Jo Shorthouse. With thanks to Dr Kate Pendry. Consultant Haematologist Central Manchester Hospitals. and. Clinical Director for PBM NHSBT

Transcription

1 Jo Shorthouse With thanks to Dr Kate Pendry Consultant Haematologist Central Manchester Hospitals and Clinical Director for PBM NHSBT

2 What is Patient Blood Management? Why is Patient Blood Management important? The recommendations Implementation of Patient Blood Management

3 What is Patient Blood Management? An evidence-based, multidisciplinary team approach to optimising the care of patients who might need transfusion Focuses on measures for blood avoidance as well as correct use of blood components when they are needed Improves patient care, optimises use of donor blood and reduces transfusion-associated risk Reduces financial costs

4 Involving the patient in the decision making process Anaemia management Pre-optimisation Surgical techniques and alternatives Reducing inappropriate use Audit

5 Alternatives to blood transfusion Spahn DR, Goodnough LT Lancet

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9 Demand and Donorbase Units Issued / Donors / / / / / / / /08 Year 2008/ / / / /13 Issues Donorbase

10 Change in Red cell usage Moving Annual Total of Red Cell [Full Unit Equiv] Issues to Hospitals - 000s BBT HCS 1 NHSBT HL Teams est. BBT HSC 2 BBT HSC 3 Multiple factors

11 Moving Annual Total of Red Cell [Full Unit Equiv] Issues to Hospitals - 000s

12 Moving Annual Total of Platelet Issues to Hospitals - 000s

13 O RhD Negative Red Cells A precious and limited resource O RhD neg

14 O RhD Neg blood donors

15 Oneg issues vs total RBC issues Moving Annual Total of Red Cell [Full Unit Equiv] Issues to Hospitals - 000s MAT Total MAT O Neg

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17 Relative risks of complications of transfusion (SHOT 2012) Complication Death - Risk per components transfused Major morbidity - Risk per components transfused Overall risks from SHOT data 1 in 322,580 1 in 21,413 Hepatitis B (Public Health data) Hepatitis C HIV 1 in 1.3 million 1 in 28 million 1 in 6.7 million Acute transfusion reaction 1 in 42,473 Haemolytic transfusion reaction 1 in 322,580 Transfusion-associated circulatory overload 1 in 476,190 1 in 99,010 All errors 1 in 169,492

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19 Numbers of units Mean Age 64 years Age, by 5 year bands Male Female

20 136, 0% 2663, 6% 12250, 26% 31287, 68% Medicine Surgery O and G Not recorded

21 Breakdown of medical use by main category Category Haematology GI Bleed Non-haematological anaemia Neonatal/fetal Total Number Percentage of total

22 Highest use by diagnosis in medicine Sub-category Number Percentage of total usage Non-haematological cancer Myelodysplasia Renal failure Acute upper GI bleed Acute Myeloid leukaemia Lymphoma/CLL Critical care Sickle cell anaemia Non-haem anaemia, not specified Acute lower GI bleed Iron deficiency GI blood loss, site unknown Myeloma Total

23 Highest-using specialties in surgery by main category Category Number Percentage of total Cardiothoracic Trauma Orthopaedics GI Surgery Vascular Urology Solid Organ Tx Neuro surgery inc injury Plastic inc burns ENT Other surgery Total

24 Resources PBM champions NHSBT PBM Practitioners HTCs and HTTs Consultant haematologist dedicated to Tx NBTC PBM Recommendations

25 PBM Recommendations July 2014 transfusionguidelines.org NICE Guidelines due to be published August 2015

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27 Posters Safety Advice Information for healthcare staff Articles Guidance for hospital staff

28 Information for Patients Will I need a blood transfusion? Iron in your diet Receiving a plasma transfusion Children s leaflets PBM Anaemia FFP and cryo

29 SW : linking pre and post transfusion lab test results to transfusion episode (Clinisys) NW: Implementation of pre operative anaemia services London: Introduction of a single unit transfusion policy

30 Development of a PBM App Medical Audit Working Group: anaemia management algorithm, laboratory algorithm, definition of minimum transfusion dataset to standardise requesting Supporting Clinical benchmarking database Audits

31 National and regional leaders Hospital management Health professionals