Introduction
The administration of blood and blood components can be life saving, but does carry risks. There are also indications that blood may be in short supply in the future. Therefore it is important that the benefits of transfusion are weighed against the risks. Blood and blood components should be given only when essential. The Trust Blood Transfusion Policy, available on the hospital Intranet , gives further guidance and advice, including the use and availability of alternatives to transfusion, including Intra-operative Cell Salvage (ICS) and other techniques.
Prescription of blood and blood products is the responsibility of the doctor. Make a full assessment of the patient's clinical condition, taking into consideration laboratory test results, before prescribing: IS THE TRANSFUSION REALLY NECESSARY? If in doubt, the Consultant Haematologist can advise (Ext. 2678 or 2162 / air call.)
See specimen bottles for blood products
Prescription chart
The full patient identification details (family name, first name, date of birth, gender, hospital record number) should be written on the prescription chart. The prescription must be legible, IN CAPITALS and with no abbreviations. It must be signed by the prescribing medical officer.
Specify:
the blood or blood product to be given and any special requirements (e.g. CMV sero-negative, irradiated); the quantity, i.e. number of units, to be given; the duration of the transfusion; any special instructions (e.g. medication required before or during the transfusion); the date and time of commencement of the transfusion.
Pre- transfusion, enter into the patients medical notes:
the date; the indications for the use of blood / blood components; the number and type of blood / blood components ordered; that the patient has been informed of the risks and benefits. A patient information leaflet is available to facilitate this.
Timing of the transfusion
avoid transfusion at night unless it is a true emergency. Reaction detection may be delayed; the patient is woken frequently; and medical staff have to be alerted in the event of a possible reaction. Various Serious Hazards of Transfusion (SHOT) reports have highlighted the greater risk of transfusion errors occurring at night, when the Blood Bank and clinical areas function with greatly reduced staffing levels.
Medical notes - post transfusion:
enter: the date; the amount of blood actually transfused ; comments on the effectiveness of the transfusion; the occurrence and management of any adverse events .
Guidance on the recognition and management of adverse events can be found in the Blood Transfusion Policy.
SMUHT Blood Transfusion service
How to contact us
Consultant Haematologist Ext. 2678 or 2162 / air call - for advice on clinical matters and appropriate use
Hospital Blood Bank: 8am-5pm Ext 2160 / Out of Hours Bleep 490 - for advice on testing, and selection / availability of products
Autologous Team / Cell Salvage service - Ext. 5838 / 5843 or air-call
Transfusion Practitioner Ext. 5843 / Bleep 823 - for advice on day-to-day transfusion practice issues
Hours of Service - Blood Bank
Monday-Friday 8am-5pm full staffing; at night - 1 Bio-Medical Scientist only, to cover Haematology, Coagulation and Blood Bank. Other times (e.g. Bank Holiday) - skeleton staff only.
Tests we provide
Basic tests: blood group/antibody screen
Cross-matched blood
Emergency Cross-match /advice on use of Emergency O Negative Units
Products we provide
Blood
Platelets (not a stock item)
Fresh Frozen Plasma
Cryoprecipitate
Some specialist Clotting Factors (Defix)
Plasma Protein Fraction
Anti-D immunoglobulin
Preoperative autologous donation (PAD) now falls under new legislation (EU Directive 2002/98/EC) which dictates that the provider of this service must have blood establishment status. At present SMUHT does not hold this status and therefore PAD can only be offered on a limited basis at the NBS Manchester Blood Centre, Plymouth Grove.
How to get Blood/Products
Clinical Emergency - 'blood runners' are available. Please consult the Trust Transfusion Policy for more advice.
What we require of you for Patient Safety
The Serious Hazards of Transfusion (SHOT) report has identified the same type of errors occur each year nationally, and present a real risk of patients being given the wrong blood or blood product. Indeed, this is the greatest transfusion risk that patients face. However, this can be entirely avoided by following the correct identification procedures throughout the transfusion chain, from sample collection to administration of the blood.
Ensure : correctly labelled sample, labelled AT THE BEDSIDE immediately after drawing (BCSH Guidelines 1999-2004) - minimum of 3 identifiers; hand write the label on the sample tube - no addressographs on samples! Use a unique identifier for an unknown male/female.
IT IS NOT AN EXAGGERATION TO STATE THAT FAILURE TO ACHIEVE THESE STANDARDS MAY PROVE FATAL.
Algorithm for dealing with transfusion reactions
Guidelines and Department of Health regulations we must adhere to:
Patient safety, our legal / moral responsibilities; Health Service Circular 2002 / 009 ' Better Blood Transfusion';
British Committee for Standards in Haematology Guidelines (Administration of Blood Products, Care of the Transfused Patient, Use of Platelets, FFP etc. - see www.bcshguidelines.com)
Quality of our results/compatibility Testing:
National External Quality Assessment Service; Blood Stocks Management Scheme; daily Quality Control checks.
Use of Hospital Incident Reporting System (HIRS):
Enables lessons to be learned from errors or near misses - please report such issues to bring them to our attention. Some of them may need to be reported (anonymously) to the SHOT scheme via the Hospital Transfusion Team.
Remember, transfusion of blood or blood products must be:
|
Secure |
||
|
Appropriate |
||
|
Focused |
||
|
Effective |