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This webinar that was presented live on 19 July 2023 focused on the challenges, practical steps and potential solutions related to accurate and complete patient identification in children and neonates. Panellists included paediatric transfusion experts both from clinical and laboratory perspectives and members from the SHOT team. We also had valuable insights from a patient and parent about methods of patient identification, challenges and importance of accurate patient identification. Relevant resources, both from SHOT and external sources, were also signposted.
Additional resources:
Haemovigilance in Neonates and Children (Paediatric SHOT)
SHOT Bite No 4: Lessons in Paediatrics (including neonates)
This webinar was live on 11 July 2023. Members of the SHOT team along with members of the SG/WEG, the UKTLC, PBM team, a Transfusion Practitioner and patient representative covered some key aspects of positive patient identification. This included and overview from SHOT, WBIT – common themes and lessons learnt, practical steps regrading accurate patient identification and patient identification from a laboratory aspect. The presentation also highlighted the challenges of ensuring positive patient identification from a hospital and patient point of view. Relevant resources, both from SHOT and external sources, were also signposted.
Additional resources:
SHOT/ NHSBT animations for sampling and bedside check
SNBTS Safe blood sampling for Transfusion video: available via TURAS Learn
The strange case of Penny Allison
Blood Assist; available to download from Apple and Android app stores and as a web based version
CAS Alert: Safe Transfusion Practice: Use a bedside checklist
Safer temporary identification criteria for unknown or unidentified patients
This webinar was live on 09 June 2023. Members of the SHOT team along with Chris Robbie from MHRA and UKTLC colleagues covered some key aspects of incident investigations, regulatory framework, the use of human factors and ergonomics, and the importance of effective interventions. The presentation also covered a holistic approach to safety and the importance of learning from all events (excellence, day to day events) not just from when things go wrong. Relevant resources, both from SHOT and external sources, were also signposted.
Additional resources:
Optimising learning from incidents webinar collated slideset final amended
This webinar was live on 12 May 2023. Members of the SHOT team and UKTLC provide an overview of UKTLC, key highlights from the UKTLC survey results, latest standards, and resources. Additionally there is input from the MHRA perspective including the importance of UKTLC standards for inspections. The presentation also includes where to find additional transfusion related resources.
This webinar was live on 06 December 2022. SHOT Working Expert Group members and representatives from the 4 UK Blood Services provide an overview of Patient Blood Management (PBM) activities & share key learning points. The presentation also includes some illustrative cases, and a Q&A.
Alternative Video Format:
Transfusing Wisely Webinar 2022 (Vimeo)
This webinar was live on 04 May 2022. SHOT pulmonary working expert group members provide an overview of the TACO cases submitted to SHOT, cover key learning points and recommendations for safer patient care. The presentation also includes some illustrative cases, and a Q&A.
Alternative Video Format:
TACO Webinar 2022 (Vimeo)
Additional Resources:
This Webinar was live on Tuesday 15 February 2022. The National Comparative Audit (NCA) of Blood Transfusion is the largest programme of clinical audits of blood transfusion in the world and is funded by NHS Blood and Transplant in England. The NCA team present the findings from 3 National Comparative Audits and the SHOT team provide insights from haemovigilance reporting:
• 2018 audit of the use of fresh frozen plasma, cryoprecipitate and transfusions for bleeding in neonates and older children – Dr Helen New
• 2019 Re-audit of the medical use of red cells – Dr Andrew Charlton
• 2021 audit of NICE Quality Standard 138 – Professor Mike Murphy and John Grant-Casey
Alternative Video Format:
National Comparitive Audit (Vimeo)
Additional resouces:
National Comparitive Audit website
This webinar on 3rd December 2021 was a joint SHOT, BBTS and NBTC webinar covering the effect of cumulative delays in provision of blood in cases of major bleeding. This includes working through an illustrative case to highlight key learning points for clinical and laboratory teams.
Alternative video format:
Every Minute Counts (Vimeo)
Additional Resources:
SHOT Bite No. 8: Massive Haemorrhage Delays
Delayed Transfusions in Major Haemorrhage – video
SHOT CPD form:
SHOT Webinar CPD form – Every Minute Counts December 2021
This webinar on 19th October 2021 covered the principles of safe transfusion in HSCT patients, including learning from adverse event and near miss reporting to SHOT. There are also some illustrative case studies to highlight key learning points, which are:
Alternative video format:
Transfusion in Haemopoietic Stem Cell Transplant Patients (Vimeo)
Additional resources:
SHOT Bite No. 18 – Transfusion errors in haemopoietic stem cell transplant patients
Safe transfusions in haemopoietic stem cell transplant recipients
Transfusion errors in haemopoietic stem cell transplant recipients – video
This webinar, which was live on Wednesday 19 May 2021, was organised jointly by SHOT and the MHRA. It covered the importance of learning from Near Miss events and the principles of Incident Investigation. It includes a 50 minute presentation by experts from SHOT and the MHRA covering Near Miss events and Investigating Incidents, including highlights from previous SHOT reports, as well as a 10 minute Q&A.
Alternative video format:
Near Miss Events and Incident Investigation Webinar 2021 (Vimeo)
Additional resources:
SHOT Bite No.1(a) – Investigating Incidents: a systems based approach
SHOT Bite No.1(b) – Investigating Incidents: effective interventions
Near Miss definition updated in February 2021
Near Miss chapter from the 2019 Annual SHOT Report
Understanding Human Factors in Transfusion Parts 1 & 2
This webinar was live on Friday 12 March 2021, and covered the Haemolytic Transfusion Reactions (HTR) chapter of the Annual SHOT Report 2019 with a look at hyperhaemolysis cases and patients with haemoglobinopathies. It includes a 40 minute presentation by the SHOT Team and the SHOT HTR Working Experts Dr Anicee Danaee, Dr Tracey Tomlinson and Dr Joseph Sharif and is followed by short a Q&A session. *Important note – 1) the slide at (5:17) mistakenly says ‘Caution when using O D-negative red cells for transfusion in O D-negative individuals’. It SHOULD read ‘Caution when using O D-positive red cells for transfusion in O D-negative individuals’.
Alternative video format:
Additional resources:
Finally, you may find it interesting to listen to our 8min SHOTcast on the role of the scientist in haemovigilance.
This webinar, which was live on Thursday 28th January 2021, covered the Avoidable, Delayed or Under/Overtransfusion (ADU) chapter of the Annual SHOT Report 2019. The webinar included a 40 minute presentation delivered by the SHOT Team and Dr Paula Bolton-Maggs (SHOT Working Expert on ADU) which was then followed by short a Q&A session.
This webinar, which was live on Wednesday 2nd December 2020, covered the Febrile, Allergic and Hypotensive Reactions (FAHR) chapter of the Annual SHOT Report 2019 along with a 7-year trend analysis. The webinar includes a 40-minute presentation delivered by the SHOT Team and the SHOT FAHR Working Expert Group (Dr Janet Birchall, Medical Director of the Welsh Blood Service, Dr Jayne Peters and Dr Catherine Booth, both Consultant Haematologists at NHSBT) and is followed by short a Q&A session.
This webinar, which was live on Thursday 5th November 2020, covered the Human Factors (HF) chapter of the Annual SHOT Report 2019, as well as wider issues in applying HF to developing a safety culture. The webinar included a 40 minute presentation delivered by the SHOT Team and Dr Alison Watt (SHOT Working Expert on Human Factors) which was then followed by short a Q&A session.
Human Factors Webinar 2020 (Vimeo)
This webinar, which was live on Wednesday 14th October 2020, covered transfusion-transmitted infections included in the 2019 Annual SHOT Report. The webinar included a 40 minute presentation delivered by Dr Su Brailsford (NHSBT/PHE Epidemiology Unit Lead) and Dr Heli Harvala Simmonds (NHSBT/PHE Epidemiology Unit) which was then followed by short a Q&A session.
Transfusion-Transmitted Infections Webinar – Vimeo
This webinar, which was live on Friday 11th September 2020, covered laboratory and information technology errors included in the 2019 Annual SHOT Report. The webinar included a 40 minute presentation delivered by Dr Shruthi Narayan (SHOT Medical Director) and Dr Megan Rowley (Clinical lead for SNBTS Transfusion Team and an author of SHOT IT chapters) which was then followed by short a Q&A session.
The 2019 Annual SHOT Report was published on Tuesday 7th July 2020, and launched by way of a webinar rather than the usual face to face Symposium.
The webinar comprises a 40 minute presentation by Dr Shruthi Narayan, SHOT Medical Director, which covers the highlights from the Annual Report, followed by a Q&A session.
Live illustrations were carried out by an artist, Jenny Leonard.
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