Professional leadership

A key success factor can be leadership provided by a respected senior clinician who develops an active professional interest in improving transfusion treatment. ‘Clinical Champions’ for good transfusion may emerge from specialties such as anaesthetics/ intensive care, surgery or haematology, where transfusion is frequently utilised. One approach that has been successful is to engage such specialists in collaborative programmes of clinical audit or research on the use of transfusion in their own specialist field.

Effective Hospital Transfusion Committee

An effective and well-led Hospital Transfusion Committee (HTC) or a body with equivalent functions is widely held to be essential for improvement of clinical transfusion practice. The primary aim should be to promote a high standard of care for patients at risk of transfusion (i.e. those who must be transfused, and also those who, with good clinical management, may avoid the need for transfusion). The HTC should have a clear line of accountability to an appropriate post at a senior management level in the institution. The HTC should have the authority to determine hospital policy in relation to blood transfusion and must have an effective means of disseminating it to all relevant staff and to patients where appropriate. (www.transfusionguidelines.org.uk)

Terms of Reference for an HTC

Should include the following:

• Promote the dissemination and the use of national or local guidelines that apply to the clinical transfusion process
• Regularly review and update the hospital’s documentation for blood transfusion
• Carry out audits that evaluate the hospital’s clinical blood transfusion process against the relevant guidelines and benchmark the use of blood components against best practice
• Promote the education and training of clinical, laboratory and support staff involved in the clinical transfusion process
• Report serious adverse reactions and events to the national haemovigilance programme
• Ensure that incidents are analysed and the information is used to help improve practice and prevent a repetition

Membership of HTC

The HTC should include clinicians from specialties in the hospital that utilise transfusion, for example haematology, anaesthetics, intensive care, surgery, or obstetrics, as well as staff from nursing, blood bank and audit or research departments. The committee requires an effective chairperson who has the professional respect of senior medical personnel and can command the attention of hospital management.

Operation of HTC

The HTC should meet regularly, have a formal agenda and keep full records of its decisions. It must have the authority and support to ensure that its decisions are effectively communicated to and followed by staff who contribute to the clinical transfusion process.

Someone who is employed to make things happen

The transfusion committee may make excellent recommendations, but it needs an executive officer, a person who is employed specifically to ensure that the recommendations are converted into actions. Several countries have created a new position for this purpose. The manual uses the term Transfusion Practitioner (TP) (www.betterblood.org.uk) but posts with similar responsibilities have also been given titles such as Transfusion Safety Officer (TSO), Transfusion Nurse Coordinator (TNC) or Haemovigilance Officer (www.transfusionsafety.ca). The TP is concerned with the clinical transfusion process, ”taking quality assurance from the blood bank to the patient”. The transfusion practitioner’s job description would typically specify responsibilities such as these:

• Education and training of nursing and medical staff
• Patient information
• Promote compliance and safety in activities such as specimen collection, administration blood components and products
• Carry out transfusion practice audit
• Investigate and report adverse events and reactions
• Trouble shoot and take preventive and corrective action
• Support development and implementation of transfusion policies and guidelines

In many countries the TP have a background in nursing or the transfusion laboratory; other countries have employed doctors or pharmacists in similar roles. The goal should be for the TP to be part of a wider transfusion team that should develop with the encouragement and motivation of the transfusion committee. In several EU countries, the TP role is now viewed as an essential part of the hospital’s quality improvement programme in transfusion.