Safe transfusion practice
Secure patient identification plays a key part in all aspects of safe healthcare. Patient misidentification is increasingly being recognised as a widespread problem within healthcare organisations. The National Patient Safety Agency (NPSA) has recognised patient misidentification as a significant risk within the NHS. Concern for proper patient identification is evidenced in the NPSA Right Patient, Right Blood Safer Practice Notice (14).
Electronic Positive Patient Identification : NPSA Safer practice notice No. 14
The NPSA has developed a standard specification for IT blood tracking systems, including electronic positive patient identification, based on work carried out by the 'Do Once and Share' blood transfusion project team for Connecting for Health and the National Blood Transfusion Committee.
The specification builds on the experiences of users of the different systems currently available, and addresses the patient safety risks identified in the blood transfusion process. It identifies all the safety and functionality issues that the NPSA is currently aware of, and those that future systems will need to address.
This can be found at: http://www.npsa.nhs.uk/patientsafety
Electronic patient identification can be achieved by various means e.g. barcodes (linear or 2D) or radio frequency systems, all of which can be incorporated into a wristband and the information read or accessed electronically.
Business Cases for Electronic Positive Patient Identification / Electronic Transfusion Tracking Systems
Examples of business cases, which may be adapted for local use as required:
Royal College of Nursing: Right Blood Right Patient Right Time
This Royal College of Nursing (RCN) guidance offers clinical advice for nurses on the administration of blood in the acute hospital care setting. or call 0845 772 6100 quoting publication code 002 306.
Members can access the RCN website (www.rcn.org.uk)
National Comparative Audit of Blood Transfusion - Bedside Practice Audit
These national audits examine the safety of red cell transfusions administered to patients in hospital by auditing the processes for:
- - identifying the patient
- - monitoring the patient before, during and after the transfusion
For more information about this series of audits go to: www.blood.co.uk/hospitals/safe_use/clinical_audit/National_Comparative/index.asp
Guidelines for the administration of blood and blood components and management of transfused patients
Details the minimum data set required for a record of transfusion
Management of acute life-threatening complications of transfusion
Serious or life-threatening acute transfusion reactions are rare. However any new signs or symptoms that appear while a patient is being transfused must be taken seriously, as they may be the first warnings of a serious reaction. Transfusion reactions may be:
- Acute haemolytic transfusion reaction
- Reaction to infusion of a bacterially contaminated unit
- Transfusion Associated Circulatory Overload (TACO)
- Transfusion related acute lung injury (TRALI)
- Severe allergic reaction
All severe transfusion reactions must be reported immediately to the hospital transfusion laboratory and the implicated blood pack returned to them. Recognition and management of acute transfusion reactions is outlined in this flowchart published in the Handbook of Transfusion Medicine.
Introduction To Care Bundles
Care Bundles is an approach which systematically appraises clinical processes. It is based on measuring the actual provision of therapeutic interventions according to standards, informed by evidence, which are set by local clinicians.
A care bundle approach requires measurement of a whole group of items, usually 3 to 5 items in total. It is not a measurement of the individual items alone, as all the steps must be completed to succeed.
It is a set of steps which experts believe are critical in successful delivery of an intervention as a whole. Measuring whether these interventions are performed appropriately and giving feedback to clinicians leads to alterations in practice.
(www.modern.nhs.uk). The care bundle approach is seen as a direct way of improving the delivery of clinical care to achieve better outcomes.
In 2005, a combined DH and NHS Modernisation Agency programme, "Saving Lives: a delivery programme to reduce Healthcare Associated Infection including MRSA", advocated a care bundle approach to implement 5 High Impact Interventions, in order to improve the reliability of clinical processes, to reduce risk of infection.
The concept of care bundles is becoming more widely accepted as a way of reducing the gap between research and clinical practice in general. The Institute of Healthcare Improvement has reported use of care bundles in reducing deaths from myocardial infarction and surgical site infections. www.ihi.org/IHI/Topics/CriticalCare.
Other care bundles have been utilised within critical care practice in particular, as well as other clinical specialities.
Care bundles are relatively simple and inexpensive to implement and are easily audited. (Fulbrook, 2003). For this reason; the care bundle approach was selected to assist in enhancing best practice in transfusion within our Trust. It was proposed that this strategy could be utilised within transfusion as a method of improving compliance with several best practice interventions.
The steps for development of a care bundle followed guidance within the document: Modernisation Agency: 10 High Impact Changes for Service Improvement and Delivery: Change No6.
Included here is an example of a data collection tool, incorporating 5 items in total. The supporting evidence for their selection is included. Alternative areas of local concern can be addressed, if their selection is supported by evidence or best practice guidance.
The Criteria for successful completion are necessary to ensure that compliance is assessed reliably between assessors. These are presented on the reverse of the tool to enable easy reference for the assessor.
Once analysed the data can give a graphic representation of areas / items for development, and when combined with on going data, gives feedback regarding successful improvements.
Information provided by Liz Still, Tranfusion Practitoner, East Sussex Hospitals NHS Trust.
This page was last reviewed on 09/12/2010