The case for better blood management
Although significant progress has been made to improve blood safety and efficiency, laboratories still face workforce challenges, and the lack of global standards and better quality controls in blood management and haemovigilance pose a threat to patient safety. To help address these challenges, a symposium was hosted at the 2011 American Association of Blood Banks Annual Meeting with key opinion leaders from the transfusion medicine departments of the Cleveland Clinic, Children’s Hospital Los Angeles and USC Medical Center.
The attending experts broadly agreed that the key to safe, efficient blood management boils down to the ‘5Rs’: ensuring the Right patient gets the Right donor unit at the Right time, the Right way and for the Right reason. Presentations at the symposium discussed how the transfusion laboratory can deliver on the 5Rs through improvements in blood management and haemovigilance practices.
by Scott Saccal
Improving blood safety
Laboratories strive to protect patients’ health and deliver safe blood and blood components to the right person at the right time, but they are under constant pressure to do more with less – including fewer skilled laboratory technicians and scarcer financial resources. To help in meeting these demands, blood bank laboratories are increasingly employing automation. For example, many blood banks are standardising across instrument platforms and implementing testing technologies such as Column Agglutination (CAT). These testing methods are easier to use, and help reduce the opportunity for error and variation among both technologists and tests because they provide stable and clear endpoints that deliver accurate, objective and consistent results.
Automation helps minimise the labor-intensive, time-consuming manual tests that require specialised skills and significant experience to master, such as patient and unit typing, antibody screening and cross-matching. Automation also increases the capacity of technologists so they can focus on priorities such as time-sensitive emergency situations, difficult patient workups and quality-improvement processes. For example, computerised physician order entries have been found to reduce errors related to labour-intensive tasks by 50 percent, and all errors in general by 80 percent [1,2]. Ultimately, automated testing can increase a lab’s capacity, potentially allowing it to serve more patients while helping it operate more efficiently.
New approaches to load management and haemovigilance
Quality controls help ensure the safety of the patient at the end of the bloodline by helping to assure that from the moment a donation is made, the right blood and blood products are delivered to the right patient at the right time, and in the right way for the right reason. While great strides have been made to implement quality controls for the highest level of patient safety, there remains much work to be done.
Across the globe, a total of 106 countries have national guidelines on blood management, yet no universal safety standards exist. Further, broken system links and human errors due to distraction, fatigue and inattention account for approximately 70 percent of lab errors and cause catastrophic consequences such as the inappropriate administration of blood and/or adverse reactions [3]. Giving the wrong donor unit or giving an inappropriate transfusion can lead to serious complications, disease transmission and even fatal haemolytic reactions [4].
To combat the high incidence of laboratory errors, many hospitals and clinics are appointing Transfusion Safety Officers (TSO), to oversee work outside of the laboratory to improve patient safety during transfusions [5]. The increase in demand for blood and blood components suggests that additional measures will be needed to promote transfusion safety across departments, oversee institution-wide haemovigilance and error and accident reporting, provide education on transfusion reactions, implement guidelines, perform safety training and identify new technology for enhanced safety.
Additionally, hospitals and healthcare institutions around the world are developing ways to meet new standards – both by instituting their own rigorous policies, and by understanding and implementing the guidelines from organisations that oversee the safety of transfusions. The UK’s Serious Hazard of Transfusion programme and the U.S. Centers for Disease Control (CDC) National Healthcare Safety Network (NHSN) suggest voluntary reporting structures to create a reliable source of information for the medical and scientific community about blood transfusion issues, including warning facilities about adverse events that could be systemic.
Industry groups also are striving to improve patient care and safety while maximising healthcare system efficiencies. For example, AABB collaborates with the U.S. Department of Health and Human Services on biovigilance activities, including programmes directed at a variety of different domains such as donor haemovigilance and transfusion recipient haemovigilance. Through the collaboration, the organisations are gathering and analysing data to help find trends and establish best practices for safer, more efficient transfusions and transplants [6]. Similarly, the International Society of Blood Transfusion (ISBT) and the European Haemovigilance Network (EHN) began a working group in 2004 focused on creating a common set of definitions for issues in the field, which would enable global benchmarking and is intended ultimately to increase the safety of blood donors and recipients around the world [7].
Shared commitment to patient safety
Protecting the precious life of a patient who will receive a unit of blood remains the focus of blood bankers everywhere. As the pressures and demands rise, labs are finding new ways to be efficient and haemovigilant, while never losing sight of the real person at the end of the bloodline. Despite the continued shortage of highly skilled technologists and scientists entering the laboratory science workforce, blood bankers are utilising automation and best practices to improve transfusion testing, and implementing new approaches to blood management and haemovigilance to deliver on the 5Rs of blood safety. Protecting the safety of patients through efficient blood management and haemovigilance is a commitment all of us share as part of the transfusion medicine community.
References
1. Bates DW et al. Effect of computerized order entry and a team intervention on prevention of serious medication errors. Journal of the American Medical Association 1998; 280: 1211-1212
2. Bates DW et al. The impact of computerized order entry on medication error prevention. Journal of American Medical Informatics Association 1999; 6: 313-332.
3. Kaplan HS. Getting the right blood to the right patient: the contribution of near-miss event reporting and barrier analysis. Transfusion Clinique et Biologique 2005; 2: 380-384.
4. Shulman Ira A. ‘Assuring That The Right Patient Gets The Right Donor Unit, At The Right Time, The Right Way, And For The Right Reason.’ Slide 6. AABB annual meeting. San Diego, CA. Ortho Clinical Diagnostics Blood Management Symposium. October 24, 2011
5. Davey Richard J. ‘The Safety of the Blood Supply.’ Food and Drug Administration Division of Blood Applications webinar. Available at: http://www.fda.gov/downloads/AboutFDA/Transparency/Basics/UCM245738.pdf. Accessed October 20, 2011.
6. Biovigilance – AABB program — http://www.aabb.org/programs/biovigilance/Pages/default.aspx
7. Haemovigilance – ISBT — http://www.isbtweb.org/fileadmin/user_upload/WP_on_Haemovigilance/ISBT_StandardSurveillanceDOCO_2008__3_.pdf
The author
Scott Saccal
Worldwide Marketing Director
Transfusion Medicine
Ortho Clinical Diagnostics
