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. The Postgraduate Medical Education A/CNM 2 Haemovigilance C.U.H . 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

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

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.

Wrong Blood in Tube Events Occurring in CUH 1 WBIT event detected in January 2016 7 2015: 4 WBIT Events Detected 6 2014: 2 WBIT Events Detected 2013: 3 WBIT Events Detected 5 2010 2012: 7 WBIT Events Detected 2011 2011: 6 WBIT Events Detected 2012 4 2010: 3 WBIT Events Detected 2013 2014 3 2015 2 1 0

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

CUH/CUMH Policies & Procedures (Induction Pack) − 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

BLOOD TRANSFUSION REQUESTS 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

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 or Transfusion of >4 units in <1 hour with ongoing haemorrhage or Predicted need for > 8 units in 2 hours or An ongoing transfusion requirement in an adult of more than 150ml/min or Replacement of one blood volume within a 24hr period or 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 Second ‘Pack’ can follow if First ‘Pack’ requested – 4 units RBC – 4 units RBC • May contain Emergency O Neg units • group specific or – 2 units OCTAPLAS crossmatched – 2 units OCTAPLAS – 1 adult therapeutic dose – 1 adult therapeutic dose platelets 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.