Recommendations for Hospital Staff Involved in the transfusion process
| Recommendation | Action by |
|---|---|
| GENERAL RECOMMENDATIONS | |
| Active participation in SHOT must continue | Hospital staff involved in the blood transfusion process |
| An open learning and improvement culture must continue to be developed in which SHOT reporting is a key element | Staff involved in the blood transfusion process |
| Appropriate use of blood components must be strenuously promoted and evaluated. This must include monitoring for serious adverse effects of alternatives to transfusion | Clinicians administering blood transfusion |
| NEAR MISS | |
| Robust systems for noting patients’ special requirements should be developed together with a policy of empowering patients to be more aware of their own special needs | Clinicians |
| Ward staff at all levels must be trained in appropriate storage of blood components once they have been collected from the blood bank | Ward managers |
| TRANSFUSION RELATED ACUTE LUNG INJURY (TRALI) | |
| Every effort must be made to avoid unnecessary transfusion of plasma rich blood components including FFP and platelets. | Clinicians administering blood transfusion |
| FFP continues to be associated with risks of reactions including TRALI and should only be used when clinically indicated in accordance with BCSH guidelines. Guidelines for the management of high international normalised ratio (INR)s due to warfarin therapy should also be followed | Clinicians administering blood transfusion |
| Hospital staff should continue to be aware of TRALI and report possible cases to the local Blood Centre to facilitate investigation. Continued education of all relevant staff about this condition is needed. | Clinicians administering blood transfusion |
| Cases should be evaluated early by the consultant(s) involved. A team approach including the haematologist and chest physician and/or intensive care unit (ICU) consultant is recommended. There should be early liaison with the local Blood Centre. | Clinicians administering blood transfusion plus haematologists, chest physicians and ICU consultants |
| TRANSFUSION TRANSMITTED INFECTION (TTI) | |
| Efforts to prevent bacterial contamination of blood components should continue. These include – Continuation of diversion of the first 20-30 mL of the donation (likely to contain any organisms entering the collection needle from the venepuncture site). – Careful attention to adequate cleansing of donors’ arms. – Adherence to BCSH guidelines (1999) with regard to the visual inspection of blood components for any irregular appearance immediately prior to transfusion. | Staff undertaking pre-transfusion bedside checking |