2015 Survey of Patient Blood Management (PBM)

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1 2015 Survey of Patient Blood Management (PBM) This is the second national Patient Blood Management (PBM) survey. In 2013 you were invited to participate in the first PBM survey which provided valuable information to define the Patient Blood Management framework which was launched by the National Blood Transfusion Committee (NBTC), NHS Blood and Transplant (NHSBT) and NHS England in The aim of this survey is to: Provide information on implementation of PBM in NHS Trusts in England Compare PBM activity with the previous PBM survey performed in 2013 Provide data for Trusts to encourage implementation of PBM and to support business planning Provide data to NBTC and NHSBT to support the PBM strategy and future service development.

2 The questions in this survey are Trust wide, and we therefore recommend your Transfusion Practitioner, Transfusion Laboratory Manager, Consultant Haematologist with responsibility for blood transfusion and Hospital Transfusion Committee Chair are involved in collating the information. However it is important that only one individual submits information on behalf of your Trust via the online survey tool. TOP TIPs for completing the survey: Print the pdf document accompanying this survey Meet with your Hospital Transfusion Team and decide how to collect the information required and who will be responsible for collating information for the sections Compile a draft document and complete all sections Assign one member of the team to complete the online survey You will be able to save information as you complete the sections- but once you have clicked the submit button at the end of the survey you will not be able to submit further information.

3 SECTION 1: Your Hospital Transfusion Team and your Hospital Transfusion Committee Q1 How many hospitals are part of your NHS Trust? Q2 Transfusion Governance: Who does your Hospital Transfusion Committee (HTC) report to? Patient safety committee... Clinical governance committee... Trust Board... Other Q3 Do you have Transfusion Practitioner(s) employed at you Trust? Yes (include any vacant posts)... Q4 Please provide the following details for every Transfusion Practitioner (TP) Whole Time TP1 TP2 TP3 TP4 TP5 TP6 Part Time If part time, what is the Whole Time Equivalent (WTE, %)? What % of each TP's whose role is spent on the following areas:

4 Q6 Education TP1 TP2 TP3 TP4 TP5 TP6 Traceability Competency Assessment Audit

5 Incident Investigation Appropriate Use Other Q13 Do you have a Consultant Haematologist assigned to transfusion medicine in your Trust? Q14 If YES to previous question, how many Programme Activities (PAs) are designated to transfusion? Q15 Does your transfusion laboratory have any allocated time for PBM? If "Yes" what is this as a percentage (%)

6 Q16 Does the HTT (Hospital Transfusion Team) have any of the following staff supporting it and if so, how many WTEs (Whole Time Equivalents) does it have? Transfusion team administrator Transfusion data analyst Blood transfusion quality manager Pathology/blood transfusion IT support Central trust IT support (or external IT support) Other staff Yes No No of WTEs Q18 Please list the job titles of any "other" staff indicated in Q17 Q19 Do you have any plans to introduce or expand the following posts in the next 2 years? Transfusion team administrator Transfusion data analyst Blood transfusion quality manager Pathology/blood transfusion IT support Central trust IT support (or external IT support) Other staff Yes No Q20 If "Yes" number of of WTEs

7 Q21 Please list the job titles of any "other" staff indicated in Q20 Q22 Do you have any plans to reduce or lose the following posts in the next 2 years? Transfusion team administrator Transfusion data analyst Blood transfusion quality manager Pathology/blood transfusion IT support Central trust IT support (or external IT support) Other staff Please list "other" Yes No Q23 If "Yes", number of of WTEs Q24 Does the HTC include PBM initiatives on its standard agenda or is there a separate PBM working group? Covered by HTC agenda... Separate PBM WG/Committee...

8 SECTION 2: Transfusion Education Do not include competency assessments - we would like the information on education only Q25 Which staff groups receive transfusion education? Yes No Foundation doctors (F1/F2) Core trainees (ST1/ST2) Speciality Trainees (ST3 and above) Consultants Staff grade doctors (non-training grade) Nurses Midwives Phlebotomists Porters ODPs Others Others, please specify Estimation of % receiving transfusion education (if "not known", put "NK") Q27 Please those staff groups where transfusion education includes... Transfusion triggers and targets Indications for transfusion Risk and benefits of transfusion Alternatives to transfusion Consent for transfusion Doctors F1/F2 Doctors ST1 and above Consultants and staff grades Nurses Midwives

9 SECTION 3: Information Technology (IT) Systems Laboratory Information Systems Q28 Who is the supplier of the laboratory information system(s) (select all that apply) Apex Yes Cerner (Pathnet) Cerner (Millenium EDS Healthcare - SwiftLab IPS Fordman Computer Systems (LabNet) GE Healthcare IBGS Bank Manager In House (home built) System Integrated Software Solutions Labcentre Meditech Molis Sanguin (BTDS) SunQuest Technidata Telepath WinPath WinPath Enterprise

10 Version Number? Q30 Are there any plans to change, if so, when? Q31 Do you use electronic order comms for component requests for transfusion? Q32 How do you record clinical diagnosis within the laboratory information system? Free text... Menu driven (e.g. obstetrics - >PPH)... Coded list of extensive diagnosis (e.g. ICD codes)... Do not record clinical diagnosis... Other... Please describe "other" Q33 Is the recording of clinical diagnosis a mandatory field?

11 Q34 Are there national or local indication codes for transfusion incorporated into your laboratory information system(s) to support the transfusion request? Q35 If "Yes" to previous question, can this be bypassed? If "Yes", what is the process for authorising the transfusion? Q36 Is the date of transfusion recorded within the laboratory information system? Q37 Is the time of transfusion recorded within the laboratory information system?

12 SECTION 4: Providing Information on Blood Usage Q38 Do you use your laboratory information system to provide reports for where and why blood is being used, e.g. to inform clinical users on a regular basis? Yes, we use our laboratory information system... Yes, we use an alternative method to extract and report data... No, we do not provide reports... Q39 If you use an alternative method to extract data, please describe how you do this? Q40 If you provide reports on component usage to specific clinicians and clinical teams, please indicate to whom and how often you provide these reports Q41 Do you cross charge blood components to clinical specialties? Q42 Who is responsible for producing these blood usage reports (tick all that apply)? Transfusion Practitioner... Transfusion Laboratory Manager... Data Analyst... Other Q43 Do you use information on blood use and wastage supplied by the NHSBT PBM team and/or Blood Stocks Management Scheme to support practice? Q44 Do you undertake internal audits of blood component use against your local policies? (do NOT include NCA audits)? Q45 If you do undertake audits, how frequently do you do these? Weekly... Monthly... Quarterly... Annually... Other... Other, please specify

13 Q46 If you undertook audits of blood component use (not NCA audits) what were the subjects of the last three local audits? Audit 1 Audit 2 Audit 3

14 SECTION 5: Patient Blood Management Initiatives Please tell us which of the following patient blood management measures have already been implemented at your Trust For each speciality in the table below, please the appropriate column that applies Q47 A patient information leaflet is made available to patients who might need transfusion for... All More Than Half Less Than Half None Medical patients General surgery Orthopaedic Surgery Neonatal/Paediatric Obstetric Emergency admissions Other groups Other groups (describe) Risk, benefits and alternatives are discussed with all patients who might need transfusion All More Than Half Less Than Half None Medical Patients General surgery Orthopaedic Surgery Neonatal/Paediatric Obstetric Emergency admissions Other groups Other groups (describe) Documentation of the discussion and evidence of consent is found in the notes of all patients who might need transfusion All More Than Half Less Than Half None Medical patients General surgery Orthopaedic surgery Neonatal/Paediatric Obstetric Emergency admissions Other groups Other groups (describe) Q50 Does your policy in obtaining consent for transfusion in patients requiring surgery cover... Any of those patients who might need a transfusion Only those patients who are likely to need a transfusion All surgical patients Yes No

15 Identification and Management of Anaemia Q51 Does your Trust have a policy to identify and correct the underlying cause of anaemia before considering transfusion? Q52 If "Yes" to previous question, in which specialties is it used? Medicine... Elective general surgery... Elective orthopaedic surgery... Paediatrics... Obstetrics... Elderly care... Emergency admissions... Other... Other, please state Q53 Is your Trust able to offer iron therapy as an alternative to transfusion for patients? Yes Oral iron IV iron No Q54 If yes (i.v. iron) in which specialties is it used? Medicine... Elective general Surgery... Elective orthopaedic surgery... Paediatrics... Elderly care... Emergency admissions... Obstetrics... Other... Other, please state Q55 Is there an initiative in your Trust to minimise the frequency of blood sampling? Q56 If "Yes" does this apply to all patients? All patients... Specific specialties... Specific specialties, please list

16 Identification and Management of Bleeding Patients Q57 Has the Trust developed and implemented a protocol for the management of abnormal haemostasis that covers.. Reversal of warfarin Management of bleeding associated with novel anticoagulants (NOACs) Anti platelet drugs Yes No Major haemorrhage Q58 What viscoelastic technology do you use to guide blood component therapy in patients with haemorrhage? Yes No TEG RoTEM Q59 If "Yes" to previous question, in which departments is it used? (tick all that apply) Theatres... Emergency department... Obstetric department... Cardiac... Critical care... Laboratory... Other department(s), please state Q60 If "Yes" to previous question, where is the TEG or RoTEM equipment located? (tick all that apply) Theatres... Emergency department... Obstetric department... Critical care... Laboratory... Other... Other, please state Q61 Does the Trust use anti-fibrinolytics, e.g. Tranexamic Acid, for major bleeding in the following patients? (tick all that apply) Trauma... Surgical... General medical... Obstetric... Other... Other, please list

17 Cell Salvage Q62 Does your Trust offer Intraoperative Cell Salvage? (IOCS) Q63 If "Yes", please indicate those specialties in which it is used or not used (tick as many as apply) Use Cardiac surgery Vascular surgery Orthopaedic surgery General surgery Obstetrics Trauma Urology Liver surgery Childrens surgery Not Used Other, please state Q64 Does your Trust offer Post Operative Cell Salvage (POCS)? If "Yes", please state which specialties Q65 If "Yes", over the last two years, has your use of post operative cell salvage... Increased... Decreased... Remained the same...

18 Indication and Triggers for Transfusion Q66 Does the Trust use agreed triggers for transfusion for the following components based on... NBTC codes Local Codes Both Red Cells Platelets Frozen plasma Cryoprecipitate We do not currently use codes Q67 Do you have IT systems in place to insist on adequate clinical reasons for transfusion? Q68 Do you have protocols in place, agreed with clinical and laboratory staff to guide transfusion requesting? Q69 Do these allow for challenging requests or referral to senior colleagues? Q70 Does your Trust use individual treatment plans for transfusion dependent patients? Q71 Have you implemented a restrictive transfusion policy for red cells in non-bleeding patients? Yes, the policy covers all areas... Yes, but it covers only specific areas... No, but we are planning to... No, we do not intend to implement such a policy... If "NO", what is your rationale for not having this policy? Q72 Do you have a single unit red cell transfusion policy? Yes, the policy covers all clinical areas... Yes, but it covers only specific clinical areas... No but we are planning to... No we do not intend to implement such a policy... If "NO", what is your rationale for not having this policy? Q73 How do you re-assess your patients in order to guide further transfusion? Clinically... FBC... Both of these...

19 Q74 Do you have a policy for transfusing one ATD of platelets at a time in non bleeding patients? Yes, the policy covers all clinical areas... Yes but only in specific clinical areas... No, but we are planning to... No, we do not intend to implement such a policy... If "NO", what is your rationale for not having this policy?

20 Summary and Overview of Patient Blood Management Initiatives Please which patient blood management initiatives you have implemented or prioritised in your Trust since the previous PBM survey in 2013 Implementation of cell salvage Expansion of the cell salvage service and/or the hours it is available Revised policies and procedures for dealing with major haemorrhage Recognition and appropriate management of anaemia Introduction of near patient testing e.g. TEG and RoTEM Single unit platelet transfusion policy Single unit RBC transfusion policy Reducing wastage Appropriate use of PCCs Using indication codes for transfusion Laboratory staff challenging inappropriate requests Greater patient involvement Increased involvement of patients in the consent process Revised surgical blood order schedules Introduction of electronic systems to support and monitor appropriate and safe use Better use of data to inform clinicians about blood usage Reviewing HTC terms of reference Education of medical staff Other Other, please indicate Implemented Prioritised Q76 Have you recently submitted business cases or requests for further funding to support your PBM programme? If "Yes", please provide details Q77 In your opinion, what are your local constraints for the successful implementation of your patient blood management programme?

21 Q78 What could NHSBT provide to assist your Trust to implement PBM initiatives? The PBM team working more closely with individual Trusts on specific PBM initiatives NHSBT PBM Team members having joint roles, working in named NHS Trusts and NHSBT National clinical bench marking database National KPIs for Trusts on PBM Realignment of RTC regions e.g. in line with NHS England or pathology networks Greater use of IT e.g. more Apps, Webinars, podcasts for education etc Standardised and accredited education and training programmes for hospital transfusion teams Standardised and accredited education and training programmes for other hospital staff Standardised education and training for preregistration staff (predominantly delivered within a university setting) Focus on identification and management of anaemia in primary care National PBM Toolkit and resources to assist with implementation in Trusts Focus on informing and empowering patients and the public through campaigns and educational resources A small increase in blood component price to fund additional support and resource Yes No Not sure Q79 Please use this space for any general comments

22 Thank you for participating in this survey. Please ensure you click the "submit" button to send in your data If you have any queries about the survey questions, please contact : For technical queries please contact: Brian Hockley Tel: Mob: If you want to read about Patient Blood Management go to the section on the NBTC website at:

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