Patient Blood Management. Peter Freeman Patient Blood Management Officer Clinical Operations Hunter New England LHD.

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1 Patient Blood Management Peter Freeman Patient Blood Management Officer Clinical Operations Hunter New England LHD. 1

2 National Standard 7: Blood & Products To ensure that the patients who receive blood and blood products do so appropriately and safely Requirements for prescribing administration and documentation applies to ALL BLOOD PRODUCTS 2

3 Blood Components and Blood Products Includes fresh components red cells, platelets, plasma (FFP, cryoprecipitate). Includes manufactured blood products Albumin, Immunoglobulins, (Anti-D, CMV, IvIgs) and clotting factors (Biostate, Prothrombinex) Includes recombinant products -clotting factors Even though they are not produced from human blood (Kogenate, Xyntha) 3

4 Standard 7 Intranet Pages Clinical Governance Page 4

5 PCP updated. Policy Compliance Procedure: Patient Blood Management and Administration of Blood and Blood Products - updated November Assists compliance with NSQH Standard 7 Reflects changes to HNEMR17 form. 5

6 Purpose of PBM Position Develop, evaluate, facilitate Patient Blood Management systems and processes Enable safe and appropriate use of blood component therapy 6

Changes to the HNEMR17 Administration Form Patient Information is no longer part of the form. Space for more than one prescriber now on form Patient or responsible person for consent M.O.

7 Changes to the HNEMR17 Administration Form Patient Information is no longer part of the form. Space for more than one prescriber now on form Patient or responsible person for consent M.O. must provide information to patient. CEC Brochure provided. Available to print from the Clinical Excellence Commission. Link on Standard 7 site. Paediatric versions also available (age appropriate). 7

8 Page 1: HNEMR17C New in multiple transfusion consent section: Patient or person responsible added 8

products Removal of dose for Anti-D for paeds, MO to

9 Page 3: HNEMR17C New Prescription Section: More than one prescriber now available for multiple blood components and products Removal of dose for Anti-D for paeds, MO to indicate dose in IU also removal of antenatal usage reason in paeds 9

10 Page 2: HNEMR17 and HNEMR17C New in Prescription Section: More than one prescriber now available 10

11 Page 3: HNEMR17 New Prescription Section: More than one prescriber now available for multiple blood components and products 11

Recording Observations ALL observations must be on SAGO chart ICU / Theatre may have specific chart / electronic monitoring Frequency of observations shall be:

12 Recording Observations ALL observations must be on SAGO chart ICU / Theatre may have specific chart / electronic monitoring Frequency of observations shall be: Baseline, 15 minutes, then hourly until completion or until transfusion is ceased at 4 hours. Observations should occur 30 minutes after transfusion complete 12

13 Blood Products Prescription and CONSENT required for ALL Products Albumin, clotting factors, immunoglobulins IvIg s (eg. Intragam,Flebogamma) and Rh(D) Prophylaxis may have specific consent forms REASON for transfusion must be documented for ALL products Traceability All batch numbers must be traced to recipient. Peel off sections for some products 13

14 Page 4: For Nurses End of transfusion documentation, inclusive of patients response to transfusion Adverse Reaction Section Warnings for future transfusions 14

15 Patient Blood Management 15

16 Maximise the Patient s own Blood 16

17 Emerging evidence of effects of transfusion Increased infections Increased length of hospital stay Increased morbidity and mortality Unwanted effects to immune system Risks often outweigh the benefits Red cell transfusion is a live tissue transplant 17

18 Very limited benefits of transfusion Life saving in acute bleeding Life saving when bone marrow diseased, suppressed. Otherwise historical, cultural practise Lacking evidence until recent times Evidence suggests poorer outcomes if transfused 18

19 Myths Busted - NO increased rates of infection - for viral risks yes, but there are other risks Transfusion gets patients home sooner No increased lengths of stay - NO the LHD pays for all blood products 19

20 Cost of Blood Products $402 $278 $170 $1200 Cost of Tfn is x 4.8 = $

21 Lack of. 21

22 Avoiding Unnecessary Transfusion 22

23 Rates of Iron Deficiency / anaemia Without adequate iron stores, patients cannot manufacture normal red cells Iron deficiency occurs long before anaemia is evident >10% population over 65 yrs anaemic > 20%population over 80 yrs anaemic 75% of these will be iron deficient Iron infusion is safe, effective, fast, cheap! 23

24 Anaemia - risk of UNNECESSARY transfusion 24

25 Study 227,000 Surgical Patients in USA Surgery : General, vascular, orthopaedic, urological, gynaecological, neurological and thoracic 30% had anaemia pre-surgery This made them 35% more likely to have postop complications cardiac, respiratory, urinary, wound sepsis, blood clots RISK OF DEATH within 30 days of surgery 41% higher in mildly anaemic patients 44% higher in moderate to severe anaemia. Published in the Lancet. 25

Single Unit transfusion When transfusion is required: Patient is symptomatic (NOT based on Hb alone) Symptoms short of breath, hypotension, increased heart rate, dizzy.

26 Single Unit transfusion When transfusion is required: Patient is symptomatic (NOT based on Hb alone) Symptoms short of breath, hypotension, increased heart rate, dizzy. Transfuse 1 unit only and reassess Reduces risk and harm Harm is DOSE DEPENDENT (2 units doubles the risk / harm) Culture of 2 units transfusion is habit, convenient, misguided, harmful. Is against the National Guidelines 26

27 Patient Blood Management Guidelines National Blood Authority 6 modules EVIDENCE BASED Developed by a Clinical / Consumer Reference Group Specialist colleges, organisations and societies Active participation from clinical community 27

28 NBA PBM Guidelines Recommendations evidence strong Practise points consensus of best practice 28

29 Credentialing Any person involved in any part of the transfusion process. Includes Agency staff, temporary / casual / part-time staff. Policy Compliance Procedure mandates Every 2 years 29

30 BloodSafe e-learning Australia Mandatory Completion Every 2 years: Clinical Transfusion Practice module for clinical staff. (Medical officers, nurses, midwives, laboratory staff) Pre-employment requirement for JMO s in HNE LHD. Includes Transporting Blood and Collecting Blood Specimens 30

31 Requirement according to employment: Some staff are not required to complete entire course: Transporting Blood module for wardsmen / porters (or anyone transporting blood and blood products) Collecting Blood Specimens for blood collectors (Phlebotomists). 31

32 Other Credentialing Courses Specific Groups may mandate. PBM and Iron Deficiency recommended, not mandated. Medical course medical, cardiac, cancer, CKD, Gastro. And now also Chronic disease. 32

33 Audits of Form and Credentialing Local Standard 7 (Blood Committees) regular audits of compliance to form Reported through District Patient Blood Management Committee, and CQPCC. BloodSafe compliance monitored Clinical staff (Medical Officers, Nurses / midwives), Wardsmen / porters, blood collectors. 33

34 Final Word..Speak up! 34

Blood is serious business

Blood is serious business Transfusion at RCH BLOOD TRANSFUSION Anthea Greenway Dept of Clinical Haematology >10000 fresh blood products per year Supports craniofacial and cardiac surgery Support bone marrow, liver transplant and