for Laboratory Staff Based on the Patient Blood Management Guidelines Be SINGLE m inded Single Unit Transfusion Guideline Applies to The stable normovolaemic inpatient who is ID: 503917
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Slide1
Single Unit Blood Transfusion Guideline for Laboratory Staff
Based on the
Patient
Blood Management Guidelines
Be
SINGLE
m
indedSlide2
Single Unit Transfusion Guideline
Applies to:
The stable, normovolaemic
inpatient who is NOT actively bleeding is NOT in an operating theatreHaemoglobin as defined in the Patient Blood Management GuidelinesSlide3
The Guideline
Transfuse one unit,
then
reassess the patient for clinical symptoms before transfusing anotherIf the patient’s symptoms are relieved, don’t transfuse more unitsEvery unit is a new clinical decision Base decision on patient symptoms, not only on haemoglobinSlide4
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
Strategies to
preempt
and reduce the use of blood products: an Australian perspective. Hofmann, A et al.
Curr
Opin
Anesthesiol
2012, 25:66-73.Slide5
Be SINGLE m
inded
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
G
uidelines
*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.Slide6
Indications for a Second unit
Active blood loss
Hb
< 70g/L for general patientsHb <80g/L for cardiac patients** See Patient Blood Management Guidelines for other patient groupsOn going chest painLess than 8g/L rise in haemoglobin following first unitSlide7
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) Slide8
Be SINGLE m
inded
Refer disputes to medical staff / champions:
Politely suggest that the request is outside the guidelinesRe-confirm that the inpatient is NOT actively bleeding or NOT in the operating theatreProvide blood if the patient is bleedingRemain calm, polite and professional, and refer the caller to appropriate medical support staff.Slide9
Be SINGLE mindedSlide10
Single Unit Transfusion Policy
Benefits:
Safer, evidence based transfusion
PLUS:Reduced risk for non-infectious adverse eventsReduced demand on limited blood supplyReduced risk from new infectious agentsBe SINGLE minded