SHOT (Serious Hazards of Transfusion) is the United Kingdom’s independent, professionally led, confidential enquiry into the serious hazards of transfusion.
SHOT collects information on transfusion reactions and adverse events from all healthcare organisations in the United Kingdom that are involved in the process of blood transfusion.
SHOT investigates the contribution of deficiencies in the transfusion process to serious adverse patient outcomes.
SHOT identifies areas where laboratory and clinical practice need to be improved and makes appropriate recommendations for changes that will improve outcomes for patients.
SHOT provides authoritative data to inform policy in blood transfusion.
SHOT supports the production of clinical guidelines in blood transfusion.
SHOT undertakes research, studies and audit in the area of transfusion safety, and this may be solely, collaboratively or by commission.
SHOT provides and encourages education on all facets of transfusion safety and the management of transfusion reactions as relevant to all personnel involved in the blood transfusion process.
To improve patient safety in blood transfusion.
SHOT encompasses all labile blood components issued by the 4 UK Blood Transfusion Services (NHS Blood & Transplant, Scottish National Blood Transfusion Service, Welsh Blood Service and Northern Ireland Blood Transfusion Service), the Ministry of Defence and the Blood Services in the Crown Dependencies. Reactions and events related to all forms of autologous transfusion, including cell salvage, are included.
Adverse reactions and events related to virus inactivated fresh frozen plasma (FFP) and adverse events (errors) related to administration (or failure of administration) of anti-D Ig (immunoglobulin) are also included.
New types of components regularly become available and SHOT will undertake to collect adverse events on all or any of these which are considered by the SG to be within the scope of SHOT.
SHOT does not receive reports of adverse reactions or events related to other fractionated blood products e.g. coagulation factors, albumin, IVIg etc.
Confidentiality of patients and donors is assured.
SHOT aims to work collaboratively with other bodies with responsibility for transfusion safety e.g. Medicines and Healthcare products Regulatory Agency (MHRA), the National Patient Safety Agency (NPSA), the CMO’s National Blood Transfusion Committee (NBTC) of England and its counterparts in Scotland, Wales and Northern Ireland, the 4 UK Blood Transfusion Services, the Department of Health Blood Policy Unit and the Advisory Committee on the Safety of Blood, Tissues and Organs (SaBTO).
The Competent Authority for the Blood Safety and Quality Regulations UK (2005) is the Medicines and Healthcare products Regulatory Agency (MHRA).
SHOT aims to promote international haemovigilance by collaborative working within the International Haemovigilance Network, the International Society of Blood Transfusion (via its haemovigilance working party), and the European Commission via its Competent Authorities Haemovigilance Sub Committee.
SHOT has reciprocal representation on the British Committee for Standards in Haematology (BCSH) Transfusion Task Force.
SHOT is funded by the 4 UK Blood Services via the UK Transfusion Forum.
NHSBT currently ‘hosts’ SHOT and provides resources such as office space, and services such as IT, human resources and finance support.
SHOT consists of the SHOT office team, the Steering Group (SG) and the Working Expert Group (WEG).
The Steering Group (SG) provides professional ownership and strategic direction, monitors the performance of SHOT and is accountable to the UK Forum through the Medical Director for the use of resources and management of the budget. Membership of the Steering Group will consist of nominated representatives of theRoyalCollegesand other professional bodies. The Steering Group will always include
The duration of membership of an individual member will normally be 3 years renewable for further 3 year terms subject to agreement with the body which he/she represents. Founder members and former SHOT MDs may remain on the SG for an additional 2 years or until they retire with the agreement of the Group and may then become honorary members, retaining access to the SG area of website if they wish. A chair is elected from among the members. This appointment will be held for 3 years renewable for further 3 year terms, but with flexibility to act as an ex officio chair to allow some overlap with the incoming chair. To enable the chair to focus on chair duties, the Royal College/professional body represented by the chair may be requested to nominate another representative during the chair’s term of office.
The Medical Director acts as secretary for the Steering Group.
The Steering Group meets face to face twice every year.
The Steering Group will also incorporate the Working Expert Group (WEG).
Members of the SG will bring to the meeting the views of the professional body which they represent and in turn seek endorsement from their professional body of major initiatives of the SHOT scheme. The WEG will develop some themes for each SG meeting and the SG will bring items and ideas for strategic development from their own professional bodies.
The SG will also be responsible for:
The SG may also convene working groups for specific functions as required and co-opt additional members as agreed.
SG minutes will be provided to all members of the SG and to the Department of Health for information.
A publications group will be formed, which will be a sub-group of the Steering Group. The aim of this group will be to produce academic papers, using SHOT data, for submission to peer reviewed journals. The activity and membership of this
sub-group will be reviewed on a 3 yearly basis.
The WEG incorporates the concept of an Expert Panel and all members of the WEG are an integral part of the Steering Group. In addition to Steering Group meetings the WEG will meet on at least 4 further occasions (possibly some by teleconference) without the rest of the SG. Further ad hoc and sub-group meetings may be held as required.
Minutes of WEG meetings will be sent to SG members.
The WEG membership will include the core SHOT team and other experts as appropriate, comprising at least:
It must be ensured that the expertise within the Group covers the main areas of SHOT reporting, so other members will be co-opted as required
As an NHS organisation, SHOT is obliged to apply financial guidelines from the NHS to potential claims from Steering Group members for expenses, which may be paid by SHOT:
This comprises the Medical Director, the Operations Manager, the Research Analyst, the Laboratory Incidents Specialist, the Clinical Incidents Specialist, the Transfusion Liaison Practitioner, and two Information Officers.
The day to day management of SHOT is undertaken by the Medical Director and the Operations Manager (see organogram). The SHOT office team will publish a regular newsletter.
The Medical Director of SHOT is employed by one of the UK Blood Services and is managerially accountable to the UK Forum. It is essential for SHOT to retain autonomy for professional accountability and that it is independent of the UK Blood Services. For that reason professional accountability of the Medical Director is to the Steering Group through its Chair.
The National Co-ordinator for Transfusion Transmitted Infections is employed jointly by the HPA and the NHSBT and is managerially accountable to the Consultant in Epidemiology and Health Protection at the HPA.
SHOT is affiliated to the Royal College of Pathologists.