progress with transfusion safety in hospitals: a continuing ......mike murphy professor of blood...
TRANSCRIPT
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Mike Murphy Professor of Blood Transfusion Medicine,
University of Oxford
Consultant Haematologist,
NHS Blood & Transplant/Oxford University Hospitals
Progress with transfusion safety in
hospitals: a continuing journey
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Transfusion safety in hospitals
• Haemovigilance has provided the data to
indicate where improvements in transfusion
safety were needed
• A number of initiatives have led to improved
transfusion safety
• But further progress is required
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UK TRANSFUSION LABORATORY
COLLABORATIVE
Recommended minimum standards
for
hospital transfusion laboratories
September 2010 Bill Chaffe, Joan Jones, Clare Milkins, Clare Taylor,
Deborah Asher, Hedley Glencross, Mike Murphy
and Hannah Cohen, on behalf of the UK
Transfusion Laboratory Collaborative, c/o SHOT
Office, Manchester, UK
The collaborative recommendations are
intended to encourage effective and
appropriate use of technology and staff in
hospital transfusion laboratories within
the framework of current legislative
requirements.
MANY DRIVERS FOR IMPROVING
HOSPITAL TRANSFUSION
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Transfusion safety in hospitals:
where are we now?
• Safety of hospital transfusion still an issue
• Poor education and training
• National, regional and local audits consistently show inappropriate use of 15-20% red cells and 20-30% platelets/plasma
• Low uptake of methods to avoid use of blood
• Evidence base getting stronger but more research needed
• Poor IT for blood safety and for providing data on blood usage
See NBTC Annual Reports
http://www.transfusionguidelines.org.uk/Index.aspx?Publication=NTC&Section=27&pageid=1075
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“Our vision” in Oxford
To develop and implement process change in
hospital transfusion supported by IT to:-
• Enhance patient safety
• Reduce the administrative burden for clinical staff
• Optimise our use of resources (reduce blood use and blood wastage)
• Achieve compliance with tightening statutory and governance requirements
• Ensure the rapid availability of blood for urgent transfusions
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End-to-end electronic transfusion Bar-coded patient ID on the wristband is used to label the sample and blood bag
Davies et al. Transfusion 2006; 46: 352-364
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0
10
20
30
40
50
60
70
80
90
100
Baseline After training After training and introduction of
barcode ID
%
Compliance with pre-transfusion bedside
checking on an haematology ward (Transfusion 2003;43:1200-1209)
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Use of the electronic process for the
pre-transfusion bedside check
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Benefits 2006-11 (125,000+ units red cells transfused)
(Murphy et al. Transfusion 2012;52:2502-2512)
• No ABO incompatible red cell transfusions
• No serious wrong blood events
• ‘Wrong blood in tube’ reduced to 1 in 26,690
samples (national benchmark 1 in 3,000
samples)
• Compliance with blood traceability,
competency assessment etc
• Less blood wastage
• Lower blood usage
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National implementation of electronic
transfusion systems in England
2007* 2010
Blood tracking 23/98 (24%) 55/116 (47%)
Bedside checking 12/98 (12%) 18/115 (16%)
Data from surveys of hospitals in England by the National Blood Transfusion
Committee
* Murphy MF & Little T. Transfusion Medicine 2008; 18: 204-206.
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An evidence-based, multidisciplinary
approach to optimising the care
of patients who might need a
blood transfusion
PBM includes:-
• Minimising blood sample volume
• Appropriate transfusion triggers
• Managing pre-op anaemia
• Intra- and post-op management
e.g. cell salvage, assessing and
managing abnormal haemostasis
Patient Blood Management (PBM)
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Blood ordering process using EPR
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Select clinical reason for transfusion
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Select specific criteria for transfusion
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Complete number of units, time etc
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Alert if criteria for appropriate
transfusion not met
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Transfusion safety in hospitals
• There has been significant improvement
supported by haemovigilance
• But further progress is required
• Reliance on standard methods will not be
enough
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Thank you
• Funding: NHS Blood & Transplant and Oxford University Hospitals
• Research Nurses: Claire Dyer, Amanda Davies, Simon Noel
• Blood Transfusion laboratory: Julie Staves
• Oxford IT: John Skinner, Jonathan Kay, Paul Altmann
• Implementation team: Barbara Cripps, Alan Cook, Edward Fraser, Rachel Parker
• Commercial partners: Haemonetics, Olympus, Neoteric, iSoft