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Blood Bank Chronicles

Blood Bank Chronicles

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26 views8 pages

Blood Bank Chronicles

Blood Bank Chronicles

Uploaded by

ambitiousamit1
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Or) ame eae Cur x ‘Blood bank accrediation ~ tool for quality improvement ‘inspection to eeticetanstision related reaction Events on quality management Preventing Blood Transtusion Errors ‘through Process Excellence Fecueing Chances OF O/oss (Contamination During The Blood Component issue Process Managing Donor Retention After Adverse events Mode! Bio0d Bank BIGUAIAMIAeereditation - A tool for quality improvement ‘Accreditation is a process in which certiication of competency, authority, or credbiltys presented. \With increase in population and development of more advanced medical and surgical procedures, the need for blood is ever increasing. There is no substitute for blood andits safety cannot be Underscored or underemphasized. Blood banking is integral part cot health care requires uniform standards to deliver quality blood and products ‘Quality is the ongoing process of building and sustaining relationships by assessing, anticipating, anc futling stated and implied needs: ‘Accreditation provides a format to ensure work flow processes and reproducibility of results and hence improve qualty. This is also ensured by participating in the External quality assurance programs where theresuls are compared with other testing labs. Blood Bank Accreditation program being used a tool for quality improvement wil promote the highest standards of cre for both patents anc denors in all aspects of blood banking andtransfusion medicine. Pet hitp:uma.qcin.org/nbqpiqualiyinda/Vol-$-Nog/bloadBank. php pfu. qualtyaigest com/htmlqualtycet html - Special Coverage | blood transhsion is a special kind of transplantation andlor meal theepeute Intention tat cares wah # grat Donets and sks 1o the feopient I inwches the rsfor of hing tssuo om one person to nother and hus a ecpient ofa ranctsion Tay experence an adverse reacton to the rodvet dung or aerthevanstsion. Bacterial contamination occurs in approximately 112.3000 patelet concetrates (Pcs) and may Induce ‘sepsis. In ‘approximately one in six recipients ofthe contaminated product." ‘Mirada eartamaton accounted forthe this mast commen caure of lrancusion associated fatalities reported to the US Food and Org ‘cmistaon between 2008 and 2008." ‘Adverse reactions occur n 1 to 6 percent of al blond vanstusions and aro ‘more froquont (10 porcen) in patents with hematologic and encologic ‘eordere Keeping the above in in ki mperaive to ensure tal blood ‘ranauson rests inthe ltmate benetothe repent whi reducing the bt deupam canes Need of SOP's for Pre-Release Visual Inspection to Reduce Transfu n Related Reactions tiskol adverse anstison reaction \Veualinapacton lore isuance ofthe blood component isthe est sep, ‘whlch would contibute in mirimizng vanetsion related reacions. THs Can be acheved a Standard Operating Procedure (SOP) i formals andimplemonted The folowing point shouldbe bome in mind in effecting the saest pre release ieunlaapecton process 1. Vieibity: Inspection of the Hood products should take place in a wlkitare. 2 Memolyss: Te degree ot Hemoyis shouldbe ascertained keepingtne Pemstiiekeisinmd {Red Cell Contamination relevant platelets plsma Beryoprociptate 44 Bacterial Contamination: Some of the atiibutes of bacteal contamination ae a ubbies, dk purple to tek coloration red ols cots & fon ctandsete 5. Pantoulate mator: Vibe the form o large to smal colored masses ‘hatdonot sips wih gents anipulsten ‘Accepable lous of emoyss a8 NA | Sonegegnecttenctes ‘contamination Hemotyis ‘come at ony spose AASB commends Red eo wa AASB racomrnende so cormaine | Yet stander of coepabity ontamintion| Cea eon Es cma desea pera a ens wh pena SSSR Wei. teers ood componoTs wih Dona af acepibi fo wanton. acter ‘Blood Components are not acceptable for tansusion ~ Blood components contaning cats / bn sands should not be ranshises + Blood components conning ela’ aggregates should not be vanstaed Pariulate * Vine Parteuate Maer (WPM), Blood components contsing WPM are ceptable fr tanstuBen. mater WEN may isspate wth a change n temperature ‘ee Herolyss, Linea, bacterial | + Discoloration ato eters (ew), | + Oisenloraton due 1 ietens contamination ‘fal contraceptives (Green iain’ | (yelow, ofl contraceptives Discoloration ‘erlarge quatites of carols (Green, vlamin or lroe (orange) areal! accaptanl or traneusion quanies of sare (orange) 20 al accopiabl for wanstusion, Ife above is adhered io, complications Ike Tanstusion related Hemolyeis ftl sepc reactions due to baci contarinaton may be minimized. “Relerences are not pete ce to space consi, ordeals plese contact he author on Emal lt: chasba.cr@gmal.com 24th Regional Congress (ISBT) 1 Became 2013, Koda rur Mela 2012 World Stem Goll Summit “rsh Dee 2012, Farin USA ‘ot Annual SCT Moti Ee crt ibe ‘own ive —— Process Excellence Preventing Blood Transfusion Errors through Process Excellence Introduction: ‘Awell defined blood transfusion service with excellent processes benefts the patient who avails ofthe service as well {as the overall organization. Many serious rsks of blood transfusion have been identiied which includes. near miss events that can result in patent adverse outcomes SHOT UK 2011 reports that annually near miss events comprise of 1rd of the total and include wrong blood in tube (WBIT) and patient Identiication errors. In fact, half of the adverse events were preventable errors Established Organizational Processes to prevent Errors: 1. Standardized transfusion order forms ‘The use ofa pre-printed, controlled blood request form should be used to monitor and encourage ctnically appropriate transfusions. ‘Common practices observed today are incomplete request forms, land forms forwarded by Nurses on verbal orders of clinicians. It remains the responsibilty of the clinicians to forward the blood requests a the practice of accepting incomplete, inaccurate and legible requests could lead to potential legal implications. To encourage compliance the Blood Bank should not release blood products untithe deficiency ismet 2. Uniform Blood Sample collection process ‘2. Use two separate identiiers for patient identification eg: Full Name and registration number '. Collec from only one patient at atime This reduces the isk ot Patient identification error and wrong blood in tube (WBIT), a ‘major cause of ABO incompatible transfusions Label the sample at the Patient bedside The practice of {generating labels atthe nursing stations after leaving the patient room, could lead to labeling errors when mutiple ‘amples ae collected. Sample collection should involve only ‘one patient at atime, abeled a patent bed side, after patient dentiicaion processiscomplete 3. Rejection of incorrectly labelled samples ‘Samples for type and cross match that reach the blood bank with {an incorrect label or which do not correspond with blood request form must be rejected and subjected to root cause analysis as a potentalnearmiss event 4. Blood group confirmatory check I the patient was groupedireceived transfusion previously, a Fistoric blood group confirmation is performed trom previous records. I previously not grouped, a second sample is requested for testing priorto release ofblooc unt. A bedeice group check ust prior to star of ransfusion should be established asthe final check toprevent ABO mismatch transfusions 5. Pre-ransfusion checklist Repeat emphasis on theneed forthe correctblood unitto reach the ‘correct patient is vial to reduce risk of incompatible reactions, ‘Good processes involve the use ofa pre-ranstusion checklist al the bedside to ensure a final check betore stat of transtusion, ‘performed by two separate individuals. the processisinterrupted, the fnal check using the checklist is repeated trom the beginning. Bloos safety is enhanced when the 8 rights of transfusion acminstation are applies for every unit: Right product, Right patient, Right dose, Fight Time, Right reason, Right site, Right documentation and Fightresponse Rights of Transfusion 6. Incidentreporting of Near miss events Incident reporting provides opportunity for process improvement by investigation and staff education withthe ultimate aim that the ‘event should not repeat itself. This involves documenting the incident and reporting tothe hospital quality committee to ensure preventive actions/processes are implemented to correct the system that allowed the error to occur 7, Transfusion audits “Transfusion verication audits can be conductedin allcinical areas that provide transfusions to help ensure independent double ‘checks on the process. A hospital Transtusion Nurse/ Oicer can ‘be appointed to work with the blood bank management and ‘suppor clinicians inthe safe and effective use of blood. Their ole includes active promotion of good transfusion practice by facitaing vanstusion auait, feedback, incident reporting, folow up of errorsinear miss, encourage education and training and {acitae implementation of new technologies that enhance patent safely Conclusion: ‘Subjecting all errorsinear miss events to appropriate review, Investigation, and root cause analysis isan essential element for Improving tanstusion safety. With continuous training and ‘management support, the blood transfusion practice has the ‘potential to improve practices in the safe administration of Bi003, Prevention of transfusion errors is the need of the hour and through established processes this goalis now not beyond our reach “Relorences arnt rind dueto apace canst frdelalplease contactthe ‘uor on ma ear abbas 1657 : Sir Christopher Wren first injected some fluids into the circulation of animals Process Excellence Reducing Chances Of Cross Contamination During The Blood Component Issue Process ‘The primary function of @ blood transtusion seni is to provide an ‘effective component of optimum ‘quality to the patent while ensuring the safety ofthe donor. In order to ‘achieve this goal the blood bank personnel must be vigilant at every step ofthe process so that qualty is ‘maintained romeinto ven eee Contamination of a blood component may occur at any of the stages from the colection process, component preparation, and storage to the issue process. This article focuses on the risk of ‘105s: contamination during theissue process. ‘The issue process involves the following steps 1 Evaluation oftnerequistion form 2.Planning and revival ofthe components requested 3.Completing the serological testing ( as per blood bank ‘uietines) 4.Final processing the components “+ Thawing Fresh Frozen PlasmalGryoprecipitate + Pooling of Components ‘Lab SideLeucodepletion 6.Completion of cocumentation and nal issue ‘The final processing of components is the stage at which Contamination of the blood components is likely. Water baths) thawers used for thawing plasma are a source of bacterial cross Contamination of plasma. The most commonly found organisms are Pseudomonas cepacia and Pseudomonas aeruginosa. (1.2)* ‘The cause ofthis contamination s that blood bags often have leaky ‘seals, camaged tubing or micro-punctures which have been linked to bacterial contamination.(3} The water inthe thawer provide a ‘medium forthe transfer of bacterial contaminants from one bag to another and the plasma leaked from a blood bag provides a ‘medium for bacterial growth. Over-wrapping of plasma bags reduces the risk of contamination provided the right types of plastic ‘over wraps are usedin he corect manner. ‘The use of simple plastic bags or repeated use ofthe same over \wrap is not advocated asitis ineffective. n spite ofthe reduced risk (of bacterial cross contamination there is a residual risk of micro tears and leakage in the plastic over-wraps. The proper cleaning {and disinfection ofthe thawing baths along with sending samples & Transfusion Medicine Chronicles 1666 : Richard Lower performs the first successful transfusion, ‘ofthe water from bath for culture at regular intervals is roquirod to prevent bacterial contamination of plasma. An SOP (Standard ‘Operating Procedure) regarding use of the plasma thawed is imperative to this end. There have been repeated efforts 10 ‘overcome the inherent disadvantages of wet plasma thawers. He “The use of microwaves to thaw plasma has also been tied but there use declined due to reports of overheating and generation of hotspois.[4;5]* There have been efforts torevivethis method thas not caught on due the inherent disadvantage of the short microwaves (p00r penetration and preferential absorption by the liquid phase of plasma).[6.7]" Racio frequency (RF) heating of fresh frozen plasma has also been tried as an altemative to microwave thawing and shown some promise.7]* A plasma thawer using heated air is being marketed by a German manufacturer but there are no studies in pub med on its efficacy (7)* Recently Plasma thawers withthe water and plasma segregated by the use of plastic bladders filed with heated water streamed through them have been introduced into the market and may provide a safer way to thaw plasma. There efficacy, saety profile ‘and exgonomics needs to be studied before using them becomes standard practic. Pooling and making aliquots of components are also procedures ‘raught with the risks of contamination and should be dane in a sterile environment using a sterile connecting device. fan open ‘system is used the platelet component must be issued for use within 4 hrs and RBCs within 24 hrs (Canadian Blood Services Guidelines from the website). There Is also a risk of one of the Platelets components being contaminated with bacteria, Efforts are being made to develop a quick and reliable system to test for bacterial contamination prior toissue, (8, 9,10]* Hiab side leucodeplation is done using an open system, it should be done ina clean environment using all aseptic precautions and the components must be issued within ahs or platelets and within ‘2th for red cals. the intervening time the components should be stored at optimally (Blood bank retigerator at 4°C for red cells ‘andina plateletincubator cum agitator at 22-C fr platelets) Blood safety is a prictity issue for transfusion specialists. Bacterial ‘contamination is an important complication and an impediment to safe blood supply. An effective quality management plan and ‘tit adherence to guidelines and SOPs is required to prevent bacteria contamination of bioos components ‘fearences era notaries auetossac constant dea pleaeconactthe ‘utoron Ena es meensbaipsicnomai.eom albeit on an animal Donor safety is of paramount importance {uring blood donation ane is assured. nso far as can be, by donor selection ‘uidoines, SOPs, acoquataly tained stat and appropiate facies. Despite these ‘measures, varous acverse events and ‘eaters ean and do occu dung ane ater Diood donation. These complications can be a negative experience for. donors Preventing them musta riety, [Complications rested to blood donation ‘ocur in about 1% of all whole blood oration procedures 2. i wel recognized that contain categories of donors have higher reactionratas 3. Deseription and classification: Adverse events and reactions can ‘manesnemsetvesin sevora ways. The Working Group on Completions Related to Blocd Donation, a joint working group ofthe Iterational ‘Society of Blood Transfusion an the European Haemovigance Network was esabished fr thispurpose. They classy complcationsinttwo main Categenes: those wih predominantly local symptoms anc those seth predominantly generazedsymptons ‘Complications mainly with neal symptoms. These complications are rectly caused themsertoncl he nonce. (s) Complications mainly characterized by the occurrence of loodouicethevessls + Hematoma, Arter puncture, Delayedbeeding (&) Compeatons mainly character by pin, + Nerveertation Nowe injury, Fendoninry, Panta rm (©) Otrerkindsotestegores wath oa! symptoms + Theombophiebitis, ley ea ‘8: Complications main with generalized symptoms. + Vasovagalreacton: + Complicatons elated io aphacesis: + Cirate reacion, Hemelyss, Generatzed allergic reacton, Air emboism Provention strategies Several sategies can be used to reduce the risk of complications occurring dringardaterbiood donation Preventionottype A) complications [Needle techniques: Good neecie inserion techriques reduce the ‘requancy and seventy Type A complications Jorgensen and Sorensen ietheotowing advice on needeinseron techniques’. + Alsaysmovethenescleforwardinasiow ongoing movement + Tbe noodles not inserted inthe vein at ho fret stom is rot asable to do a second ty by moving tho neeco @ Ite Bit backwards, change crocion anc tren move foward agalninanew recon, az te wil ineease the rik of inure and occurence of haomatoma,andthereby hock asevere complication. + Nove ty to inset the needle twice, using the same puncture ste. Instoad ty the thorar, + Nove ask fr or va hep inserton was not a succes, as hs wll, aways incudeatryinanew drecion. Prevention otype (8) complications Type 8 compteations, characterized pradominanty as generaizod ‘symptoms such as vasovagal reactions, require diferent precautionary ‘measures. Jorgenson and Soreneon idently the folowng generally _aecoptod but nt evidence-based pracicos™ + Gontie treatment of the donor, provcing rorostmants before andaterdonatontoredieethe rst vasovagsreactons. ‘+ Observing the donor during and after donation, treating the donor a ompleaton ooo and making sure the donor {eal absolitely wellbore leaving thebiood session, “+ Gwung ack fo the donor an secendary bleeding, cn, rest ‘and retum to work aer the donation. Aeking the donor to Contacthebiood onertsymatomsrbocevt + Applying pressure to tne venepuncture sie and it necessary a pressure bancage fa naomaioma s dowiopig, “Tne preventon techniques ortyp 8 complcatons sted below have been suggestedincovera studios. ‘+ Musele tension: whon a donor makes ropeated and ehyihmic Contractions. wih the major muscle groups in his arms and logs, the blood fw to the brain can be inroased in order preventsinting + Distracting the donor during the bleeding procedure. Watchingamoviecould reduce sressinadoncr + Water or caffeine loading. Several studies have reported fewer complications when donors dink water or cofles before thelr donation "= Management ‘Adequate management of complications during biood sessions several goal Fs, tis esantalfrthe heath and walbsingof donors Second, proper management of complications helps 10 abeate the negative fects complications mayhaveon dover motvaton andon donot ‘elu rales. Employees must be prepared and equipped to hance the ‘most requent completions. Protocls, training, ist aid equipment and nar counseling are imperave. Some donors who have had severe ‘complications maybe advsedincttedenate again, + Stafftraining + Managing emergencies * Donor counseling: ls an essential element of good donor care that each donor who suffers @ complication of donation Degivenspecticadviceabautthecomplicaton. + Donor advice: Donors should be advised on measures they should take topreventine complication from geting worse Donor fllow-up: This snot ony an essential element cf good danor care, bulls basic good customer relalonships” As the compicaion may have @ negative seston acdonorsmolvationtomake& subsequent donation The Toow.up ofthe donor and the provision of adequate infomation play 29, impotantolein encouraging the donor tocontnueto dona Eftecton donor motivation-next donation ‘Aogatve experience during 100d donation can havea negative tect on donor motkation. Several suces have shown that experiencing & ‘ompleaton during te bleeding procedure isan important factor that reves donors am making asubsequentconaton 1,14. France tal 15 found mater ign vasovagaleactiosin hoi bioo¢ donors ne tknood atreturing for ane donation reduced by 20% ost tne donors ard by ‘33% for expotencod donors, For moderate and sovere vasovagél ‘complications retumrates reduced by 50%. Gorin and Petereenfoundthat the more severe a compilation, the lower the rotun rato 16. Adequate hanging ofa complication therefore, serves multiple goals: ensuring the donors heath andretainingte dor ora subsequent donation hlerences ere not printed se tospace consti. for dean plese conet he sure on Era vormssh1803

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