The Evolving Role of the Transfusion Practitioner

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Abstract

Much of the recent work in transfusion practice has shifted to focus on the patient, after efforts over previous decades to ensure the quality and safety of blood products. After the commencement of hemovigilance and transfusion practice improvement programs, the introduction of transfusion practitioners (TP) into health care services and blood centers has continued to increase worldwide. Since this relatively new role was introduced, much work of the TP has focused on patient and staff education, adverse events, transfusion governance, and monitoring of transfusion practices within organizations. The complex nature of the transfusion process makes the TP an integral link in the transfusion chain. Together with hospital transfusion teams and committees, the TP works collaboratively to facilitate the transfusion change management programs and initiatives. Recently, the TP role has evolved to include an emphasis on patient blood management and, to some extent, is shaped by national standards and regulations. These established roles of the TP, together with the ever-changing field of transfusion medicine, provide new opportunities and challenges for a role that is continuing to evolve worldwide.

Section snippets

World Experience

Australia, like the rest of the developed world, invested in the TP role during the implementation of transfusion practice improvement and formal hemovigilance programs. One of the first hemovigilance reporting schemes was established in the UK, in 1996. Serious Hazards of Transfusion (SHOT) is an independent professionally led reporting scheme that captures data on adverse transfusion events from participating health care organizations. In 2005, The UK Blood Safety and Quality Regulations 2005

Australian Experience

Within Australia, there have been a number of transfusion practice improvement projects ranging from local hospital-level to state-wide partnerships involving a number of health services in coordinated programs. From 2001, state-wide projects, such as BloodSafe in South Australia and Blood Matters in Victoria, were established to implement strategies and practical tools to assist health services to improve clinical practice and transfusion outcomes and included the piloting of TPs in a number

Education and Qualifications for the TP Role

The TP is a specialist role similar to other hospital-based specialist practice roles (infection control and diabetes care) and can be fulfilled by individuals from a variety of professional backgrounds. A 2010 survey of England and North Wales TPs by the NHSBT revealed 69% of respondents were nurses [4]. However, many professionals are from a scientific background. A professional with a blood transfusion scientist/technologist qualification has a strong laboratory and blood banking knowledge

Providing Transfusion Education in Hospitals

A 2003 survey on the recommendations of the UK HSC Better Blood Transfusion found that respondents thought the best way to improve transfusion practice in hospitals was to increase education and training, followed by the appointment of a TP [14]. Implementing transfusion-related education programs for hospital staff is an essential part of the TP role. Establishing in-service lectures on safe transfusion practice to clinicians, nurses, orderlies, and blood bank staff is a frequent

Auditing

The collection of data through auditing assists with transfusion governance and quality improvement processes and identifies any practice improvement areas. Transfusion practice auditing within a health care service is an important role undertaken by the TP. Local auditing provides data for the HTC, quality or governance unit, and executive committees on consent rates, blood administration or product usage, and compliance with transfusion policies and procedures. Data collection may also follow

Adverse Event Management

Despite years of work that TPs, HTCs, and jurisdictional organizations have invested in promoting appropriate and safe blood product usage, errors and adverse events still occur in transfusion practice. Another role of the TP is to capture, monitor, and manage errors and adverse events that occur within their health service. Recognizing and reporting on transfusion-related incidents and adverse events are important, as the TP can work with the transfusion team to make recommendations for future

Administrative

Since the 1998 release of the HSC UK Better Blood Transfusion recommendations, 91% of hospitals surveyed have established HTCs [14]. In 2011 in Australia, the National Safety and Quality Health Service published standards outlining the need for a Transfusion Quality Improvement Programme overseen by an HTC [13]. Hospital transfusion committee transfusion governance activities include monitoring, reviewing, and improving hospital transfusion data such as wastage, consent rates, and

Transfusion Governance

The acquisition of extended transfusion knowledge gained from experience, further study, and TP networks ensures that the TP is an excellent resource for both clinical and laboratory staff. In a survey of English hospitals in 2003, respondents were asked to indicate what they considered to be the best ways of improving blood transfusion practice. Suggestions included better accessibility to advice and improved communication between the hospital blood bank and other departments [14]. These can

Patient Blood Management

The evolution from a “product-centered” approach toward a “patient-centered approach” gave rise to patient blood management (PBM). Patient blood management aims to improve patient outcomes [20] and has been adopted by the World Health Organization as the new standard of care for transfusion practice [21]. Adoption of a multidisciplinary, coordinated approach to PBM has reportedly resulted in a reduction in red cell utilization (and associated costs); avoidance of transfusion-related incidents

Challenges/Opportunities

Health services worldwide have used the TP role to improve transfusion practice through change management programs, which provide opportunities for TPs contribute to the introduction of best practice initiatives. Slapak et al [7] describe how a TP working with the Puget Sound Blood Center and a 350-bed Seattle hospital found a “defect rate” (one or more requirements of correct patient monitoring missing) of 37% during a random audit of blood component administration documentation. The TP worked

Evolution of the Role

The role and responsibilities of the TP vary widely and have evolved significantly. A summary of these responsibilities is outlined in the Table.

The focus of the TP historically has been to promote within their organization the safe and appropriate use of blood products. While the focus on staff and patient education, appropriate clinical practice, and collection of data remains, the role now includes the promotion of PBM and the achievement of and compliance with national standards, where

Conclusion

The central focus of the TP should remain to promote the safe and appropriate use of blood, with key responsibilities in transfusion governance, education, and hemovigilance reporting. However, opportunities are evolving to include the implementation of PBM programs and the introduction of new technologies to improve patient and product identification and ordering of blood products. Patient safety remains a collaborative approach between the blood providers, health services, and transfusion

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    Conflict of interest: No conflict of interest to declare.

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