2015 Survey of Patient Blood Management (PBM)

Transcription

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. 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. 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. 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 The icons give you a bit more information and what is required for specific questions. Hover you mouse over the icon to see the information. Remember - ensure you click on the "SUBMIT" button at the end of the survey once you have completed the questions to your satisfaction

2 SECTION 1: Your Hospital Transfusion Team and your Hospital or Trust Transfusion Committee Q1 Please write the name of your TRUST Q2 How many hospitals are part of your NHS Trust? Q3 Transfusion Governance: Who does your Hospital Transfusion Committee (HTC) report to (tick all that apply)? Patient safety committee Clinical governance committee Trust Board ne - we do not report Q4 Do you have Transfusion Practitioner(s) employed at your Trust? (include any vacant posts) Q5 Please provide the following details for every Transfusion Practitioner (TP) Whole Time TP1 TP2 TP3 TP4 TP5 TP6 Part Time Q6 If part time, what is the Whole Time Equivalent (WTE, %)?

3 Q7 Please rank (1-6) in order of workload priority, the following areas of your Transfusion Practitioners current role(s) Education Tracing component use Competency assessments Audits Incident investigations Appropriate use of components Please indicate any other areas you feel should be included Q8 Do you have a Consultant Haematologist assigned to transfusion medicine in your Trust? Q9 If YES to previous question, how many Programme Activities (PAs) are designated to transfusion? Q10 Does your transfusion laboratory have any allocated time for PBM? If "" what is this as a percentage (%) Q11 Does the Hospital Transfusion Team (HTT) have any of the following staff supporting it and if so, how many WTEs (%) 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) staff Q12 of WTEs (%)

4 Q13 Please list the job titles of any "other" staff indicated in Q11 Q14 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) staff Q15 If "" number of WTEs(%) Q16 Please list the job titles of any "other" staff indicated in Q14 Q17 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

5 Pathology/blood transfusion IT support Central trust IT support (or external IT support) staff Please list "other" Q18 If "", number of of WTEs(%) Q19 Does the HTC include PBM initiatives on its standard agenda or is there a separate PBM working group/committee? Covered by standard HTC agenda Separate PBM WG/Committee

6 SECTION 2: Transfusion Education Do not include competency assessments - we would like the information on education only Q20 Which staff groups receive transfusion education? 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 s s, please specify Q21 Estimation of % receiving transfusion education (if "not known", put "NK")

7 Q22 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 Staff grades Core trainees Nurses Midwives ODPs

8 SECTION 3: Information Technology (IT) Systems Laboratory Information Systems Q23 Who is the supplier of the laboratory information system(s) (select all that apply) Apex Cerner (Pathnet) EDS Healthcare - SwiftLab IPS Fordman Computer Systems (LabNet) GE Healthcare IBGS Bank Manager In House (home built) System Integrated Software Solutions Intersystems Labcentre Meditech Molis Sanguin (BTDS) SunQuest Technidata Telepath WinPath WinPath Enterprise (please describe) Q24 Version Number?

9 Q25 Are there any plans to change, if so, when? Q26 Do you use electronic order comms for component requests for transfusion? Q27 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 Please describe "other" Q28 Is the recording of clinical diagnosis a mandatory field?

10 Q29 Are there national or local indication codes for transfusion incorporated into your laboratory information system(s) to support the transfusion request? Q30 If "" to previous question, can this be overridden? If "", what is the process for authorising the transfusion? Q31 Is the date of transfusion recorded within the laboratory information system? Q32 Is the time of transfusion recorded within the laboratory information system?

11 SECTION 4: Providing Information on Blood Usage Q33 Do you provide reports for where and why blood is being used, e.g. to inform clinical users on a regular basis?, we use our laboratory information system, we use an alternative method to extract and report data, we do not provide reports Q34 If you use an alternative method to extract data, please describe how you do this? Q35 If you provide reports on component usage to specific clinicians and clinical teams, please indicate to whom and how often you provide these reports Q36 Do you cross charge blood components to clinical specialties? Q37 Who is responsible for producing these blood usage reports (tick all that apply)? Transfusion Practitioner Transfusion Laboratory Manager Data Analyst Q38 Do you use information on blood use and wastage supplied by the NHSBT PBM team and/or Blood Stocks Management Scheme to support practice? Q39 Do you undertake internal audits of blood component use against your local policies? (do NOT include NCA audits)?

12 Q40 If you do undertake audits, how frequently do you do these? Weekly Monthly Quarterly Annually, please specify Q41 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

13 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 Q42 Following on from the NCA audit of consent for transfusion, have you implemented action plans which include... a patient information leaflet is made available to all patients who might need a transfusion risks, benefits and alternatives are discussed with all patients who might need a transfusion the discussion and evidence of consent for transfusion is documented in medical notes Q43 Do you have a policy for obtaining consent for transfusion in patients requiring surgery Q44 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

14 Identification and Management of Anaemia Q45 Does your Trust have a policy to identify and correct the underlying cause of anaemia before considering transfusion? Q46 If "" to previous question, in which specialties is it used? Medicine Elective general surgery Elective orthopaedic surgery Paediatrics Obstetrics Elderly care Emergency admissions, please state Q47 Is your Trust able to offer iron therapy as an alternative to transfusion for patients? Oral iron IV iron Q48 If yes (i.v. and/or oral iron ) in which specialties is it used? Medicine Elective general Surgery Elective orthopaedic surgery Paediatrics Elderly care Emergency admissions Obstetrics, please state Q49 Is there an initiative in your Trust to minimise the frequency of blood sampling?

15 Q50 If "" does this apply to all patients? All patients Specific specialties Specific specialties, please list

16 Identification and Management of Bleeding Patients Q51 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 Major haemorrhage Q52 Do you use any of the following viscoelastic technology do you use to guide blood component therapy in patients with haemorrhage? TEG RoTEM Q53 If "" to previous question, in which departments is viscoelastic technology used? (tick all that apply) Theatres Emergency department Obstetric department Cardiac Critical care Laboratory department(s), please state Q54 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 We do not use anti-fibrinolytics, please list

17 Cell Salvage Q55 Does your Trust offer Intraoperative Cell Salvage? (IOCS) Q56 If "", please indicate those specialties in which it is used or not used (tick as many as apply) Cardiac surgery Use t Used NA Vascular surgery Orthopaedic surgery General surgery Obstetrics Trauma Urology Liver surgery Children's surgery, please state Q57 Does your Trust offer Post Operative Cell Salvage (POCS)? If "", please state which specialties Q58 If "", over the last two years, has your use of post operative cell salvage... Increased Decreased Remained the same

18 Indication and Triggers for Transfusion Q59 Which codes/agreed triggers for transfusion does your Trust use for the following components? NBTC codes Local Codes Both Red Cells Platelets Plasma (FFP/Octoplas) Cryoprecipitate We do not currently use codes Q60 Do you have IT systems in place to insist on adequate clinical reasons for transfusion? Q61 Do you have protocols in place, agreed with clinical and laboratory staff to guide transfusion requesting? Q62 Do these allow for challenging requests or referral to senior colleagues? Q63 Does your Trust use individual treatment plans for transfusion dependent patients? Q64 Have you implemented a lower transfusion threshold policy for red cells in non-bleeding patients?, the policy covers all areas, but it covers only specific areas, but we are planning to, we do not intend to implement such a policy If "NO", what is your rationale for not having this policy?

19 Q65 If "" to specific clinical areas please select all that apply Medicine Elective General Surgery Elective Orthopaedic Surgery Trauma Paediatrics Obstetrics Elderly Care Cardiac Surgery Clinical Haematology Critical Care Please describe "" Q66 Do you have a single unit red cell transfusion policy?, the policy covers all clinical areas, but it covers only specific clinical areas but we are planning to we do not intend to implement such a policy If "NO", what is your rationale for not having this policy? Q67 If "" to specific clinical areas please select all that apply Medicine Elective General Surgery Elective Orthopaedic Surgery Trauma Paediatrics Obstetrics Elderly Care Cardiac Surgery Clinical Haematology Critical Care Please describe ""

20 Q68 How do you re-assess your patients in order to guide further transfusion? Clinically FBC Both of these Q69 Do you have a policy for transfusing one ATD of platelets at a time in non bleeding patients?, the policy covers all clinical areas but only in specific clinical areas, but we are planning to, we do not intend to implement such a policy If "NO", what is your rationale for not having this policy? Q70 If "" to specific clinical areas, please select all that apply Medicine Elective General Surgery Elective Orthopaedic Surgery Trauma Paediatrics Obstetrics Elderly Care Cardiac Surgery Clinical Haematology Critical Care Please describe "other"?

21 Summary and Overview of Patient Blood Management Initiatives Q71 Please which patient blood management initiatives you have implemented or working towards in your Trust since the previous PBM survey in 2013 Implemented Working Towards 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, please indicate Q72 Have you recently submitted business cases or requests for further funding to support your PBM programme? If "", please provide details

22 Q73 In your opinion, what are your local constraints for the successful implementation of your patient blood management programme? Q74 Which of the following could NHSBT provide to assist your Trust to implement PBM initiatives? The NHSBT 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 t sure National clinical bench marking database National KPI's 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 pre-registration 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

23 Q75 Please use this space for any general comments

24 NHSBT and hospitals in the UK are currently participating in a large research study called AFFINITE. This study aims to improve the effectiveness of surveys like this and other clinical audits. We would like to use your fully anonymised data from this survey as part of the AFFINITE study. This is entirely optional and will not affect any aspect of this survey or its reporting. Further information about AFFINITE can be found here: medhealth.leeds.ac.uk/info/555/research/1388/affinitie_programme Q76 Do you have any objection to us using your data from this survey as part of the AFFINITE study? 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 your local PBMP practitioner For technical queries please contact: Brian Hockley brian.hockley@nhsbt.nhs.uk Tel: Mob: If you want to read about Patient Blood Management go to the section on the NBTC website at: