may require reporting to the state systemState report7.3.3 – Participate in national haemovigilance reportingIn some cases will be extracted from state system or, may require reporting to the national systemNational report
19 Criterion Three Managing blood and blood product safety
20 Management of blood and blood products Blood must be stored and handled appropriately to prevent risk to patients. Systems should be implemented to reduce risks associated with receipt, storage, collection, and transport (Action and 7.7.2)Wastage of blood should be minimised (Action and )
21 Responsibility where services are outsourced Many health service organisations receive blood from an outsourced pathologyIt remains the health service organisation’s responsibility to demonstrate compliance with the StandardA health service organisation uses blood provided by a contracted pathology providerYour health service organisation should have a contract with the pathology provider that includes requirements and provision of reports to enable hospital to check they meet the standardsYour health service organisation should review reports provided and implements strategies with contracted pathology provider to rectify problems
22 Criterion Four Communicating with patients and carers
23 Communication (Actions 7.9.1, 7.9.2 and 7.10.1) Develop or identify resources to inform patients and their carers about the alternatives, risk and benefits of transfusion (Action 7.9.1)Provide this information to patients and their carers in a format that is understood and meaningful (7.10.1)Allow patients and carers to partner in decisions on their care based on the communication on the alternatives, risks and benefits of transfusion (Action 7.9.2)
24 Consent (Action )Have a documented consent policy which is specific to, or includes transfusion of blood and blood productsEnsure written and documented consent meets local policyEnsure the consent is actually informed – link with 7.9 and 7.10Assess compliance with the consent policy is assessed, and take actions to increase compliance
26 Available resources Clinical practice guidelines National Blood AuthorityPatient Blood Management GuidelinesModule 1: Critical Bleeding Massive TransfusionModule 2: PerioperativeModule 3: MedicalModule 4: Critical CareModule 5: ObstetricModule 6: Paediatric/NeonatesGuidelines on the Prophylactic Use of Rh D Immunoglobulin (anti-D) in ObstetricsCriteria for the Clinical Use of Intravenous Immunoglobulin (second edition)NHMRC guidelines portalFactor VIII and FIX GuidelinesWarfarin Reversal Consensus GuidelinesAustralian and New Zealand Society of Blood Transfusion (ANZSBT) guidelines and publications
27 Available resources Product information and product management 10 Tips to Help Manage you Blood Product InventoryManaging blood and blood product inventory – Guidelines for Australian Health ProvidersAustralian Red Cross Blood Service Blood Component Information CircularThe Australian Red Cross Blood Service blood components and products web siteBloodSafe eLearning Australia module on Transporting Blood https://www.bloodsafelearning.org.au/ANZSBT Guidelines for the Administration of Blood ProductsANZSBT Guidelines for Pre-Transfusion Laboratory PracticeNational Pathology Accreditation Advisory Council (NPAAC) Requirements for Transfusion Laboratory PracticeAustralian Standard for Medical Refrigeration Equipment – For the Storage of Blood and Blood Products (AS3864)NBA BloodNetNBA BloodPortal https://portal.blood.gov.au/Flippin’ Blood
28 Available resources Adverse event recognition and reporting See Jurisdictional programsNBA Haemovigilance Reports 2008National Haemovigilance Data DictionaryFlippin’ BloodANZSBT Guidelines for the Administration of Blood Products(http://www.anzsbt.org.au/publications/)Patient information and consentThe Australian Red Cross Blood Service – Information for PatientsJurisdictional ProgramsNew South Wales – Blood WatchQueensland iBlood Management ProgramSouth Australia – BloodSafeVictoria – Blood MattersWestern Australia Patient Blood Management Program