1. ROLE OF HOSPITAL TRANSFUSION COMMITTEE IN STRENGTHENING BLOOD TRANSFUSION SERVICES
Prof. Debasish Gupta
Sri Chitra Tirunal Institute of Medical Sciences and Technology, Thiruvananthapuram

2. HOSPITAL TRANSFUSION COMMITTEE
Hospital Transfusion Committees (HTC) should be created to oversee all aspects of blood and blood product transfusion within individual institution
Every transfusing hospital should have their own HTC
Implement national policy and guidelines on the clinical use of blood
Monitor the use of blood and blood products at the local level

3. Role of Hospital Transfusion
Committee
Promotion of Best Transfusion Practices through:
Work inter-departmentally to promote safe and effective transfusion therapy
Monitor hospital transfusion performance by:
Active surveillance (observation audits) of bedside processes related to patient sample collection, blood requests, blood delivery, and bedside administration of blood
Tracking data on key indicators of the transfusion process
Participating in overall program of error/accident reporting

4. Role of Hospital Transfusion Committee Contd.
Recommend and implement approved changes in process of bedside blood administration
Educate staff (nursing, physician) to recognize and report transfusion reactions and disseminate information on hospital guidelines for appropriate blood usage
Provide basic training for new physician staff responsible for administering blood in high usage areas (eg, residents)
Contribute to improving processes for blood utilization review
Implementation of new technology designed to enhance patient safety

5. Blood Utilization Committee
To ensure “Safe Transfusion Practices”
Creation of Hospital Transfusion Committee or
Blood Utilization Committee
is being promoted all across the world

6. Blood Transfusion - Guidance & Regulations
WHO recommendations
Safe and Adequate blood supply
Clinical transfusion process
Appropriate use of blood
Collection samples, patient ID
Compatibility testing
Administration of blood
Adverse event reporting
Hospital transfusion committee
‘Better Blood Transfusion Practice’

7. National Blood Policy
Objective 5: To encourage appropriate clinical use of blood and blood products.
State/U.T. Government shall ensure that HTC are established in all hospitals to guide, monitor and audit clinical use of blood

8. FUNCTIONS OF HOSPITAL TRANSFUSION COMMITTE EDUCATION & COMMUNICATION
POLICY &
RETURN
MONITORING PRACTICE
Promote best practices
Local Guidelines
Data Collection
Blood Request & Usage
Adverse events
Blood Transfusion Protocol
National Guidelines
Laboratory
Wastage & Expiry
Clinical
Induction
Expenditure
Training (all staffs involved)
MSBOS
Hemovigilance Reporting
Continuing professional development
Dissemination & Review

9. AN EXAMPLE OF AN IDEAL COMMITTEE MEMBERSHIP:
Department
Position/Specialty
No. of People
Hospital Blood Bank
Both Medical Director & Senior Lab Manager 2
Hospital Administration
Higher level staff number 1
Clinical Services *
Physician & nurse from each area*
2 x number of areas
Nursing Department
Director of Nursing
Biomedical Engineering
Engineer
Medical Records
Higher level staff member
State Blood Transfusion Council
Risk Management
* Includes Paediatrics, Obstetrics & Gynaecology, Anaesthesiology, General Surgery, Internal Medicine, Heamatology/ Oncology and Super specialities

12. “Generally speaking, clinicians receive little or no formal training on the clinical indications for blood transfusion therapies during their time at medical school. HTC can promote best practice by providing continuing professional education and monitoring performance by clinical audit and peer review. Regularly notifying clinicians of their performance is an additional strategy that may improve transfusion practice.”

13. “Unsurprisingly, hospitals have been forced to elaborate strategies to ensure appropriate use of blood products. The hospital transfusion committee (HTC) now plays a pivotal role in this area. This article reviews the development, organization, and function of HTCs in relation to blood conservation and the evidence supporting relevant intervention to ensure appropriate blood utilisation.”

14. “Audits of practice and incident reporting, most notably to national haemovigilance schemes, indicate that poor hospital transfusion practice is frequent and occasionally results in catastrophic consequences for patients. Improvements in practice are needed and depend on a combined approach including a better understanding of the causes of errors; a reduction in the complexity of routine procedures taking advantage of new technology systems, which enforce agreed guidelines and policies; the setting and regular monitoring of performance standards for key aspects of the hospital transfusion process, improved organisation of transfusion in hospitals and staff training; and further research on the safe and effective use of blood and alternatives to donor blood. There needs to be a greater recognition that ‘transfusion safety’ applies to the hospital transfusion process as well as the contents of blood bags and that resources need to be provided for the improvement of transfusion safety and management in hospitals commensurate to their importance.”

17. Effective Implementation of Hospital Transfusion Committee ?
Where do We stand in
Effective Implementation of
Hospital Transfusion Committee ?

18. STRENGTHS
National Blood Policy recommends and promotes creation of HTC
Many Transfusing Hospitals have created their own HTC
Significant improvement reported in blood collection, component preparation and appropriate use of blood
Enrolment and Participation in Hemovigilance Programme of India

19. Development of Transfusion policy and guidelines
All aspects of the transfusion chain:
Consent for Transfusion
Sample collection
Request procedures (elective and emergency situations)
Checking patient identity
Conducting the transfusion
Monitoring of transfusion – identification and reporting of adverse reactions
Proper documentation
Reporting

20. EMPHASIS OF THE POLICY
On Blood Safety – Adoption of new technology, automation
Appropriateness of blood use
Indication for transfusion of specific component and their dosage
Reservation of blood in advance in special cases
Reduction of Wastage
Responsibilities of all staff involved in transfusion chain
Standards for each activity

21. BLOOD ORDERING
Institute with HTC encompasses appropriate and efficient use of blood through:
Development of Maximum Surgical Blood Order Schedule (MSBOS)
Recommends maximum blood order for each procedure
Efficiency of MSBOS is monitored by using C:T ratio
Rationalize blood usage
Reducing risk of outdating

22. BLOOD AUDIT
HTCs promote best practice by monitoring performance through
clinical audit and peer review.
Prescribing practice can be monitored and corrective measures taken
Clinical audit involves evaluation of ongoing practice
Its comparison to set standards;
When such standards are not met, appropriate changes are implemented
Monitoring their effect

23. INVOLVEMENT OF CLINICIANS IN HTC
Defining transfusion policies – International/ National/Local Guidelines
Understanding Management of Transfusion Medicine Unit
Gaining knowledge of Newer technology for blood safety
Advocacy in HTC function
Instrumental in:
Integration of Transfusion Medicine into the standard organization of clinical departments
Raising the visibility of the Transfusion Medicine within the hospital.

24. Gaps and Shortcomings in the Programme
LACUNAE
Gaps and Shortcomings in the Programme

25. Blood Storage Centres at FRU District Blood Banks
1. No directives issued by several State Health Department to the hospitals and Blood Banks for creation of HTC
2. No HTC or Non-functional HTC
Stand-alone Blood Banks
Blood Storage Centres at FRU
District Blood Banks
Many transfusing Hospitals
3. No defined Guidelines on HTC by Health Authority

26. 4. Lack of Regular Medical Doctor in
Blood Banks to start HTC
5. Inadequate members for the HTC
6. Non-participation or Non-cooperation from clinicians & administration
7. Meetings of HTC are conducted irregularly or infrequently
8. Poor or No action taken on the agendas of the meeting

27. Bed side transfusion practices
9. Under-reporting or Non-reporting of Adverse Transfusion Reactions
10. Proper Blood Audit not carried out
11. Lack of training programme on:
Bed side transfusion practices
Appropriate use of blood/ Rational use of blood
Clinical use of blood / Blood components
Adverse effect of Blood Transfusion

28. Lack of support from Health sector/ Administration
Reasons:
Non-participation by clinicians, residents, nursing staff – interest, time
Lack of Budget
Lack of support from Health sector/ Administration
Conflict of Interest

29. Hospital Transfusion Committee at SCTIMST: Our Experience
HTC formed in 1995
Held every quarter– 3 times /year
Members includes:
One Faculty each from Cardiology, Cardio Thoracic Surgery, Paediatric Cardiac Surgery, Neurology, Neurosurgery, Anaesthesiology
One Faculty from Bio-Medical Technology wing
Nursing Superintendent
Faculty of Transfusion Medicine – Member Secretary
Head of Transfusion Medicine – Chairperson

30. IMPORTANT DECISIONS FROM HTC
Implementation of National Blood Policy
Support of HTC to voluntary blood donation programme of the department
Developed Guidelines for blood transfusion practices
Introduction of Consent Form for patient receiving transfusion of blood & blood products
Regular Auditing of blood and blood components
Introduction of Autologous transfusion in selected clinical cases
Proposal to start Diploma in Blood Transfusion Technology for science graduates (since 1999)
Proposal to start M.D. programme (since 2015)

31. Portfolio Presentation
INITIATIVES
OF HTC

32. ACADEMIC ACTIVITIES
Several Academic activities were conducted regularly:
Rational use of blood
Leuko-reduction of blood and blood products
Massive Transfusion
Appropriate bed side transfusion practice
Autologous transfusion and Blood Conservation
Adverse effect of Blood Transfusion

33. Contn.... Outcome: 100% blood component usage by clinical departments
Leucodepletion of blood and blood products initiated
Protocols for Massive Transfusion developed
Blood safety measures implemented in all areas of blood services
Autologous transfusion programme introduced

34. Contn.. Studies undertaken:
Assessing the demand of blood and blood products
Maximum surgical blood order schedule
Transfusion Triggers
Blood audit
Adverse transfusion reactions

35. RECENT
DEVELOPMENTS
Approval of implementation of NAT for additional blood safety
Reporting of adverse transfusion reaction to HvPI
Clinical trials of indigenous preparation of plasma derivatives by BMT wing - ongoing
HTC supported the complete phasing out of Replacement donors – 100% VBD from 1st October 2016

36. CHALLENGES 100% attendance of members not achieved
Occasionally rescheduling of Meetings
New Clinical Residents indulge in wrong transfusion practices
Training of New Residents on appropriate transfusion practice
No information on blood units issued outside hospital
Financial issues

37. Improvement in Better Transfusion Practices
Better understanding the cause of errors
Reduction in the complexity of routine procedures
Adoption of new technology
Enforce approved Guideline and Policies
Regular monitoring of performance standards in hospital transfusion process
Improved organization of transfusion
Staff training on regular basis
Research on safe and effective use of blood
Alternatives to donor blood

38. IMPACT OF HTC HTC have a strong impact on better transfusion practice:
With adequate Government support
With adequate Administrative support
With sufficient resources
With real authority

39. CONCLUSION HTCs play a key role in blood conservation.
Development of an appropriate transfusion policy
Properly conducted clinical audit
Education of clinicians, nursing staff and other staff
Ensuring appropriate blood usage
Universally accepted transfusion triggers
Implementation of autologous transfusion
- Optimize the use of an expensive therapy with limited availability

40. Thank you