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Blood and Blood Products
Standard 7: Blood and Blood Products
The Victorian Department of Health is making this document freely available on the internet for health
services to use and adapt to meet the National Safety and Quality Health Service Standards of the
Australian Commission on Safety and Quality in Health Care. Each health service is responsible for all
decisions on how to use this document at its health service and for any changes to the document. Health
services need to review this document with respect to the local regulatory framework, processes and
training requirements
The author disclaims any warranties, whether expressed or implied, including any warranty as to the
quality, accuracy, or suitability of this information for any particular purpose. The author and reviewers
cannot be held responsible for the continued currency of the information, for any errors or omissions, and
for any consequences arising there from.
Published by Sector Performance, Quality and Rural Health, Victorian Government, Department of Health
June 2014
Blood and Blood Products
1
Acknowledgements
The Department of Health Victoria acknowledges the contribution of medical and health specialists, Victorian health
services, and members of the National Safety and Quality Health Service Standards: Educational Resources Project
project team, Steering Group and Advisory Committee.
For the Blood and Blood Products module the Blood Matters Program, Department of Health, Victoria/
Australian Red Cross Blood Service, provided specialist advice.
The Educational Resources Project Steering Group members comprised:
 Associate Professor Leanne Boyd, Steering Group Chair; Director of Education, Cabrini Education and
Research Precinct, Cabrini Health
 Ms Madeleine Cosgrave, Project Manager
 Ms Susan Biggar, Senior Manager, Consumer Partnerships, Health Issues Centre
 Mr David Brown, Consumer representative
 Dr Jason Goh, Medical Administration Registrar - Cabrini Health
 Mr Matthew Johnson, Simulation Manager, Cabrini Education and Research Precinct, Cabrini Health
 Ms Tanya Warren, Educator, Cabrini Education and Research Precinct, Cabrini Health
 Ms Marg Way, Director, Clinical Governance, Alfred Health
 Mr Ben Witham, Senior Policy Officer, Quality and Safety, Department of Health Victoria
The Educational Resources Project Advisory Committee members comprised:
 Associate Professor Leanne Boyd, Advisory Committee Chair; Director of Education, Cabrini Education and
Research Precinct, Cabrini Health
 Ms Madeleine Cosgrave, Project Manager
 Ms Margaret Banks, Senior Program Director, Australian Commission on Safety and Quality in Health Care
 Ms Marrianne Beaty, Oral Health National Standards Advisor, Dental Health Services Victoria)
 Ms Susan Biggar, Senior Manager, Consumer Partnerships, Health Issues Centre
 Mr David Brown, Consumer representative
 Dr Jason Goh, Medical Administration Registrar, Cabrini Health
 Ms Catherine Harmer, Manager, Consumer Partnerships & Quality Standards, Department of Health,
Victoria
 Ms Cindy Hawkins, Director, Monash Innovation and Quality, Monash Health
 Ms Karen James, Quality and Safety Manager, Hepburn Health Service
 Mr Matthew Johnson, Simulation Manager, Cabrini Health
 Ms Annette Penney, Director ,Quality and Risk, Goulburn Valley Health
 Ms Gayle Stone, Project Officer, Quality Programs, Commission for Hospital Improvement, Department of
Health Victoria
 Ms Deb Sudano, Senior Policy Officer, Consumer Partnerships & Quality Standards , Department of Health
Victoria
 Ms Tanya Warren, Educator, Cabrini Health
 Ms Marg Way, Director, Clinical Governance, Alfred Health
 Mr Ben Witham, Senior Policy Officer, Consumer Partnerships & Quality Standards, Department of Health
Victoria
Blood and Blood Products
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Contents
Blood and Blood Products
4
Introduction
4
Learning outcomes
4
National Standards
4
Aim of Standard 7
4
Policies and procedures
5
Background
5
Principles of blood and blood product safety
5
Use of blood and blood products
5
Prescriptions for transfusion
7
Sampling and testing
7
Administration of blood and blood products
7
Engaging with patients and carers
10
Documentation
11
Managing blood and blood product safety
12
Education and resources
12
Audit and evaluation
13
Reporting adverse events
Error! Bookmark not defined.
Summary
14
Glossary of Terms
15
Test Yourself
16
Answers
18
References
19
Blood and Blood Products
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Blood and Blood Products
Introduction
This module relates to The National Safety and
Quality Health Service (NSQHS) Standard 7: Blood
and Blood Products.
the level of care consumers should be able to
expect from health services.
Aim of Standard 7
The intention of Standard 7: Blood and Blood
Products is to ensure safe, appropriate, effective
and efficient blood management systems are in
place and that patients and carers are engaged in
decisions relating to their management.
Standard 7 also relates to Standard 1: Governance
for Safety and Quality in Health Service
Organisations and Standard 2: Partnering with
Consumers. The principles in these Standards are
fundamental to all Standards and provide a
framework for their implementation.
ACSQHC, 2012
Learning outcomes
On completion of this module, clinicians will be
able to:
1. Describe the principles of patient blood
management.
2. Understand the requirements for safe
administration of blood and blood products.
3. Discuss recognition and response to adverse
effects during administration of blood or blood
products.
Standard 7 also relates to Standard 5: patient
Identification and Procedure Matching
Criteria to achieve Standard 7:
Governance and systems for blood and blood products
prescribing and clinical use
Health service organisations have systems in place for
the safe and appropriate prescribing and clinical use of
blood and blood products.
Documenting patient information
4. Discuss the documentation requirements in
relation to transfusion of blood and blood
products.
The clinical workforce accurately records a patient’s
blood and blood product transfusion history and
indications for use of blood and blood products.
5. Describe the process for engaging patients and
carers in the plan for treatment that includes
blood or blood products.
Managing blood and blood product safety
National Standards
The Australian Commission on Safety and Quality
in Health Care (ACSQHC) developed the 10 NSQHS
Standards to reduce the risk of patient harm and
improve the quality of health service provision in
Australia. The Standards focus on governance,
consumer involvement and clinically related areas
and provide a nationally consistent statement of
Blood and Blood Products
Health service organisations have systems in place to
receive, store, transport and monitor wastage of blood
and blood products safely and efficiently.
Communicating with patients and carers
Patients and carers are informed about the risks and
benefits of using blood and blood products, and the
available alternatives when a plan for treatment is
developed.
Table 1: Criteria to meet Standard 7 (ACSQHC, 2012)
4
Policies and procedures
There are numerous policies, procedures and
resources within health care services to assist you
with the management of blood and blood
products. It is important to access, read and
adhere to systems, policies and procedures within
your organisation in relation to blood and blood
product safety.
ACSQHC, 2012
adverse events must be recorded,
reported and reviewed to identify areas
for improvements in safety and quality

Patients and carers should:
o be Informed of the risks and benefits
of using blood and blood products
and the available alternatives
o provide informed consent
o be engaged in developing the plan
for treatment with the opportunity
to ask questions
Background
The transfusion of blood and blood products can
lead to complications and adverse outcomes for
patients. The risks associated with transfusion of
blood and blood products usually fall into two
categories:
1. Errors in procedure such as:
ACSQHC, 2012; ANZSBT/RCNA 2011
Use of blood and blood products
Blood and blood products should only be given
when the expected benefits to the patient are
likely to outweigh the potential risks.

incorrect patient identification

inaccurate blood sample labelling
ACSQHC, 2012; Australian Red Cross Blood Service (the Blood
Service)

administration of blood or blood
products to the wrong patient
The blood and blood products covered by Standard
7 include:
2. Transfusion reactions.
Australian Haemovigilance Report, 2010
Principles of blood and blood
product safety
Best practice guidelines in effective blood and
blood product management outline the following
key messages:


systems must be in place to receive, store
and transport blood and blood products
safely and efficiently and to monitor
wastage

the decision to transfuse should be made
balancing the potential benefits for the
patient with the potential risks

accurate documentation is required for all
aspects of blood and blood product
management
Blood and Blood Products
1. Fresh blood products
 Red blood cells
 Platelets
 Fresh frozen plasma
 Cryoprecipitate
 Cryodepleted plasma
2. Plasma-derivatives and recombinant
products
 albumin
 factor concentrates
 immunoglobulins, including
immunoglobulin replacement
therapy (e.g. IVIg) and hyperimmune
globulins
5
PATIENT BLOOD MANAGEMENT
Patient blood management is the management
and preservation of the patient’s own blood.
These strategies help to improve patient outcomes
and reduce or avoid the need for a blood
transfusion through:

optimising the patient’s own blood volume
(e.g. iron therapy to boost iron stores and
haemoglobin)

minimising the patient’s blood loss (e.g.
careful surgical technique and managing
medications)

increasing tolerance of anaemia (oxygen
therapy and specifying haemoglobin levels
at which transfusion is required)
The decision on whether to transfuse should be
carefully considered. It should be made balancing
the potential benefits for the patient with the
potential risks and take into account any available
alternative treatments.
The Patient Blood Management Guidelines funded
by the National Blood Authority outline indications
for effective patient blood management in the
following six modules:
 1. critical bleeding and massive transfusion
responsibility are responsible for obtaining and
documenting informed consent.
INFORMED CONSENT
Informed consent means a conversation has
occurred between the patient, carers and the
prescriber about the risks, benefits and
alternatives to transfusion. This conversation must
occur prior to any transfusion of blood or blood
products.
As a result of this discussion the patient should be
aware of:

why a transfusion is being recommended

the risks and benefits of transfusion

alternative options

the risks of refusing transfusion

provided with information in a format that
is understood
The clinician needs to ensure that the patient
understands this information. The patient and
carer must also be given the opportunity to ask
questions and have them answered.
You should follow your organisation’s documented
procedures in life-threatening situations where
consent cannot be obtained.
 2. peri operative
 3. medical (including haematology and
oncology)
 4. critical care
The status of Modules 5 and 6 is:
 5. obstetric – due for to be released for
public consultation June 2014
 6. paediatric and neonatal – expected to
be available in 2015
National Blood Authority (NBA), 2013
DOCTORS’ RESPONSIBILITIES
Doctors should ensure that blood and blood
products are given only when clearly indicated.
Doctors and other clinicians with prescribing
Blood and Blood Products
INFORMED REFUSAL OF BLOOD AND BLOOD
PRODUCTS
All competent adults have the right to refuse
transfusion of blood and blood product.
There must be a conversation between patients,
carers and prescribers to ensure understanding of
the likely risks and results of refusing transfusion.
The notes should include documentation of the
refusal of transfusion and any agreed alternatives.
Clinicians have a legal and moral duty to the
patient to respect and act on the patient’s
informed refusal, irrespective of the clinician’s
personal beliefs and opinions.
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The wishes of the patient must never be assumed.
For example, for many Jehovah’s Witnesses, blood
transfusion is forbidden, however there may be
variation amongst individuals.
The Jehovah’s Witnesses have set up Hospital
Liaison Committees to assist clinicians. Further
information can be found on the Office of the
Public Advocate Victoria website:
http://www.publicadvocate.vic.gov.au
There are specific requirements for the transfusion
of blood and blood products where parental
consent is refused. Further information may be
found in section 24 of the Human Tissue Act (Vic),
1982.
Sampling and testing
The patient’s identity must be positively confirmed
at pre transfusion sample collection and before the
administration of blood or blood products.
To safely identify the patient you must, where
possible:

ask the patient to state their full name and
date of birth

confirm the patient’s identity using at least
three approved identifiers
All samples and specimens must be correctly
labelled at the patient’s side with the patient’s:

surname

given name
Prescriptions for transfusion

date of birth
Blood or blood products must be prescribed by a
health professional accredited to prescribe blood
products.

UR number (if they are an inpatient)
Consumers Health Forum of Australia, 2013;
Medical Treatment Act 1988
The prescription must be recorded on the
intravenous fluid or transfusion chart using
appropriate and consistent terminology of the
blood product to be administered. It must be
legible and contain:

patient identification details: family name,
given name, gender, date of birth and
unique patient identification number if
available

date and timing and urgency of the
transfusion

the route and rate of administration

the number of units or dose of blood
product to be given

the product type and any special
requirements(e.g. irradiation)
The prescription should outline other relevant
instructions such as the use of blood warmers and
any medication required before or after the
transfusion.
Blood and Blood Products
This information should be confirmed with the
patient and matched to the identification band and
the request form or cross match request slip.
Administration of blood and blood
products
The Australian and New Zealand Society of Blood
Transfusion (ANZSBT/RCNA) Guidelines for the
Administration of Blood Products 2nd Edition (2011)
provide clinicians with guidance on the safe
administration and management of patients
having blood or blood products as part of their
medical treatment.
PREPARATION
Prior to collection of the blood or blood product
for transfusion the following measures should be
implemented.
Prescription and informed consent
Ensure that there is a valid prescription and that
informed consent has been obtained.
7
Venous access and equipment
You must make sure that intravenous access is
both patent (open and unobstructed) and of the
correct size and location to support transfusion.
Blood and blood products must be transfused
using the appropriate administration sets and
infusion devices which should be specified in your
organisation’s procedures or guidelines.
Indications for the use of rapid infusion sets and
blood warmers may also be found in your
organisations procedures or guidelines and as
specified by the prescriber.
ANZSBT/RCNA 2011
Location and timing of transfusion
Transfusion should only take place when there are
adequate numbers of trained staff available to
observe and monitor the patient. This should
include two staff to perform the blood product and
patient identity checks at the patient’s side. There
should also be access to emergency medical
support.
Transfusion should occur as soon as the product is
delivered to the clinical area.
Overnight and out-of-hours transfusion should be
avoided unless clinically indicated.
Priming administration sets
TRANSFUSION
Priming of the set may be done with 0.9% sodium
chloride or the blood product. At completion of
the transfusion, blood administration sets may be
flushed with 0.9% sodium chloride, however, there
is no evidence to suggest that this is of benefit
between units, except to keep the vein open if
there is delay.
The final check at the patient’s side is a vital step in
preventing transfusion error and should occur
immediately prior to commencing the transfusion.
Staff must be vigilant to ensure that the right
blood is administered to the right patient.
Platelets must not be transfused through a blood
administration set which has been used for red
cells, as red cell debris may trap infused platelets.
The exception to this is during massive transfusion
when platelets and plasma may need to be
transfused through the same administration set.
The patient’s identity must be confirmed by asking
the patient to state name, DOB, and ensure these
accurately match the ID band and the product
compatibility slip immediately prior to the
administration of blood or blood products.
ANZSBT/RCNA 2011
Medications
Pre-medication (if required) should be
administered with enough time to take effect.
Medication must not be added to the blood or
blood product at any time. The administration set
should not be used to administer medications prior
to or during transfusion as they may interact with
the product or additives in the blood product, e.g.
anticoagulants. These should be noted in the
health service’s policy
ANZSBT/RCNA 2011
Blood and Blood Products
ANZSBT/RCNA 2011
Positive identification of the patient
Matching to the prescription
The prescription or order must be available and
confirmed at the patient’s side immediately before
the transfusion commences.
The blood product checking procedure must
ensure the following:

the patient details attached to the product
match the patient who will receive the
transfusion

the blood product type is the same on the
prescription, product and laboratory
compatibility label (including any special
requirements, e.g. irradiation)
8

the blood group on the blood product and
the laboratory compatibility label matches
the blood group of the patient
transfusion is not to go ahead, the red blood cells
must be returned to controlled storage conditions,
within 30 minutes to prevent wastage.

the blood product has not passed its crossmatch or product expiry date
Duration of transfusion
The integrity of the blood product is confirmed by
excluding:

any leaks

any evidence of haemolysis, unusual
discoloration or cloudiness

the presence of any large clots
If any discrepancy is found during the checking
process at the patient’s side, the blood product
must not be used and should be returned to the
transfusion service provider.
If there are no discrepancies, the blood product
must be spiked immediately, by one of the
clinicians involved in the identification and
matching process. The commencement time must
be documented on the appropriate paperwork or
in the clinical record.
ANZSBT/RCNA 2011
Observation and monitoring
As a baseline, the vital signs of the patient must be
measured and recorded prior to each transfusion.
This includes temperature, pulse, blood pressure
and respiration rate (T,BP,P,R).
The patient must be closely observed for the first
15 minutes after commencement of each unit to
identify any adverse effects. This should include
patient observation and measurement of
(T,BP,P,R). . Patient monitoring should continue
throughout the transfusion. A final set of
observations should be taken after the transfusion
is complete.
All observations must be recorded in the patient’s
medical record.
All transfusions should be completed within 4
hours of commencement of the transfusion or 4 ½
hours from release from storage.
Transfusions should start slowly, where clinically
appropriate. After 15 minutes, the transfusion can
be increased to the specified rate as long as there
are no signs of adverse reaction. The rate will
depend on the context, age and clinical status of
the patient.
Recognising and responding to adverse events
Prior to commencement of the transfusion,
patients and any carers who are present, should be
educated regarding potential adverse effects.
They should be advised to report any effects to
staff during or after the transfusion.
The management of a transfusion reaction is
dependent upon the type and severity of the
reaction. Severe transfusion reactions such as
haemolytic or septic events can occur within
minutes of commencement and require urgent
treatment.
The most common sign of an adverse transfusion
reaction is a rise in the patient’s temperature. This
may be due to the transfusion or as a result of the
patient’s underlying illness. A rise in temperature
should prompt stopping the transfusion and a
clinical assessment of the patient.
You should refer to your organisation’s policies and
procedures for managing and reporting transfusion
reactions.
Inform your blood supplier/pathology service and
return any unused portion of the blood product for
follow-up testing.
Transfusion of red blood cells should be
commenced within 30 minutes of the product
being released from controlled storage. If for
some reason this has not occurred, and the
Blood and Blood Products
9

Immediately report the reaction to the
transfusion service provider, who will advise on
return of the implicated product and
administration set, and any further blood or
urine samples needed from the patient
Signs

Localised rash/itching and/or isolated temperature
rise < 1.5 °C
Monitor and record the patient’s temperature,
pulse, respiration and blood pressure

Record the volume and colour or any urine
passed (looking for evidence of
haemoglobinuria
The following lists some common signs of
transfusion reactions and suggested actions should
signs and symptoms develop.
Mild transfusion reactions
Suggested actions

STOP the transfusion

Maintain IV access

Monitor and record the patient’s temperature
and vital signs

Repeat all identity checks of the patient and
blood pack.

Contact medical staff immediately for further
instructions and to review patient.
Moderate to severe reactions
Signs
Any of the following could be considered signs of a
moderate to severe transfusion reaction:

Temperature >1.5 °C above baseline

Hypotension/shock OR hypertension

Tachycardia

Tachypnoea, wheeze, stridor

Rigors or chills

Nausea, vomiting or pain (local, chest, back)
Required actions
If a moderate or severe transfusion reaction is
suspected the following steps MUST be undertaken:

STOP the transfusion immediately and seek
urgent medical advice; Medical Emergency
Team (MET) support may be required
depending on the specific clinical situation

Repeat all clerical and identity checks of the
patient and blood pack
Blood and Blood Products
ANZSBT/RCNA 2011
All adverse events including transfusion
reactions should be reported to the
nurse/midwife in charge, the attending
medical officer and be documented in the
clinical record. They should also be
reported on your organisation’s risk or
incident management system, pathology
provider/ the Blood Service. It is very
important to notify the lab/ Blood Service
as there may be other associated blood
components implicated and these could
potentially be a risk for other patients.
Many blood components are made from a
single donation and if there is a reaction to
one of the components then others could
also be at risk. This is often overlooked.
Further information on the recognition and
management of transfusion reactions is available
in the guidelines (ANZSBT/RCNA 2011). The NBA is
developing a chart to assist clinicians in the
recognition and management of adverse
transfusion reactions.
Reporting adverse events
All adverse events including transfusion reactions
should be reported to the nurse/midwife in
charge, the attending medical officer and be
documented in the clinical record. They should
also be reported on your organisation’s Risk or
Incident Management System and to state or
national systems. It is important to report outside the
organisation as this is where trends or clusters of events
can be detected.
10
Patients and carers should be fully informed of any
adverse events and the organisation’s open
disclosure processes implemented.
This collaboration enables an opportunity for
patients, carers and clinicians to share information
which may impact on the effectiveness of the plan.
Information trends can then be used to inform
quality improvement activities such as system,
policy, protocol and equipment improvements and
education and training activities.
Health care professionals should consider the
following in order to encourage patients to be
involved in their own care:
ACSQHC, 2012
The NBA has developed reporting and governance
frameworks for the National Haemovigilance
program for Australia. It reports on serious
transfusion related adverse events occurring in
public and private hospitals.
Relevant adverse events should also be reported
to the:

the Blood Service

pathology service providerState
Haemovigilance Incident Reporting
Scheme (Serious Transfusion Incident
Reporting=STIR)

the service’s risk management tool

the product manufacturer
You should refer to your organisation’s policies and
procedures regarding reporting of these adverse
events.
 ensuring a conversation takes place
between the clinician and the patient or
carer about the specific transfusion,
including risks, benefits and alternatives
 ensuring the patient understands and agrees
to the transfusion and document informed
consent in the clinical record
 explaining the need for repetitive
identification
 explaining the patient’s role in safe care,
including their ability to raise concerns with
the heath care team
 providing relevant, easy to understand
information about transfusion
 offering information in languages other than
English and not assuming literacy
Patients and carers should be encouraged to ask
questions and take part in discussions and
decisions about their care.
Reporting criteria and further information is
available at the:
 Blood Matters at:
http://www.health.vic.gov.au/bloodmatter
s/stir.htm
 National Blood Authority at:
www.blood.gov.au
Engaging with patients and carers
Patients and carers should be educated about the
benefits and risks of transfusion of blood and
blood products. They must be involved in the
development of a plan for care. This plan should
identify the reasons for transfusion of blood
products and outline any treatment alternatives.
Blood and Blood Products
ACSQHC, 2012
Documentation
It is important to ensure accurate and
comprehensive documentation in the clinical
record in relation to all aspects of the transfusion
of blood and blood products.
This information should include:

a record of the conversation between the
patient, carer and prescriber resulting in
consent to, or refusal of, the transfusion

indications for transfusion or
administration of the blood product
11

known medical conditions and transfusion
history

the prescription, laboratory compatibility
report and product details including
identification number, type and volume
administered

time of transfusion commencement and
completion

evidence of patient observations during
transfusion

patient response to the transfusion
including occurrence and management of
any adverse events
The details of any transfusion of blood or blood
products should also routinely appear in discharge
documentation to inform future decision making
and treatment.
According to the Australian Standard (AS 3864
1997) Medical Refrigeration Equipment - For the
Storage of Blood and Blood Products:

red blood cells must only be stored in
temperature-controlled and monitored,
dedicated blood refrigerators and not in
ward or domestic refrigerators

all other blood products must be stored
according to their specific requirements
ANZSBT/RCNA, 2011
Before collecting any blood product from
controlled storage, clinical staff and the patient
must be adequately prepared to commence the
transfusion process without delay.
You must comply with your organisation’s
procedures to accurately identify and record blood
product removal from storage.
ACSQHC, 2012
ACSQHC, 2012
Managing blood and blood product
safety
Management of blood and blood products refers
to handling, transport, and storage (including
inventory management).
Inadequate product stores can potentially put
patients at risk. Alternatively, storing too much
blood can deplete products held by the supplier to
insufficient levels, increase the age of blood at
transfusion and increase wastage.
Health care organisations must have systems and
processes in place to ensure that blood and blood
products are ordered, stored and handled
appropriately. This is critical to maintain the
quality and integrity of the product and to
minimise wastage.
Education and resources
Clinical and relevant ancillary staff should be aware
of the requirements for safe and appropriate
storage of blood and blood products. Education is
also required regarding:

consent and refusal processes

appropriate clinical use of blood and blood
products

safe transfusion administration practices

documentation requirements for all
aspects of blood and blood product
management

recognition and reporting of adverse
events
These systems should ensure the adequate supply
of products to meet clinical needs and minimise
the requirement to discard products.
Blood and Blood Products
12
RESOURCES FOR STAFF
There are considerable education and training
resources available to guide organisations and
clinicians in blood and blood product safety.
These are available at the following sites:

Australian Red Cross Blood Service at:
www.transfusion.com.au
RESOURCES FOR PATIENTS
Patient information resources from the following
sites may be adapted to suit a health service’s
requirements:
 Blood transfusion: Have all your questions
been answered and Frequently asked
questions about blood transfusion (2012)
at:
http://docs.health.vic.gov.au/docs/doc/Bl
ood-transfusion:-Have-all-your-questionsbeen-answered-

Blood Matters Program Victorian
Department of Health at:
http://www.health.vic.gov.au/bloodmatter
s

Blood Safe e-learning at:
https://www.bloodsafelearning.org.au
 Blood Matters at:
National Blood Authority at:
www.blood.gov.au
 National Blood Authority at:
NBA inventory management guidelines at:
www.blood.gov.au/sites/default/files/doc
uments/nba-inventory-managementguidelines.pdf
 Other Australian State Jurisdictional Blood





The Australian and New Zealand Society of
Blood Transfusion (ANZSBT) Guidelines for
the Administration of Blood Products 2nd
Edition at:
http://www.anzsbt.org.au/publications/do
cuments/ANZSBT_Guidelines_Administrati
on_Blood_Products_2ndEd_Dec_2011_Hy
perlinks.pdf
ANZSBT Guidelines for Pretransfusion
Testing 4th Edition at:
http://www.anzsbt.org.au/publications/do
cuments/ANZSBTguide_Nov02b.pdf
Other Australian State Jurisdictional Blood
Programs, e.g. NSW Blood Watch, SA
Blood Safe
www.health.vic.gov/bloodmatters
www.blood.gov.au
Programs, e.g. NSW Blood Watch, SA Blood
Safe
 The Australian Red Cross Blood Service
Patient website at:
www.mytransfusion.com
Audit and evaluation
You may be required to participate in audit
activities which could include examination of:

patient clinical records

informed consent documentation

transfusion records
The purpose of audit is to measure compliance
with policies and protocols and to monitor the
frequency and severity of adverse events in
relation to blood and blood products. This
information can be used to improve practice.
A range of audit tools can be found on the Blood
Matters website:
http://www.health.vic.gov.au/bloodmatters/tools/da
ta-collection.htm
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Summary
Blood and blood product safety is the focus of
Standard 7 in the National Safety and Quality
Health Service Standards.
The key messages are:
1. The risks associated with transfusion of blood
and blood products usually fall into two
categories:

Errors in procedure such as:
o incorrect patient identification
o inaccurate blood sample labelling
o administration of incorrect blood
or blood products, or to the wrong
patient

Transfusion reactions
2. Patient blood management practices should be
employed to manage and preserve the
patient’s own blood. These strategies help to
improve patient outcomes and reduce or avoid
the need for a blood transfusion.
3. The decision to transfuse should be made
balancing the potential benefits for the patient
with the potential risks.
or blood product is administered to the right
patient.
8. Transfusion should only take place when there
are adequate numbers of trained staff
available to observe and monitor the patient.
9. The patient must be closely observed for the
first 15 minutes after commencement of each
unit and monitored throughout the
transfusion, to identify any adverse effects.
10. Systems must be in place to receive, store,
transport blood and blood products safely and
efficiently and monitor wastage.
11. Accurate documentation is required for all
aspects of blood management.
12. All adverse events should be reported to the
clinicians in charge and be documented in the
clinical record. They should also be reported
on your organisation’s risk management
system, pathology provider/ the Blood Service.
It is very important to notify the lab/ Blood
Service as many blood components are made
from a single donation, and if there is a
reaction to one of the components then others
could also be at risk.
4. Patients and carers should:

be informed of the risks and benefits of
using blood and blood products and
available alternatives

provide informed consent

be engaged in developing the plan for
treatment
5. Informed consent means a conversation has
taken place between the patient, carer and
prescriber about the risks, benefits and any
alternatives to transfusion.
6. Correct patient identification at ALL points in
the transfusion chain is vital to ensure patient
safety in transfusion
7. The final check at the patient’s side is a vital
step in preventing transfusion error. Staff
must be vigilant to ensure that the right blood
Blood and Blood Products
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Glossary of Terms
BLOODNET
Australia’s national blood ICT system enabling
online ordering, receipting, dating and inventory
management of blood and blood products.
TRANSFUSION
The administration of all blood and blood products
regardless of their route of administration
including fresh blood components such as:
ACSQHC, 2012

red blood cells
HAEMOVIGILANCE
Defined by the International Haemovigilance
Network as ‘a set of surveillance procedures
covering the whole transfusion chain (from the
collection of blood and its components to the
follow-up of 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 occurrence or
recurrence’.

platelets

fresh frozen plasma

cryoprecipitate

cryodepleted plasma
ACSQHC, 2012
INFORMED CONSENT
Informed consent is a legal procedure undertaken
to ensure that a patient understands the
implications of treatment, in this case, transfusion
of blood and blood products. Informed consent is
given after a dialogue has occurred between the
patient (and carers) and doctor about the risks,
benefits and any alternatives to transfusion. As a
result of this discussion the patient should:
 know why a transfusion is being
recommended
Plasma derivatives and recombinant products like:
 albumin
 immunoglobulins, including
immunoglobulin replacement therapy and
hyperimmune globulins
 cclotting factors
ACSQHC, 2012
TRANSFUSION GOVERNANCE GROUP
The group responsible for overseeing the
Transfusion Quality Improvement System. This
may be a dedicated transfusion committee or an
agenda item on a quality committee.
ACSQHC, 2012
TRANSFUSION QUALITY IMPROVEMENT SYSTEM
 be aware of the risks and benefits
 be aware of any alternatives
 have had an opportunity to ask questions
and have them answered
 give consent for the transfusion
A cycle of activities to review current practice
relating to transfusion practice, assess risks,
identify opportunities for improvement,
implement practice improvement and measure the
results.
ACSQHC, 2012
ACSQHC, 2013
Blood and Blood Products
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Test Yourself
True or False?
1. Any discrepancy that is found in the transfusion checking process; such as loss of product integrity
(e.g. clots in the bag), incorrect labelling (e.g. discrepancy in the DOB or spelling of name) or the,
can still be administered if instructed by the treating Medical Officer.
True or False (please circle)
2. Patient blood management refers to the preservation of patients’ own blood, improving the
tolerance of anaemia, to reduce or avoid the need for a blood transfusion.
True or False
3. In life threatening situations, where consent cannot be obtained, you should follow your
organisation’s procedures.
True or False
4. To safely identify your patient pre transfusion, you need to use at least two approved identifiers.
True or False
5. The final check that takes place should be at the patient’s bedside, immediately prior to spiking the
blood product.
True or False
6. Medications can be added to blood and blood products.
True or False
7. Baseline observations should be taken once the transfusion has commenced.
True or False
8. Red blood cells should begin transfusion within 30 minutes of the product being released from
controlled storage.
True or False
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9. The transfusion should run over a maximum of 6 hours to maintain the quality of the blood
product.
True or False
10. The blood products and patient identity checks should be performed at the patient side
immediately prior to transfusion.
True or False
11. The most common sign of an adverse transfusion reaction is a rise in the patient’s temperature.
True or False
12. Red blood cells must only be stored in temperature-controlled, dedicated blood refrigerators and
not in ward or domestic refrigerators.
True or False
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Answers
1. False – the blood product should not be administered, and should be returned to the transfusion
service provider.
2. True.
3. True.
4. False – at least three approved identifiers must be used.
5. True.
6. False – medications should not be added to blood and blood products.
7. False – baseline observations should be taken prior to transfusion commencement and 15 minutes
into the transfusion and the patient should be observed closely.
8. True.
9. False – The transfusion should be run over maximum 4 hours.
10. False – at least 2 staff members should complete the blood products and patient identity checks at
the patient’s side.
11. True.
12. True.
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References
Australian Red Cross Blood Service Transfusion - http://www.transfusion.com.au/
Australian and New Zealand Society of Blood Transfusion Ltd and Royal College of Nursing Australia.
(2011). Guidelines For the Administration of Blood Components, 2nd Edition. Sydney, 2011.
Australian Commission on Safety and Quality in Health Care (2012). Safety and Quality Improvement Guide
Standard 7: Blood and Blood Products. Sydney: Commonwealth of Australia
Australian Commission on Safety and Quality in Health Care (2013). Blood and Blood Products, Standard 7:
Fact Sheet. ACSQHC, Sydney
Blood Matters Home - http://www.health.vic.gov.au/bloodmatters/index.htm
BloodSafe Home – Welcome to BloodSafe eLearning Australia. 2012. Accessed at
www.bloodsafelearning.org.au/node/9
Consumers Health Forum of Australia. (2013). Informed Consent in Healthcare: An Issues Paper. Accessed
at: https://www.chf.org.au/pdfs/chf/Informed-Consent-Issues-Paper.pdf
Medical Treatment Act 1988 (Enduring Power of Attorney)
National Blood Authority. Australian Haemovigilance Report 2010, A Report by the National Blood
Authority Haemovigilance Advisory Committee. Canberra: National Blood Authority, 2010.
National Blood Authority. Patient Blood Management Guidelines: Module 1 Critical Bleeding Massive
Transfusion. NBA, 2011.
National Blood Authority.(2012). Patient Blood Management Guidelines: Module 2 Perioperative.
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