Blood management systems and policies for hospitals

A quality conscious hospital comprehends the need for an efficient blood transfusion service and strives to support, maintain and strengthen it within the boundaries of its health facility. Unlike most services within a hospital, the blood transfusion service is governed by stringent guidelines and policies, is licensed by the local regulatory body and functions in accordance with current national or international standards. The blood management system aims to ensure donor and patient satisfaction and promote blood safety, through outcomes that are consistent, traceable and effective.

A blood transfusion service is incomplete without a well defined quality management system (QMS) that ensures implementation and effectiveness of essential policies and best practices. The blood bank QMS improves current practices with planning, periodic review and monitoring for continuous improvement

Code of Ethics

They play a critical role in the blood transfusion service. Blood banks should bypass unethical practices and substandard testing or processing techniques that ultimately compromise blood safety. It is the responsibility of the blood bank management to define, document and ensure compliance to the code of ethics. Every effort must be taken to provide safe blood from 100 per cent voluntary, low risk, non-remunerated donors and pursue effective testing and processing strategies in accordance with National Blood Policy. Regular training of staff is essential to identify and prevent professional donors from jeopardising the national blood supply.

Confidentiality

To safeguard donor and patient identity and secure confidential records, access to blood bank documentation system is restricted to authorised personnel. Every hospital transfusion service is encouraged to establish a Confidentiality policy which is considered to be the foundation of all blood bank processes. Newly recruited staff is encouraged to read, understand and implement the confidentiality policy on a day to day basis.

Counselling and informed consent

This has become an extremely vital part of a hospital-based blood service. Every donor and recipient has the right to be informed in an understandable language, about the advantages and risks associated with blood donation or transfusion and allowed to make an informed decision regarding the same. Information is disseminated through pamphlets, emails, posters, counselling sessions, awareness talks during blood donation camps and World Blood Donor Day programmes. In addition, a deferred donor or donors found reactive for transfusion transmitted infections, is provided referral and follow up services. Eligible donors are encouraged to register with Voluntary Blood and Apheresis programmes. Identity of donors and recipients are kept anonymous and related or directed donations are avoided, as the negative impact far outweighs the positive.

Process control

Provision of safe blood and components requires appropriate infrastructure and an adequate and reliable supply of kits and reagents. Standard operating procedures, work instructions, periodic staff training and professional development are prerequisites to ensure smooth workflow. The use of reliable, specialised and calibrated equipment for blood collection, storage, transport, testing and processing provides the assurance of quality, safety and efficacy. Fully automated analyzers for testing have minimised technical errors, reduced turnaround time and infectious disease window period, thus bringing the transfusion services one step closer to providing near zero-risk blood. Continuous 24-hour wireless temperature monitors are recommended to monitor temperature and maintain viability of blood and components during storage and transport. Apheresis machines have provided the alternative to prepare the component of choice in a safe and reliable manner. Quality assurance indicators monitor blood utilisation rates and provide opportunity to reduce transfusion adverse reactions, control wastage, reduce turnaround time from receipt of blood order to bedside transfusion and help predict the overall performance of the hospital blood bank services.

Policy for procurement and utilisation of blood

In the event of an emergency, massive blood loss or natural or man-made disasters, the blood centre shall have a well documented protocol for procurement of blood and blood components. Monitoring the blood stock on a daily basis can avert stock-out situations. A Maximum Surgical Blood Order Schedule (MSBOS) formulated by hospital transfusion committee is made available to all clinicians to encourage appropriate and judicial use of blood. Exchange of blood between FDA-approved blood banks in the city, can help meet emergency situations and prevent wastage and expiry. Blood banks can efficiently reduce turnaround time for procurement of blood by immediate access to online blood bank stock inventory available under State Blood Transfusion Centre (SBTC) website.

Efficient communication system

An effective internal communication system is essential for safe, appropriate and timely provision of blood. A clear and effective mechanism is identified for inter-staff communication and dissemination of information throughout the hospital. Feedback forms from patients, clinicians, camp organisers and donors provide the opportunity for improvement of services. Use of inter-departmental circulars and email facility is encouraged to enable exchange of relevant information or advancements in the field, indicate process changes or convey decisions taken by the hospital transfusion committee

Policy for crisis management

It is necessary to identify and define crisis situations that may arise in a transfusion service that require immediate action and review. It is recommended to include a policy for prevention and management of critical situations, such as equipment breakdown, fire, power failure, floods and other sentinel events into the standard operating procedures. Coordination between concerned hospital departments is essential to ensure backup of standby equipments, generator or UPS supply. Staff training exercise includes mock drills and periodic assessment to provide assurance of unhindered blood services at all times. Mandatory user training on technical and safety standards, maintenance and calibration of equipment installed, adds to the confidence of end user during emergencies

Documentation and reporting

Blood Bank Records is retained manually, electronically or as a combination of both for the specified period as per legal requirements. A well-organised documentation system enables traceability of a blood unit from collection to final disposal in a timely manner.

As a part of quality improvement process, process deviations, near miss incidents, complaints and incidents are reported, documented and discussed in management quality review meetings. Corrective and preventive action discussed is initiated and implemented at the earliest. Where change of process is evident, the concerned departments and clinicians are informed for immediate compliance

Infection control policy

Blood bank personnel are at a constant risk of acquiring infection or needle stick injuries. Staff members are trained to strictly adhere to hospital infection control policy and report incidents of needle stick injuries or splashes. The immunisation policy for hospital employees will be applicable to the blood bank staff as well. Personnel are encouraged to practice universal precautions in the laboratory, during blood collection, testing and processing. Waste disposal, handling blood spills and disinfection policy of blood bank remains common to that of hospital. However, the hospital infection control nurse and blood bank management share responsibility of conducting regular training and surprise audits to verify compliance to infection control practices.

Conclusion

Consistent quality and safety in the provision, prescription and administration of blood and blood components can only be achieved through inter-departmental coordination and cooperation. Be it the Blood Bank Management who supervise and take active decisions on a day to day basis, or qualified staff who perform the individual tasks; every hospital requires committed, dedicated, quality conscious and trained personnel to ensure uniform standards at all levels.