Policy responses and statements
- Name of organisation:
- NHS Quality Improvement Scotland
- Name of policy document:
- Draft Clinical Standards for Blood Transfusion
- Deadline for response:
- 31 March 2006
Background: Over 3 million units of blood components are used in the UK each year - 300,000 of these in Scotland alone. Blood is given regularly and routinely for chronic disorders, before and after surgery, as well as in emergency situations and the service is dependent on freely given donations to meet this need. Scotland is unique in that blood supplies exceed demand and over 250,000 donations are given each year.
The Scottish National Blood Transfusion Service (SNBTS) is responsible for collecting, processing, storing and supplying all blood components in Scotland and NHSScotland Boards are responsible for ordering and managing their supplies in a safe and effective environment. Both SNBTS and NHSScotland are aware of the risks involved in all aspects of blood management and 2 important pieces of work have been carried out, which identified a number of areas where processes and practice could be improved. As a result of this, the Scottish Executive Health Department introduced an extensive programme of work to improve and support transfusion practice in Scotland (the Better Blood Programme, Appendix 5) and asked NHS QIS to consider how it could address the quality improvement issues identified.
NHS QIS set up a steering group to take this work forward and a report (available on the NHS QIS website) was produced in July 2004 with recommendations which focus on tackling key issues. One of the main recommendations within the report is that clinical standards for transfusion practice be developed and disseminated throughout NHSScotland.
COMMENTS ON
NHS QUALITY IMPROVEMENT SCOTLAND
DRAFT CLINICAL STANDARDS FOR BLOOD TRANSFUSION
The Royal College of Physicians of Edinburgh is pleased to respond to NHS QIS on Draft Clinical Standards for Blood Transfusion.
GENERAL COMMENTS
The College welcomes the NHS QIS standards in terms of their role in delivering safe care for patients. It is clear, from a number of years of SHOT reporting, that a key area of patient morbidity is IBCT whereby 100 patients have either died or suffered major morbidity related to a transfusion episode. Therefore, providing clinical standards in this area is an important piece of work.
SPECIFIC COMMENTS
Standard 1
Traceability is a real issue. Anyone who accesses medical records will quickly realise that there are very many instances when either the reason for transfusion or the transfusion records, or both, are missing. There are now IT systems using the latest technology, including RFID, whereby the process of transfusion and its safe administration (eg bar-coding and concatenating with patients’ wrist bands) is very secure. These are expensive, but offer a way to secure implementation. There have been trials of these IT systems in a number of hospitals that have had a significant degree of success.
The College is aware that there has been a major effort by clinical transfusion practitioners to formally train hospital staff involved in transfusion procedures. This is a very laudable activity and every effort needs to be made to ensure this programme continues into the future. Time needs to be made available to release clinical staff in hospitals to allow this to happen. It should be part of the agenda of each hospital transfusion committee.
Standard 2
It is increasingly important to involve the patient in the decision to transfuse. Adequate informed consent needs to be obtained and recorded. There have been many initiatives (eg The Human Tissue Act 2004) which put patient consent central to the decision-making process. This may be an area of “clinician education” rather than resource.
Standard 3
The BSQR & European Directives have resulted in the UK adopting increasing regulation in blood establishments and blood banks. This will increasingly involve inspections by independent regulators/competent authorities such as MHRA and will promote quality and safety of blood products. Staff, particularly in blood banks, need to be trained in these new aspects of their work, and encouraged to network with each other to share experiences.
Standard 4
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Positive patient identification is core to the basis of these clinical standards. Staff participating in the transfusion process must be suitably trained. This may present implementation difficulties with staff shortages, fast turnover and other pressures.
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SHOT is still a voluntary system although, with the introduction of SARRE, adverse event reporting should become increasingly routine. Not only should reports be submitted to SHOT and SARRE, but clinical incident reports should be raised locally and discussed by the local HTC, and this fact should be recorded. In this way, it can be demonstrated that teams are monitoring practice and learning from mistakes and near misses.
Copies of this response are available from:
Lesley Lockhart,
Royal College of Physicians of Edinburgh,
9 Queen Street,
Edinburgh,
EH2 1JQ.
Tel: 0131 225 7324 ext 608
Fax: 0131 220 3939
[31 March 2006] |
