Be SINGLE minded Single Unit Transfusion Guideline Applies to: The - - PowerPoint PPT Presentation

Single Unit Blood Transfusion Guideline for Laboratory Staff

Based on the Patient Blood M anagement Guidelines

Be SINGLE minded

Single Unit Transfusion Guideline

Applies to:

• The stable, normovolaemic

inpatient who

–is NOT actively bleeding –is NOT in an operating theatre

• Haemoglobin as defined in the

Patient Blood M anagement Guidelines

The Guideline

Transfuse one unit, then reassess the patient for clinical symptoms before transfusing another

–If the patient’s symptoms are relieved,

don’t transfuse more units

–Every unit is a new clinical decision –Base decision on patient symptoms,

not only on haemoglobin

Single Unit Transfusion Guideline

WHY Current practice does not align with evidence-based recommendations

• Prescribing a single unit of blood may reduce the risk
• f an adverse event:

– Harm from transfusion is dose dependent – Transfusion is an independent risk factor for increased

morbidity, mortality and length of stay.

• There is a lack of evidence for benefit of transfusion

in a non-bleeding patient.

Five Drivers Shifting the paradigm from Product-focused Transfusion Practice to Patient Blood M anagement” Axel Hofmann, Shannon Farmer, Aryeh Shander. The Oncologist 2011;16(suppl 3):3-11 Strategies to preempt and reduce the use of blood products: an Australian perspective. Hofmann, A et al. Curr Opin Anesthesiol 2012, 25:66-73.

Be SINGLE minded

HOW When blood is ordered for a patient…

ASK:

– Is the patient actively bleeding? – What is the current haemoglobin? *

EXPLAIN:

– Only one unit will be issued, in compliance with the Patient

Blood M anagement Guidelines

• * If Hb <70 g/ L a 2 unit request likely to be acceptable
• Note: Hb<80g/ L for patients with acute coronary syndrome

Hb<100g/ L for renal patients.

Indications for a Second unit

• Active blood loss
• Hb < 70g/ L for general patients
• Hb <80g/ L for cardiac patients*

* See Patient Blood M anagement Guidelines for other patient groups

• On going chest pain
• Less than 8g/ L rise in haemoglobin following first

unit

Single Unit Transfusion

Empowered Staff: Laboratory staff can “gate-keep” compliance.

• Guideline document is accessible in

laboratory – prompt for questions about compliance.

• Inclusion criteria for a second unit is defined.
• Support from champions to resolve challenges

to requests: (medical staff, haematologists)

Be SINGLE minded

Refer disputes to medical staff / champions:

• Politely suggest that the request is outside the

guidelines

• Re-confirm that the inpatient is NOT actively

bleeding or NOT in the operating theatre

• Provide blood if the patient is bleeding
• Remain calm, polite and professional, and

refer the caller to appropriate medical support staff.

Be SINGLE minded

Single Unit Transfusion Policy

Benefits:

Safer, evidence based transfusion

PLUS:

• Reduced risk for non-infectious adverse events
• Reduced demand on limited blood supply
• Reduced risk from new infectious agents

Be SINGLE minded