Managing Better Blood Transfusion at Trust Level
Hospital Transfusion Committee (HTC)
NHS Trusts involved in blood transfusion should establish a Hospital Transfusion Committee (HTC) (or share a committee with another NHS Trust) with the authority and resources to take the necessary actions to improve transfusion practice. HTCs should meet at least 3 times/year. The membership should include the members of the Hospital Transfusion Team (HTT) and representatives from clinical areas where blood transfusions are frequently used including medicine, surgery, obstetrics and paediatrics, and also from senior management and clinical governance/risk management.
Senior NHS Trust management should be represented on the HTC.There should be HTC representation on the NHS Trust’s clinical governance/risk management committee, and the Chair of the HTC should be invited to present an annual report on blood transfusion.
The HTC should:
- Promote safe and appropriate blood transfusion practice through local protocols based on national guidelines.
- Audit the practice of blood transfusion against the NHS Trust policy and national guidelines, focusing on critical points for patient safety and the appropriate use of blood.
- Lead multi-professional audit of the use of blood within the NHS Trust, focusing on specialities where demand is high, including medical as well as surgical specialities, and the use of platelets, plasma, and other blood components as well as red cells.
- Regularly review and take appropriate action on data on blood stock management, wastage and blood utilisation provided by the Blood Stocks Management Scheme (BSMS) and other sources.
- Provide feedback on audit of transfusion practice and the use of blood to all NHS Trust staff involved in blood transfusion.
- Develop a strategy for the education and training of all clinical, laboratory and support staff involved in blood transfusion.
- Promote patient education and information on blood transfusion including the risks of transfusion, blood avoidance strategies and the need to be correctly identified at all stages in the transfusion process.
- Modify and improve blood transfusion protocols and clinical practice based on new guidance and evidence.
- Be a focus for local contingency planning and the prevention and management of blood shortages.
- Report regularly to their Regional Transfusion Committee (RTC), and through the RTC to the National Blood Transfusion Committee (NBTC).
- Participate in the activities of the RTC.
- Consult with local patient representative groups where appropriate.
- Contribute to the development of clinical governance.
Hospital Transfusion Team (HTT)
NHS Trusts involved in blood transfusion should implement arrangements for promoting good transfusion practice through the development of an effective clinical infrastructure, including the establishment of an HTT.
The HTT should consist of:
- Lead consultant for transfusion (with funded sessions dedicated to blood transfusion)
- Hospital transfusion practitioners or equivalent (e.g. nurses, biomedical scientists, medical professionals); the number of these staff depending on the size of the NHS Trust
- Blood transfusion laboratory manager
- Other members, eg from the HTC, can be co-opted.
- There should be identified clerical, technical, managerial and information technology support as required, and access to audit and training resources to promote and monitor the safe and effective use of blood and alternatives to blood transfusion.
The role of the HTT is to:
- Implement the HTC’s objectives
- Promote and provide advice and support to clinical teams on the safe and appropriate use of blood
- Promote patient information and education on blood transfusion safety and use of alternatives.
- Actively promote the implementation of good transfusion practice
- Be a source for facilitating training all NHS Trust staff involved in the process of blood transfusion
- Produce an annual report including its achievements, action plan for transfusion safety, quality and blood conservation and its resource requirements for consideration by senior management at Board level through the HTC and the NHS Trust’s clinical governance and risk management arrangements
Sharing good practice - an example of how the HTC and HTT operates at The Queen Elizabeth Hospital, King's Lynn NHS Trust.
These notes by Claire Atterbury, Transfusion Practioner, describe the membership, terms of reference and functioning of the HTC and HTT at King's Lynn.
Claire Atterbury and Consultant Haematologist, Jane Keidan, have also produced a PowerPoint presentation describing how their Trust's HTT operates.
Transfusion Practitioner (TP)
All Trusts should implement arrangements for promoting good transfusion practice through the development of an effective clinical infrastructure. This includes the appointment of a TP or equivalent (e.g. nurse, biomedical scientist, medical professional).
Details of business cases, help and advice can be obtained from members of the UK Better Blood Transfusion Teams
Audit Practitioner for Transfusion
The effective local implementation and audit of guidelines supporting appropriate blood transfusion is vital in order to continue to improve practice. A dedicated blood transfusion auditor may help achieve this. This role may include:
- The continuous audit of blood and blood product usage
- The continuous audit of compliance with local and national guidelines relating to blood transfusion
- Input into the development of local blood transfusion guidelines
- The audit of blood loss following specific procedures
- Acting as an additional easily accessible point of contact and advice for clinicians regarding blood transfusion
- Providing a visible link between the hospital Audit Department, Blood Transfusion and clinicians
- The performance of specific audits of other aspects of blood transfusion when required e.g. audit of documentation, patient identification, traceability etc.
In those Trusts in which a blood transfusion audit practitioner has been employed there is good evidence of a progressive improvement in compliance with local guidelines and substantial financial savings.
Relevant issues to bear in mind when considering employing an Audit Practitioner:
- Writing the Business Case
- Defining a Job Description and Person Specification
- Roles and Responsibilities
- Training and Support
- Policies, Toolkits and Guidelines
In order to institute a new service within a Trust it is vital to be able to demonstrate that the innovation is desirable in terms of improving the quality of patient care, and is affordable financially for the institution.
The business plan prepared must be relevant to the patient population to be treated: an example business case may be accessed below. This may be modified and used to suit local circumstances. Prior to submitting the business plan, it is invaluable to set aside time to visit an institution that has employed an Audit Practitioner in order to gain an insight into how the role works.
Defining a Job Description and Person Specification:
The job description for the Audit Practitioner will vary according to the specific needs of the individual Trust. Occasionally it may be possible to combine the roles of Audit Practitioner with those of Transfusion Practitioner although this will only generally be possible if there is more than one Transfusion Practitioner in post.
Roles and Responsibilities:
The Audit Practitioner should ideally work with the Hospital Transfusion Team providing feedback regarding the effectiveness of and compliance with local and national transfusion guidelines. The role will also allow the audit of specific aspects of transfusion practice relevant to that particular Trust and provide an additional line of communication between the clinical staff and the Transfusion staff. It is suggested that the Audit Practitioner is responsible to the Consultant Haematologist leading blood transfusion, although other lines of responsibility have been shown to work well and may be considered in individual Trusts. The practitioner should provide reports on a regular basis for individual clinicians and the Hospital Transfusion Committee as appropriate.
Training and Support:
The efficient collection of transfusion related data ideally requires the provision of computer hardware and software including hand held portable devices for use in clinical areas. Training in the use of these devices and the associated database management will be essential.
Policies, Toolkits and Guidelines:
The day-to-day experience of the Audit Practitioner can provide an invaluable insight into clinician behaviour and may therefore play a useful role in the development, evaluation and refinement of further policies and guidelines.