Criterion: Prescribing and clinical use of blood and blood products
The clinical use of blood and blood products is appropriate, and strategies are used to reduce the risks associated with transfusion.
Although blood and blood products remain a critical element of clinical practice, there is increasing evidence that allogeneic blood transfusions pose risks to patients, and that a significant proportion of transfusions are unnecessary or could be avoided. Allogeneic transfusions can be associated with adverse patient outcomes, potentially leading to increased morbidity, delayed recovery, extended hospital stays or mortality.1
Introduction of PBM strategies can minimise these risks. PBM describes a range of medical and surgical strategies that aim to conserve and optimise the patient’s own blood, which can reduce or avoid the need for allogeneic transfusion and improve patient outcomes. It is a person-centred approach, as opposed to having a product-centred focus. PBM is not an intervention or an alternative to blood transfusion; it is sound, evidence-based clinical practice that aims to improve clinical outcomes by avoiding unnecessary exposure to blood components. It includes the three pillars of:
- Optimising blood volume and red cell mass (including haemoglobin and iron studies)
- Minimising blood loss
- Optimising the patient’s tolerance of anaemia.
Benefits of appropriate management through PBM include:
- Assessment and management of conditions that, without appropriate interventions, might lead to a blood transfusion (so that transfusions are done only when necessary)
- Improved patient outcomes, including fewer complications, faster recoveries and shorter hospital stays
- Reduced patient exposure to the potential risks associated with receiving blood and blood products from another person, including
- allergic and immunological complications – blood transfusion may be considered as a type of organ transplant and, as with any transplant, the body may react to foreign components
- infectious risk – blood in Australia is very safe, and donor blood is carefully screened and tested; however, infectious disease transmission remains a very low risk
- incorrect blood transfused – although strict procedures are used to ensure that patients receive the correct blood product, the potential for a patient to receive the wrong blood (meant for someone else) still exists, which can result in serious medical problems.
- The NBA website provides more information on PBM and supporting resources.
Documenting blood management history and decisions
Accurately recording a patient’s blood and blood product transfusion history, including any previous reactions and specific indications for use, in the patient’s healthcare record is essential to enable easy and accurate review of records. Blood and blood products can be implicated in recalls or lookback processes by the Australian Red Cross Blood Service or other commercial suppliers. The NBA website lists these suppliers.
Health service organisations need to be able to trace all blood and blood products to allow recall if possible, and treatment, testing or counselling of the recipient as required. This can only be achieved through well-maintained records of the fate of all blood and blood products.
Review of transfusion history is also an important component of the pre-transfusion process. It can identify any red cell antibodies, transfusion reactions or special patient requirements2, and improve transfusion safety by reducing the risk of an adverse transfusion reaction. In addition, recording detailed information about transfusion is important to allow audit of the patient healthcare record. For example, documenting the indication for transfusion is essential to audit transfusions against guidelines (see Action 7.1).
Reviewing and reporting adverse events
The Stewardship Statement includes the requirement to manage blood and blood products in ways that ensure that transfusion-related adverse event information is collected and managed according to state or territory requirements. Governments have also endorsed the Strategic Framework for the National Haemovigilance Program3, which redefines the scope of national haemovigilance arrangements to emphasise activities that contribute to national standardisation. The NBA will continue to collect, analyse and report haemovigilance data received from states and territories at the level defined in the Australian haemovigilance minimum dataset.4
Although information collected about incidents relating to the administration of blood and blood products varies between states and territories, all states and territories have agreed to align the information they collect about transfusion to allow very specific transfusion-related information to be collected and provided for national reporting. Definitions and types of adverse events that should be reported are in the Australian haemovigilance minimum dataset.4