Transfusion practitioner

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There are more than 100 different titles that are used as another name to Transfusion Practitioner (TP). The most common titles used include Transfusion Practitioner, Haemovigilance Officer, Transfusion Safety Officer, Transfusion Nurse, Patient Blood Management (PBM) Practitioner, and PBM Nurse. [1]

Contents

The role of the TP has a long history with roles being in place since late 1990's and early 2000's in countries such as United Kingdom (UK), Australia, United States of America and Canada. [2] [3] [4] [5] [6] [7] [8] A range of healthcare professionals from various clinical specialities undertakes the TP role. Many have a nursing, midwifery or scientific qualification, although, in some countries, medical officers undertake aspects of the role. [8] [6]

Focus of Transfusion Practitioners

It is a specialist role focusing on patient safety through best practice and appropriate use of blood and blood products. Much of their work centres on aligning practices with local, national, or international standards and guidelines. [8] There are many activities that comprise the TP role and some or all of these may be within TPs position (job) descriptions depending on the area they work, and the strategic direction of the organisation they work in. [9] [3] TP activities aim to increase awareness and knowledge to improve clinical decision making and enhance practice. Blood management and transfusion practice require a multidisciplinary approach and TPs are seen as the link between different health professionals and departments, such as clinical and laboratory colleagues, as well as patients. [8] [10] [11] To comply with governance regulations/mandatory standards many organisations have established blood management or transfusion committees (BMC) (or equivalent). Their responsibilities include risk management, and surveillance of appropriate use and management of blood, waste minimisation and analysis of events. These committees ideally include multidisciplinary membership, and provide support, guidance, and endorsement of the TP activities. The TP plays an essential role in supporting the work of the committee. [8] [10] [6] Transfusion Practitioners improve transfusion practice by promoting safe transfusion practice in a variety of ways. [5] [11] Activities of the TP may include:

Haemovigilance

Haemovigilance is the set of surveillance procedures that monitors, reports, investigates, and analyses adverse events related to transfusion. It covers the entire blood transfusion chain, from blood donation and processing of blood and its components, through to their provision and transfusion to patients. These reporting systems play a fundamental role in enhancing patient safety by learning from failures and then putting system changes in place to prevent them in the future. The TP's involvement in haemovigilance within the hospital setting, starts with education of those involved in the transfusion process so they can recognise, manage, and report reactions. The TPs roles ensures clinical transfusion incidents, transfusion reactions, specimen labelling errors are investigated and report data to haemovigilance governance programmes (e.g. SHOT in the UK). By conducting process reviews and communicating directly with the relevant colleagues and patients, the TP can provide essential details that are needed to complete investigations. This information can assist with determining the transfusion reaction type and recommendations for future transfusion plans for the patient, or the implementation of corrective and preventative measures. National haemovigilance schemes e.g. SHOT provide the TP with a resource for educating clinical colleagues on transfusion safety and recommendations for best practice. [12] [13] [14] [3]

Education

Developing and implementing blood management/transfusion related education sessions/programs is an important aspect of the TP role. Education can be targeted for the appropriate clinical groups (nursing, medical and allied health professionals) highlighting and promoting evidence-based practice change or national/international recommendations. TPs act as a resource regarding transfusion and PBM information for all staff involved in the transfusion process. They develop, deliver, evaluate, and revise transfusion-practice/PBM educational content based on evidence-based practice and national/international recommendations. Education topics include, but are not limited to:

TPs collaborate with department heads and senior management to facilitate mandatory and non-mandatory staff education/training consistent with regulatory requirements/recommendations.

Audit

Surveillance is often achieved through audits which helps to identify gaps in practice, compliance to standards and guidelines and staff knowledge deficits. Data collection through audit supports governance and practice improvement, where the results can be used to consolidate practice or drive change as required. The TP plays an important role in auditing and reporting to the blood management committee (or equivalent) to develop locally agreed action plans to implement quality improvements arising from audits. The TP liaison role between departments and clinical specialties helps them to facilitate and manage improvements/change involving and engaging appropriate stakeholders. [3] [10] TPs participate in local, regional or national audits. Audit activities may include:

An example from the UK is the National Comparative Audit of Blood Transfusion (NCABT) which is a programme of clinical audits that look at the use and administration of blood and blood components in the National Health System (NHS) and independent hospitals in the UK. [15] This audit programme's objectives are to provide evidence that blood is being prescribed and used appropriately and administered safely. It also highlights where practice is deviating from the guidelines and how this might affect patient outcomes. Data collection for these audits can be undertaken by a variety of health care professionals within the participating organisations, however the majority of the data collection and data submission is undertaken by the TP.

Patient Blood Management (PBM)

PBM is an evidence-based integrated multidisciplinary approach to optimise the care of patients to reduce unnecessary exposure to transfusion. Helping health professionals use transfusion only when appropriate and enabling them to understand the practices required to minimise waste. TP's can play an active role in helping to establish and embed PBM practices to improve patient and safety outcomes. Some PBM practices activities that TPs could undertake include:

The broad reach of the TP allows them to develop constructive working relationships with the many clinical users of blood products and assists with the implementation of PBM programmes. [3] [11]

Skills & Abilities

The TP role demands highly skilled and component health care professionals. Typical PT skills/abilities are:

Further information Elements to build a business case. [9] [3]

Related Research Articles

<span class="mw-page-title-main">Anemia</span> Medical condition

Anemia or anaemia is a blood disorder in which the blood has a reduced ability to carry oxygen due to a lower than normal number of red blood cells, a reduction in the amount of hemoglobin or hemoglobin abnormalities. The name is derived from Ancient Greek: ἀναιμία anaimia, meaning 'lack of blood', from ἀν- an-, 'not' and αἷμα haima, 'blood'. When anemia comes on slowly, the symptoms are often vague, such as tiredness, weakness, shortness of breath, headaches, and a reduced ability to exercise. When anemia is acute, symptoms may include confusion, feeling like one is going to pass out, loss of consciousness, and increased thirst. Anemia must be significant before a person becomes noticeably pale. Symptoms of anemia depend on how quickly hemoglobin decreases. Additional symptoms may occur depending on the underlying cause. Preoperative anemia can increase the risk of needing a blood transfusion following surgery. Anemia can be temporary or long term and can range from mild to severe.

<span class="mw-page-title-main">Blood transfusion</span> Intravenous transference of blood products

Blood transfusion is the process of transferring blood products into a person's circulation intravenously. Transfusions are used for various medical conditions to replace lost components of the blood. Early transfusions used whole blood, but modern medical practice commonly uses only components of the blood, such as red blood cells, white blood cells, plasma, platelets, and other clotting factors.

Transfusion medicine is the branch of medicine that encompasses all aspects of the transfusion of blood and blood components including aspects related to hemovigilance. It includes issues of blood donation, immunohematology and other laboratory testing for transfusion-transmitted diseases, management and monitoring of clinical transfusion practices, patient blood management, therapeutic apheresis, stem cell collections, cellular therapy, and coagulation. Laboratory management and understanding of state and federal regulations related to blood products are also a large part of the field.

<span class="mw-page-title-main">Medical guideline</span> Document with the aim of guiding decisions and criteria in healthcare

A medical guideline is a document with the aim of guiding decisions and criteria regarding diagnosis, management, and treatment in specific areas of healthcare. Such documents have been in use for thousands of years during the entire history of medicine. However, in contrast to previous approaches, which were often based on tradition or authority, modern medical guidelines are based on an examination of current evidence within the paradigm of evidence-based medicine. They usually include summarized consensus statements on best practice in healthcare. A healthcare provider is obliged to know the medical guidelines of their profession, and has to decide whether to follow the recommendations of a guideline for an individual treatment.

Clinical governance is a systematic approach to maintaining and improving the quality of patient care within the National Health Service (NHS) and private sector health care. Clinical governance became important in health care after the Bristol heart scandal in 1995, during which an anaesthetist, Dr Stephen Bolsin, exposed the high mortality rate for paediatric cardiac surgery at the Bristol Royal Infirmary. It was originally elaborated within the United Kingdom National Health Service (NHS), and its most widely cited formal definition describes it as:

A framework through which NHS organisations are accountable for continually improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish.

<span class="mw-page-title-main">Platelet transfusion</span> Treatment for bleeding irregularities

Platelet transfusion, also known as platelet concentrate, is used to prevent or treat bleeding in people with either a low platelet count or poor platelet function. Often this occurs in people receiving cancer chemotherapy. Preventive transfusion is often done in those with platelet levels of less than 10 x 109/L. In those who are bleeding transfusion is usually carried out at less than 50 x 109/L. Blood group matching (ABO, RhD) is typically recommended before platelets are given. Unmatched platelets, however, are often used due to the unavailability of matched platelets. They are given by injection into a vein.

The International Society of Blood Transfusion (ISBT) is a scientific society founded in 1935 G.C, which promotes the study of blood transfusion and provides information about the ways in which blood transfusion medicine and science can best serve patients' interests. The society's central office is in Amsterdam, and there are around 1500 members in 103 countries. Currently, the President is Michael Busch.

The term human blood group systems is defined by the International Society of Blood Transfusion (ISBT) as systems in the human species where cell-surface antigens—in particular, those on blood cells—are "controlled at a single gene locus or by two or more very closely linked homologous genes with little or no observable recombination between them", and include the common ABO and Rh (Rhesus) antigen systems, as well as many others; 44 human systems are identified as of December 2022.

ISBT 128 is a global standard for the identification, labeling, and information transfer of medical products of human origin (MPHO) across international borders and disparate health care systems. MPHO includes blood, cells, tissues, human milk, and organ products among others. The Standard is managed by the International Council for Commonality in Blood Banking Automation (ICCBBA).

A Patient Safety Organization (PSO) is a group, institution, or association that improves medical care by reducing medical errors. Common functions of patient safety organizations are data collection, analysis, reporting, education, funding, and advocacy. A PSO differs from a Federally designed Patient Safety Organization (PSO), which provides health care providers in the U.S. privilege and confidentiality protections for efforts to improve patient safety and the quality of patient care delivery

<span class="mw-page-title-main">Packed red blood cells</span> Red blood cells separated for blood transfusion

Packed red blood cells, also known as packed cells, are red blood cells that have been separated for blood transfusion. The packed cells are typically used in anemia that is either causing symptoms or when the hemoglobin is less than usually 70–80 g/L. In adults, one unit brings up hemoglobin levels by about 10 g/L. Repeated transfusions may be required in people receiving cancer chemotherapy or who have hemoglobin disorders. Cross-matching is typically required before the blood is given. It is given by injection into a vein.

<span class="mw-page-title-main">Transfusion-associated circulatory overload</span> Medical condition

In transfusion medicine, transfusion-associated circulatory overload is a transfusion reaction resulting in signs or symptoms of excess fluid in the circulatory system (hypervolemia) within 12 hours after transfusion. The symptoms of TACO can include shortness of breath (dyspnea), low blood oxygen levels (hypoxemia), leg swelling, high blood pressure (hypertension), and a high heart rate (tachycardia).

<span class="mw-page-title-main">Sickle cell disease</span> Group of genetic blood disorders

Sickle cell disease (SCD) is a group of blood disorders typically inherited. The most common type is known as sickle cell anaemia. It results in an abnormality in the oxygen-carrying protein haemoglobin found in red blood cells. This leads to a rigid, sickle-like shape under certain circumstances. Problems in sickle cell disease typically begin around 5 to 6 months of age. A number of health problems may develop, such as attacks of pain, anemia, swelling in the hands and feet, bacterial infections, and stroke. Long-term pain may develop as people get older. The average life expectancy in the developed world is 40 to 60 years.

Patient Blood Management (PBM) is a set of medical practices designed to optimise the care of patients who might need a blood transfusion. Patient blood management programs use an organized framework to improve blood health, thus increasing patient safety and quality of life, reducing costs, and improving clinical outcomes. Some strategies to accomplish this include ensuring that anemia is treated prior to a surgical operation, using surgical techniques that limit blood loss, and returning blood lost during surgery to the patient via intraoperative blood salvage.

Clinical peer review, also known as medical peer review is the process by which health care professionals, including those in nursing and pharmacy, evaluate each other's clinical performance. A discipline-specific process may be referenced accordingly.

Serious Hazards of Transfusion (SHOT) is the United Kingdom's haemovigilance scheme.

Single unit transfusion refers to transfusing a single unit or bag of blood product to a person who is not bleeding and haemodynamically stable followed by an assessment to see if further transfusion is required.. The benefits of single unit transfusion include reduced exposure to blood products. Each unit transfused increases the associated risks of transfusion such as infection, transfusion associated circulatory overload and other side effects. Transfusion of a single unit also encourages less wastage of blood products and can be cost-effective. Single unit transfusion can be as part of an institutional or national guidelines and instituted with the help of a transfusion committee or transfusion practitioner. Education of medical staff is important and catch phrases such as "Why use two when one will do", "every ONE matters" or "one bag is best - then reassess" have been used.

<span class="mw-page-title-main">Drug utilization review</span>

Drug utilization review refers to a review of prescribing, dispensing, administering and ingesting of medication. This authorized, structured and ongoing review is related to pharmacy benefit managers. Drug use/ utilization evaluation and medication utilization evaluations are the same as drug utilization review.

The Medication Appropriateness Tool for Comorbid Health conditions during Dementia (MATCH-D) criteria supports clinicians to manage medication use specifically for people with dementia without focusing only on the management of the dementia itself.

References

  1. ↑ Dhesi, Amanpreet Singh; Moss, Rachel; Deelen, Rozemarijn; o'Reilly, Clare; Bielby, Linley (2020). "A survey of transfusion practitioners in international society of blood transfusion member countries". Vox Sanguinis. 115 (3): 200–210. doi:10.1111/vox.12882. PMID   31944334. S2CID   210330871.
  2. ↑ Department of Health, H. S. (2007, November 01). Better Blood Transfusion, Safe and Appropraite Use of Blood. London, SE1 6XH, England. Retrieved June 9, 2023, from https://webarchive.nationalarchives.gov.uk/ukgwa/20130105054416/http:/www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Healthservicecirculars/DH_080613)
  3. 1 2 3 4 5 6 Johnson ST, P. K. (2013). Transfusion Medicine's Emerging Positions: Transfusion Safety Officers and Patient Blood Management Coordinators. Bethesda: AABB Press.
  4. ↑ Pavenski, Katerina; Howell, Alanna; Mazer, C. David; Hare, Gregory M. T.; Freedman, John (2022). "ONTraC: A 20-Year History of a Successfully Coordinated Provincewide Patient Blood Management Program: Lessons Learned and Goals Achieved". Anesthesia & Analgesia. 135 (3): 448–458. doi: 10.1213/ANE.0000000000006065 . PMID   35977355. S2CID   251642111.
  5. 1 2 Dalrymple, Kirsty; Watson, Douglas (2014). "Ten years of transfusion practitioners and better blood transfusion in Scotland". Nursing Management. 20 (10): 27–30. doi:10.7748/nm2014.02.20.10.27.e1147. PMID   24571162.
  6. 1 2 3 Bielby, L.; Haberfield, A.; Kelsey, G.; Kay, S. (2018). "The role of the transfusion practitioner in the multidisciplinary team". ISBT Science Series. 13 (3): 338–346. doi:10.1111/voxs.12408. S2CID   80580153.
  7. ↑ Slapak, Colleen; Fredrich, Nanci; Wagner, Jeffrey (2011). "Transfusion safety: Is this the business of blood centers?". Transfusion. 51 (12pt2): 2767–2771. doi:10.1111/j.1537-2995.2011.03454.x. PMID   22150688. S2CID   39817453.
  8. 1 2 3 4 5 Miller, Kristy; Akers, Christine; Davis, Amanda K.; Wood, Erica; Hennessy, Clare; Bielby, Linley (2015). "The Evolving Role of the Transfusion Practitioner". Transfusion Medicine Reviews. 29 (2): 138–144. doi:10.1016/j.tmrv.2014.08.005. PMID   25634259.
  9. 1 2 Transfusion Practitioners, I. (2023, June 14). Transfusion Practitioner Tools. Retrieved from International Society of Blood Transfusion: https://www.isbtweb.org/communities/transfusion-practitioners/transfusion-practitioners-tools.html)
  10. 1 2 3 Moss, Rachel; Bielby, Linley; Vanden Broek, Jana (15 December 2021). "TP, MDT, PBM, TxP: what are these, and how are they important for patient safety". Transfusion Today. 129: 4–5. Retrieved 29 July 2023.
  11. 1 2 3 4 Bielby, L.; Moss, R. L. (2018). "Patient blood management and the importance of the Transfusion Practitioner role to embed this into practice". Transfusion Medicine. 28 (2): 98–106. doi:10.1111/tme.12526. PMID   29660827. S2CID   4957183.
  12. ↑ "The role of the Transfusion Practitioner in Haemovigilance". Omnia Health Insights. 16 January 2020.
  13. ↑ WHO. (n.d.). Blood Safety - Haemovigilance. Retrieved from http://www.who.int/bloodsafety/haemovigilance/en/)
  14. ↑ SHOT. (n.d.). Serious Hazards of Transfusion. Retrieved from https://www.shotuk.org/)
  15. ↑ NHSBT. (2023, June 14). National Compartive Audit of Blood Transfusion. Retrieved from NHSBT: https://hospital.blood.co.uk/audits/national-comparative-audit/)
  16. ↑ Bielby, Linley; Moss, Rachel; Mo, Allison; McQuilten, Zoe; Wood, Erica (2020). "The role of the transfusion practitioner in the management of anaemia". ISBT Science Series. 15: 82–90. doi:10.1111/voxs.12523. S2CID   202829756.
  17. ↑ Bielby, L.; Stevenson, L.; Wood, E. (2011). "The role of the transfusion nurse in the hospital and blood centre". ISBT Science Series. 6 (2): 270–276. doi: 10.1111/j.1751-2824.2011.01537.x . S2CID   70871549.
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