HAEMOVIGILANCE a set of surveillance procedures covering the whole - - PowerPoint PPT Presentation

HAEMOVIGILANCE

‘a set of surveillance procedures covering the whole transfusion chain from

the collection of blood and its components to the follow-up of its recipients, intended to collect and assess information on unexpected or undesirable effects resulting from the therapeutic use of labile blood products, and to prevent their occurence & re-occurence’

• Ms. Emma O’Riordan.

A/CNM 2 Haemovigilance C.U.H.

The Postgraduate Medical Education Service NCHD (Anaes.) Induction @ Cork University Hospital Date: 2016

EU Blood Directive 98/EC/2002

• The EU directive has been transposed into Irish law with full

compliance with the legislation by November 2008.

• Organisations, including hospital, not complying with the

directive could face fines or criminal charges

• Sets standards for quality and safety for collection, testing,

processing, storage and distribution of human blood and blood components

• Specifies certain technical requirements for blood and blood

components and for quality management systems, traceability and notification of adverse events & reactions , training personnel and Strict Document Control

SNBTS Blood Transfusion E-learning : All NCHD’s must complete module 1 and 2 Submit a certificate of completion to Haemovigilance either by email to brid.doyle@hse.ie or emma.oriordan@hse.ie or to the CUH Blood Transfusion Laboratory (Refer to Induction Pack) “SNBTS better blood transfusion” www.learnbloodtransfusion.org.uk/

CUH Patient Information Leaflet Informing the Patient

− Medical Responsibility − Patient Information Leaflet − Document − Transfusion Record

(form 15/15A)

− Ask the patient to read it − Discuss any concerns &

worries

− Document discussion in

the Patient Health Records

− Refusal

Blood Component Prescription Documentation (Form No. 15/15A)

─ Medical Responsibility ─ Prescription of all

Blood Components

√ RCCs, PLTS, OCTAPLAS √ FIBRINOGEN,

OCTAPLEX, ALBUMIN etc

─ Complete

√ Fully √ Clearly √ Legibly

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Name MRN Date Time Product Type Prescriber Reason for TX CMV-/Irrad Rate May-15 May-14 Jun-13 Mar-12

May 2015 Theatre Prescriptions Audit

• May 2015: 5% Transfusions not prescribed, only 23% had

prescribed special requirements, identity of the prescriber was documented in 89% of cases

Special Blood Requirements

3 SAE’s ~ irradiation requirement not indicated in 2014 2 SAE’s ~ irradiation requirement not indicated in 2015 (1 Surgical patient)

Sampling & Labelling the pre-transfusion specimen

Completion of the Blood Transfusion Request

 Medical Responsibility  POSITIVE patient identification. Identity wristband  Form & sample must be hand written (no addressograph stickers!)  Complete form using the patient’s health records: Fully! Confirm details are

correct.

 Special Blood Requirements, Transfusion history, reason etc  Sample labelled by hand immediately after taking the specimen and before

leaving the bedside.

 Absolute minimum identifiers

 Patient’s Full Name Patient’s D.O.B.  Patient’s M.R.N.  Your Signature, Bleep, MCRN Zero Tolerance for Samples received in CUH Blood Bank which did not meet the Minimum Labelling Requirements. 5.5% of samples were rejected in January – November 2015.

2015: 4 WBIT Events Detected 2014: 2 WBIT Events Detected 2013: 3 WBIT Events Detected 2012: 7 WBIT Events Detected 2011: 6 WBIT Events Detected 2010: 3 WBIT Events Detected

Wrong Blood in Tube Events Occurring in CUH

1 WBIT event detected in January 2016

1 2 3 4 5 6 7 2010 2011 2012 2013 2014 2015

BLOOD STORAGE

• Blood must be stored in dedicated blood fridges.
• There are 4 blood fridges located in CUH:
• CUH Blood Bank,
• General Theatre,
• Cardiac Theatre
• CICU.
• There is NO Blood Fridge located in CUMH.
• In an Emergency situation where more than one unit of blood is

required urgently igloo boxes should be used where a fridge is not available.

• Blood administration to the patient must be commenced within 30

minutes of leaving Blood fridge or igloo box storage.

Blood Administration

• A standard blood administration set containing an

integral filter (170-200 microns) must be used to administer blood products.

• Do not add any infusion solutions or drugs to blood

component under any circumstances as this may result in haemolysis, clotting or incompatibility.

• Blood warmer use is indicated for patients receiving

massive transfusions (at or in excess of 50ml/kg/hr) or if the patient has cold agglutinins.

Pre-administration Checks

Two people (RGN/Doctor) must undertake uninterrupted checks of:

• Patient Hospital identity Bracelet
• Patients Healthcare Records
• White Compatibility Form
• Blood Component Prescription and Transfusion Record

(Form 15/15A)

• Blood Product

Surname, First name, Date of Birth, MRN must be identical on all of the above, if there is any discrepancy do not transfuse the blood product. Contact the Blood Transfusion Laboratory.

CUH Notification of Suspected Transfusion Reaction (Back of Form 15/15A) Recognising, managing and investigating

suspected transfusion reactions

− Your responsibility to be familiar with and to apply the CUH/CUMH blood transfusion policies and procedures − CUH/CUMH policies and procedures are only available electronically on Q-Pulse − Q-Pulse available at all ward based PCs − Q-Pulse accessed through the Staff Directory (Citrix) on the desktop of all ward computers

CUH/CUMH Policies & Procedures (Induction Pack)

Two Specific Types Of Order

 Group & Hold or Group & Screen ( ~40 Minutes) – Patient Blood Group and Antibody Screen Performed – Blood is NOT Ready – Used for Procedures That Are Unlikely to Use Blood, Used As a Safety Measure  Group & Crossmatch (~60 Minutes) – Patient Blood Group and Antibody Screen Performed PLUS Units Of Blood Crossmatched For Patient – Blood IS Ready – Only Order When Definitely Going To Transfuse – Follow C.U.H. MSBOS for theatre patients.  Emergency O Rh (D) Negative units – Extreme Emergencies – Conserve O Neg Stocks – Only Compatible with ABO Rh and Kell Blood Groups

BLOOD TRANSFUSION REQUESTS

ORDER ON THE BLOOD PRODUCT REQUISITON FORM: AVAILABLE IN THE CLINICAL AREA PLATELET POOLS

• Stocks of pooled platelets are not stored in the CUH blood transfusion lab
• Ordered by the Blood Bank from IBTS as required
• Only Order When Definitely Going To Transfuse

FROZEN PLASMA (OCTAPLAS)

• Plasma requires between 20-30 minutes to be thawed out
• Must be transfused within 4 hours of thawing
• Once thawed the plasma cannot be reused
• Only Order When Definitely Going To Transfuse

PROTHROMBIN COMPLEX CONCENTRATE (OCTAPLEX)

• Primary use for reversal of over anti-coagulation with Warfarin
• Seek specialist Haematology Advice

TRANSFUSION MANAGEMENT OF MASSIVE HAEMORRHAGE

Policy & Procedure : PPG-CUH-CUH-210 (Recently updated in line with the BCSH 2015 Massive Haemorrhage Guidelines). A patient may be defined as suffering a massive haemorrhage if any of the following occur: Transfusion of more than 10 units of red cells in a 24 hr period

• r

Transfusion of >4 units in <1 hour with ongoing haemorrhage

• r

Predicted need for > 8 units in 2 hours

• r

An ongoing transfusion requirement in an adult of more than 150ml/min

• r

Replacement of one blood volume within a 24hr period

• r

Replacement of more than 50% of blood volume in 3 hrs or less (70mls/kg for adult, 90mls/kg for a child older than a neonate).

Communication

– Alert Blood Bank 22567/ On call Bleep 199 – Haematology team

 Inform Blood Bank if Emergency O NEGs have been taken  FBC, Coagulation screen & Fibrinogen  Documentation  Stand down  Massive transfusion packs

Massive Transfusion Packs

First ‘Pack’

– 4 units RBC

• May contain Emergency

O Neg units

– 2 units OCTAPLAS – 1 adult therapeutic dose platelets

Second ‘Pack’ can follow if requested

– 4 units RBC

• group specific or

crossmatched

– 2 units OCTAPLAS – 1 adult therapeutic dose platelets – 2g Fibrinogen

Products will be available as they become ready NOT in a single delivery. Transport organised by the clinical area. 2 x Fibrinogen available in the drug fridge in anaesthetic ROOM 3 in CUMH for massive obstetric haemorrhage EMERGENCY use only. Inform blood bank if they are used so that they will be replaced.

IGLOO BOX (Safe Cell Transport Box)

• Blood is safe for use for 6 hours when stored in an

igloo box.

• The time the blood has left the igloo box must be

documented in the form.

• If the blood is out of the cooler for more than 30

minutes it must be returned ASAP to the blood bank unused. If you receive a patient from another hospital with an igloo box:

• Send the container to the blood bank.
• Do not remove any blood unnecessarily from the

container, it is stored at the correct temperature.

• If blood is immediately required, it is your

responsibility to carefully check the compatibility form, nameband and MRN of referring hospital.

Traceability

There were two further episodes of non-documented units in December 2015.

98.0% 98.5% 99.0% 99.5% 100.0%

2008 2009 2010 2011 2012 2013 2014 J F M A M J J A S O N D

99.5% 99.7% 99.9% 99.9%99.9% 99.9% 99.9% 100.0% 100.0% 99.7% 100.0% 99.7%99.7% 100.0% 100.0% 99.9% 100.0% 100.0%

% Traceability Achieved 2015

Dark green bar represents 100% of units accounted for following investigation when subsequent written confirmation of transfusions was

• btained.

100% 100% 100% 100%

Clinical Areas Where Non-Documentation has Occurred in 2015

• 8 episodes of non-

documentation of a unit in 2015.

• 4 were during a massive

haemorrhage.

• CUH ED: 1 occurance
• CUH GI Clinic 1 occurance
• CUH Radiology dept: 3

Occurances

• CUH Wards: 2 Occurances

0.5 1 1.5 2 2.5 3 CUH ED CUH GI CLINIC CUH RADIOLOGY CARDIAC THEATRE CUH WARD 2A CUH WARD 3B

Think before you transfuse……

 Is the transfusion necessary?  Is the transfusion appropriate?  Has the correct sample been taken at the correct time from the correct patient and with the correct label?  Is the transfusion record complete?  Is the transfusion documented?

HAEMOVIGILANCE

Any Questions?

Any Questions?

Contact details available in Induction Pack