Question

Describe your nursing specific responsibilities of blood transfusion and What is your midwifery management of Madam Zara relative to the PIH?

Answer 1

The transfusion process is complex, involving many interlinking chains of events, and a multidisciplinary group of health professionals with different levels of awareness and understanding of transfusion practice. In recent years, many measures have been implemented to increase blood component safety and the clinical transfusion process. Haemovigilance programs report the greatest risks to patients from transfusion in many countries now relate to hospital‐based steps in the process.

The role of the Transfusion Nurse (TN) is evolving as an integral part of efforts to optimise appropriate use of blood components, reduce procedural risks and improve transfusion practice generally. The TN position is a relatively recent specialist role within hospitals and blood services, and continues to develop with growing experience of areas requiring intervention in the clinical setting, and increasing expectations for improvements in transfusion clinical governance.

The role typically includes activities to improve clinician and patient awareness of transfusion issues and practical knowledge of blood product use, and therefore to improve clinical decision‐making and enhance blood administration processes, along with responsibilities for education/training, auditing and adverse event follow‐up. Within the Blood Service in Australia the role also covers approval and provision of specialised blood products along with many of the hospital‐based TN functions.

The TN serves as an expert resource and has been fundamental in development of tools, resources and skills in the following areas:

‐ Patient blood management:

‐ Education

‐ Governance

‐ Professional development

‐ Research

Benchmarking across organizations has demonstrated that availability and review of comparative data can be a powerful motivator of change. Reviews of the TN role/programmes highlighted their effectiveness and resulted in ongoing support/funding. Skills and attributes such as confidence, persistence, energy, excellent communication/ technical knowledge and clinical experience are key requirements for the roles success.The transfusion process is complex, involving many interlinking chains of events, and a multidisciplinary group of health professionals with different levels of awareness and understanding of transfusion practice. In recent years, numerous measures have been implemented to increase both the safety of blood components and the transfusion process itself. However, haemovigilance programmes continue to report that the greatest risks to patients from transfusion in many countries relate to hospital‐based steps in the process, particularly transfusion of the wrong blood component.

Over the last decade, many countries have introduced clinical transfusion practice improvement programmes to optimize appropriate use of precious blood components, reduce the procedural risks of transfusion administration processes and improve transfusion practice generally. These improvement activities typically involve a multidisciplinary team, and the role of the Transfusion Nurse (TN) is evolving as an integral part of these programmes and continues to develop with growing understanding of areas requiring intervention in the clinical setting, and increasing requirements for improvements in transfusion clinical governance. The TN is (generally) a relatively recent specialist position within hospitals and blood services. The role is multifunctional, requiring diverse skills and attributes, and incorporates a range of clinical, quality, risk management and educational activities.

ISBT Science SeriesVolume 6, Issue 2

STATE OF THE ART† Free Access

The role of the transfusion nurse in the hospital and blood centre

L. Bielby L. Stevenson E. Wood

First published: 20 October 2011

https://doi.org/10.1111/j.1751-2824.2011.01537.x

Citations: 4

Linley Bielby, Blood Matters Program Manager, Australian Red Cross Blood Service/Department of Health, 50 Lonsdale Street, Melbourne, Victoria, Australia

E‐mail: [email protected]

2B‐E1.6

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Abstract

The transfusion process is complex, involving many interlinking chains of events, and a multidisciplinary group of health professionals with different levels of awareness and understanding of transfusion practice. In recent years, many measures have been implemented to increase blood component safety and the clinical transfusion process. Haemovigilance programs report the greatest risks to patients from transfusion in many countries now relate to hospital‐based steps in the process.

The role of the Transfusion Nurse (TN) is evolving as an integral part of efforts to optimise appropriate use of blood components, reduce procedural risks and improve transfusion practice generally. The TN position is a relatively recent specialist role within hospitals and blood services, and continues to develop with growing experience of areas requiring intervention in the clinical setting, and increasing expectations for improvements in transfusion clinical governance.

The role typically includes activities to improve clinician and patient awareness of transfusion issues and practical knowledge of blood product use, and therefore to improve clinical decision‐making and enhance blood administration processes, along with responsibilities for education/training, auditing and adverse event follow‐up. Within the Blood Service in Australia the role also covers approval and provision of specialised blood products along with many of the hospital‐based TN functions.

The TN serves as an expert resource and has been fundamental in development of tools, resources and skills in the following areas:

‐ Patient blood management:

‐ Education

‐ Governance

‐ Professional development

‐ Research

Benchmarking across organizations has demonstrated that availability and review of comparative data can be a powerful motivator of change. Reviews of the TN role/programmes highlighted their effectiveness and resulted in ongoing support/funding. Skills and attributes such as confidence, persistence, energy, excellent communication/ technical knowledge and clinical experience are key requirements for the roles success.

Conclusion The specialist transfusion practitioner/Transfusion Nurse is an integral part of a multidisciplinary team, supporting efforts at institutional and national levels to reduce transfusion risks and improve practice.

Introduction

The transfusion process is complex, involving many interlinking chains of events, and a multidisciplinary group of health professionals with different levels of awareness and understanding of transfusion practice. In recent years, numerous measures have been implemented to increase both the safety of blood components and the transfusion process itself. However, haemovigilance programmes continue to report that the greatest risks to patients from transfusion in many countries relate to hospital‐based steps in the process, particularly transfusion of the wrong blood component.

Over the last decade, many countries have introduced clinical transfusion practice improvement programmes to optimize appropriate use of precious blood components, reduce the procedural risks of transfusion administration processes and improve transfusion practice generally. These improvement activities typically involve a multidisciplinary team, and the role of the Transfusion Nurse (TN) is evolving as an integral part of these programmes and continues to develop with growing understanding of areas requiring intervention in the clinical setting, and increasing requirements for improvements in transfusion clinical governance. The TN is (generally) a relatively recent specialist position within hospitals and blood services. The role is multifunctional, requiring diverse skills and attributes, and incorporates a range of clinical, quality, risk management and educational activities.

Drivers underpinning clinical transfusion practice improvement programmes

A number of factors have prompted the development of practice improvement programmes:

1

Clinical governance : Many countries now have requirements from healthcare quality accreditation bodies that include standards for transfusion governance, and considerable resources may be required to demonstrate compliance. For example in Australia, both the Australian Commission for Safety and Quality in Healthcare (a national, standard‐setting body) and the Australian Council on Health Care Standards (a hospital assessment and accreditation body) now have detailed requirements for transfusion practice.

2

Risk management : International haemovigilance data indicate significant hazards associated with the transfusion of incorrect or inappropriate blood components, plus a substantial number of near misses with the potential for harm.

3

Demand : The demands for blood and blood products are increasing each year in many countries for a variety of reasons, such as ageing populations, changes in treatment options, introduction of new technologies, and improvements in supportive therapy. With increased demands come associated costs, including costs associated with production, management and administration of blood components and fractionated blood products.

4

Patient expectations : Patients are now much more informed about treatments, including transfusion, and their potential risks, and have expectations for more information to make informed decisions about their therapy.

5

Availability of new clinical practice guidelines and research findings, for example, in the areas of blood conservation, including intra‐ and post‐operative cell salvage techniques and the development of pre‐operative anaemia management clinics [such as from the UK Better Blood Transfusion (BBT), and Canadian onTrac programs].

Many governments and health agencies have considered these factors and now place increased emphasis on appropriate use and management of blood, and as a consequence some have provided direction and resources, including financial support, to establish clinical transfusion practice improvement initiatives.

What do these programmes look like?

Established clinical transfusion practice improvement programmes and the activities within them vary significantly both between and within countries; and are strongly influenced by the local health care system needs and government expectations. Programmes generally involve a multidisciplinary team raising awareness around transfusion to improve practical knowledge of blood product use, and provide a basis to improve clinical decision‐making and enhance blood administration processes and patient care. Data generated from audits and other programme activities can be powerful motivators of change and tools for benchmarking within and across organizations.

The individuals undertaking these roles have various titles, such as TN, TN specialist or consultant, transfusion safety officer, haemovigilance officer and specialist practitioner of transfusion. In Australia, New Zealand and the UK these specialist transfusion practitioner positions are now well established and are predominantly nursing roles, while in other settings, personnel with scientific/technical (e.g. Canada) or medical (e.g. France) backgrounds may perform some or all of these activities. In all cases, they work very closely with other healthcare professionals in transfusion support, patient blood management and blood conservation. Links to some established programmes and groups are provided at the end of this article.

Skills and attributes of the TN

The skills and attributes of TNs/practitioners are important factors in the success of the role and their contribution to clinical transfusion practice improvement programmes.

Transfusion nurses are vital connections between the different health professionals engaged in the transfusion chain, in particular, those beyond the transfusion laboratory. They act as educators, trainers, co‐ordinators, data collectors, project managers and change agents. They are critical components of hospital transfusion teams, and provide invaluable support for the efforts of the hospital transfusion committee (or equivalent).

The TN skills should include comprehensive and current knowledge of transfusion practice, excellent communication skills, an ability to interact with a broad range of people from hospital executives, quality co‐ordinators, senior and junior medical officers, scientists and nurses, to patients and relatives. The ability to understand and work with the local hospital/health service ‘politics’ is a definite advantage when implementing change. Skills such as effective project management and coordination, and attributes such as confidence, energy and persistence are necessary to see ideas through implementation and to fruition. As practice change is often achieved slowly, a coordinated and persistent approach is required for truly ‘embedded’ long term changes.

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