Single Unit Transfusion Guideline - PowerPoint Presentation

Slide1

Single Unit Transfusion Guideline

Based on the Patient Blood Management Guidelines

Be

SINGLE

m

indedSlide2

Patient Blood Management Guidelines

www.blood.gov.au

Slide3

Single Unit Transfusion Guideline

WHO

The stable, normovolaemic inpatient who

is

NOT actively bleeding, and is NOT in an operating theatreHaemoglobin as defined in the Patient Blood Management Guidelines Slide4

Be

SINGLE

mindedWHAT

Transfuse one unit, then reassess the patient for clinical symptoms before transfusing anotherIf 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 haemoglobinSlide5

Single Unit Transfusion Guideline

WHY

Current practice does not align with evidence-based recommendations

Prescribing a single unit of blood may reduce the risk of an adverse event.Harm from transfusion is

dose dependentTransfusion 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 Management” Axel Hofmann, Shannon Farmer, Aryeh Shander. The Oncologist 2011;16(suppl

3):

3-11

Hofmann

, A et al.

S2012.

trategies

to

preempt

and reduce the use of blood products: an Australian perspective.

Curr

Opin

Anesthesiol

2012, 25:66-73.Slide6

Implementing the guideline “Be

SINGLE

minded”

HOW Approval and endorsement - CHAMPIONSFrom Transfusion Governance Committee / Patient Blood Management CommitteeExecutive and Medical leadership

Transfusion Medicine LeadershipImplementationHospital wide education; medical, nursing, laboratory staff, in all areas that administer blood productsInclude in orientation education for new staffKey messages, visible signage, electronic media, newsletters.Slide7

Guiding Compliance

Empower Staff

to

question prescription / order for blood productsLaboratory staff, nursing staff, medical

staffGuideline accessible at prescription point and in laboratory including prompts for questions about complianceInclusion criteria for second unitUtilise Computerised Physician Order Entry systems if available to guide transfusion decisions and compliance to the guideline

Prompt patients to enquire about blood transfusion requirementsSupport from clinical champions to resolve challenges to requestsSlide8

Clinical Support is Vital

Nursing and Laboratory staff who question the appropriateness of a request for blood must have:

Documentation

of the guideline, including inclusion criteria for a second unit of bloodReady access to

medical support - Champions to resolve episodes of apparent non-complianceEducational material to give to staff unaware of the guidelineSlide9

Be SINGLE

m

inded

Report: Collect data and report / feedback:Data collectionLog of non-compliant requests to laboratory/ jurisdiction Incident Management SystemAudit of patient medical record for transfusionsStatistics from laboratory systems:

blood packs ordered daily from the Blood Servicepatients transfused a single unit, packs transfused daily, packs per patient dailyReporting Progress – Feedback dataTo Transfusion Governance Committee, quality committee, clinical g

overnance / executiveMedical specialties / divisions, nursing meetings, laboratories.Benchmark between departments, hospitals, health services, states.Slide10

Be SINGLE

m

indedSlide11

Be SINGLE minded

about blood transfusion

Transfuse One Unit

Re-assess the patient Don’t increase the

RISKS if NO BENEFIT Slide12

Single Unit Transfusion Guideline

Benefits:

Safer, evidence based transfusion

PLUS:

Reduced risk of non-infectious adverse eventsReduced demand on limited blood supplyReduced risk from new infectious agentsBe SINGLE

Minded