Lister Left at 2 pm. Jane O Brien JO B Minutes

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East of England Regional Transfusion Committee EAST OF ENGLAND TRANSFUSION PRACTITIONERS NETWORK Minutes of the meeting held on Thursday 9 th October 2013 at the Cambridge Blood Donor Centre APPROVED

1 East of England Regional Transfusion Committee EAST OF ENGLAND TRANSFUSION PRACTITIONERS NETWORK Minutes of the meeting held on Thursday 9 th October 2013 at the Cambridge Blood Donor Centre APPROVED Present: Name Hospital Name Hospital Donna Knight DK Queen Elizabeth KL Tina Parker TPa Broomfield Ellen Strakosch ES Luton & Dunstable Janet Pring JP Norfolk & Norwich Zoe Garside ZG Luton & Dunstable Frances Sear FS Hinchingbrooke Anne Gully AG Watford Michaela Lewin ML Papworth Joanne Hoyle JH West Suffolk Loraine Holland LH Bedford Left at 12 noon Gilda Bass GB West Suffolk Aman Dhesi ADh Chair NHSBT Tracy Nevin TN Princess Alexandra Emily Okukenu EO Barts Health Maria O Connell MO C Basildon Rebecca Smith RS Ipswich Julie Edmonds JE Lister Karen Baylis KBa Lister Left at 2 pm Left at 2 pm Claire Atterbury CAt NHSBT Queen Elizabeth KL Jane O Brien JO B Minutes NHSBT Dr Dora Foukaneli (DF) joined the group for part of the morning session Apologies: Sharon Kaznica SK Ipswich Kaye Bowen KB Peterborough Julie Jackson JJ James Paget Alex Boyle AB Norfolk & Norwich Caroline Hough CHo Addenbrooke s Sheila Needham SN Queen Elizabeth II Ali Drew ADr Norfolk & Norwich Donella Arnett DAr Watford Natalie Outten NO Southend NB: Michaela Lewin is Acting Chair of the TP Network for the period of CAt s part time secondment to the NHSBT PBM team. ADh chaired this meeting. 1. Welcome: the meeting opened with round table introductions and ADh welcomed new members. Kairen Coffey, Education and Audit Lead for NHSBT, who was going to give a presentation on Development and Leadership, was unable to attend. EO kindly offered to give a presentation on London Air Ambulances instead, so there are changes to the distributed agenda. 2. Minutes of last meeting: agreed as accurate. Matters arising: NHSBT Marketing have informed us that they will not be producing any more marketing products (eg pens, Billy Blood Drop etc). It had been suggested that a representative be invited to a TP meeting so that members can discuss their ideas for purchasable products. ADh said that it would be better to wait until changes occurring within NHSBT, including reducing the number of Blood Mobiles in order to maximise the use of static sites to increase apheresis collections and alterations to the structure of the organisation, are complete. FS has passed on a hard copy of Hinchingbrooke s pre-op assessment audit JO B has received names of 2 members of hospital pre-op teams interested in joining the regional audit working group Dr Megan Rowley chairs the NCA steering group. Any feedback on audits should be passed to ADh, who said there would shortly be an increase of staff involved with National Comparative Audit team. Frances Sear has recently joined the RTT 1

2 Patient information leaflets (PIL): KBa is now a virtual member of the PIL working group which means she will have input into changes to documents and new productions. ADh said foreign language versions are no longer available via Access 24. Instead, they can be obtained via an to Customer Services, in order that better track can be kept of orders and therefore demand. JE said there is a need for appropriate transfusion information aimed specifically at young adults. Acute Transfusion Reaction algorithm: The RTC Chair, Jim Bamber, suggested an A5 version of this document. The RTT felt that this would be a useful format and it is possible that the RTC budget may be able to fund production of this for interested hospitals. Production by the graphic designers is clearer than that produced by local printing. Action: JO B to ascertain which hospitals are interested. CAt has received only 5 completed worksheets so far and encouraged those who had not done the exercise to do so in order to facilitate discussion on TP workload. The NHSBT Paediatric Group will send hospitals a letter about the new calculation for paediatric haemoglobin following the unit change from g/dl to g/l, it will also be addresses in the new BCSH guidelines 3. RTT/RTC Update: It s in the Bag, our main education event for 2013, was held on 19 th September and very well received with 100% of delegates rating it overall as good to excellent. Those present who attended had very positive comments and praised FS for her presentation on the implementation of an IV Iron Clinic. Events for 2014: there will be a BMS study day (theme to be decided by the EoE TADG) and a repeat of our successful Midwives education event. The main event will be for those involved in surgery, with the aim of increasing transfusion knowledge and thereby improving pre operative optimisation of patients. Topics will include: pre-operative assessment; massive haemorrhage and massive trauma. AG suggested Cell Salvage as a topic and said that the main aim of her secondment to a TP role is to increase it s use at Watford. TN said having previously used cell salvage in knee surgery at Princess Alexandra, they now use Tranexamic Acid and use of blood in orthopaedic surgery is now low. TPa said surgical use of blood had decreased considerably at Broomfield and medics are the biggest users. RTC training days have been approved as part of the mandatory training for Haematology SpRs and DF suggested that we offer the same to Anaesthetic SpRs. DF said that an audit of neuro-intensive care patients was currently being analysed and the results may be of interest to those attending the education day. Transfer of blood with patients audit: ADh said this real time audit follows a retrospective audit and is currently taking place using the regional transfer of blood forms. The RTC wishes to determine how often blood components are transfused en route and how much blood is wasted or not fated. Hospitals are asked to fax JO B transfer forms when forms are faxed to sending and receiving hospitals. So far, most forms received by JO B have come from Addenbrooke s as the receiving hospital but it is equally important that the sending hospital also fax forms, especially if the patient is being transferred out of the region. TPs may be contacted by JO B to assist with traceability when the fate of the 2

3 components is not clear. Please also contact JO B if you discover incidents where blood has been transferred without laboratory knowledge; such information is not auditable but will still be useful as anecdotal evidence of poor practice. Regional Pre-op assessment audit: a working group including pre-op assessment nurses will be set up and an organisational survey distributed. 4. NPSA SPN 14 Competency review: A National workshop session was held on 23rd September. CH represented the East of England but was unable to attend this meeting. EO made the following points: Feedback both from the circulated questionnaire and the meeting indicated that competencies has increased the turnover of TP staff. There are differences all over the country including on such issues as whether the terms family name, surname or last name are used. EO feels that focus should be on over-riding principles. Paula Bolton-Maggs, Medical Director of SHOT gave a presentation showing that about 70% of those making errors are competency trained. Workshops were held considering what could be nationalised and what could be transferable between hospitals. Recommendations are that there be a one-off observational assessment, followed by e-learning at least every 3 years. LearnBloodTransfusion would be the preferred platform as this is already in place and is regularly updated 100% compliance is thought to be not achievable, the aim should be 95%; other recommendations are also not as prescriptive as NPSA SPN 14 Recommendations will be reported to the NBTC at the meeting later this month but it is possible that a decision may not be made until the next meeting of the Executive in January. There will be an NBTC update by Jim Bamber at our next RTC meeting. However, EO stated that Trusts can do their own risk assessment to implement changes prior to ratification by the NBTC Transfusion competencies may come under the Skills for Health umbrella, but there would have to be communication with NBTC Barts Health Trust no longer perform face to face training but use booklets. Action: EO to share the transfusion section of the training booklet. There followed discussion about the differences in training and assessments within the region. CAt said that competency assessment at Queen Elizabeth are undertaken by Practice Development Nurses. In addition the Medical Director is very supportive. Others reported a difference in training of medical staff, with some grades apparently missing out. There are efforts to include transfusion training into the medical under graduate curriculum. CAt noted that UEA give transfusion training just prior to the start of Foundation Year 1. It was also noted that post transfusion observations are often performed by non qualified staff, therefore it may be necessary to have a different assessment modules for transfusion reactions. 5. NHSBT and PBM team update: PowerPoint attached with these minutes 3

4 The Patient Blood Management framework is awaiting sign off by Sir Bruce Keogh. A PBM survey was circulated and CAt thanked everyone in this region for completing it. It is hoped that results may be out later this month, in order that we can determine some local actions. ADh said only England was following PBM: Wales, Scotland and Ireland are still using Better Blood Transfusion. CAt is PBM Practitioner for the East of England on a part time, 6 month secondment. ADh will continue to support the role and the permanent post should be advertised this month. CAt has been given projects including helping hospitals to improve with O negative and platelet use and re-writing A Drop of Knowledge, a guide for new TPs. ADh said his team are changing their support to hospitals in that they will assist hospitals who need it with campaigns, implementations of initiatives and use and wastage. The proposed changes at Brentwood, mainly moving to a new, smaller Stock Holding Unit are awaiting the Dept of Health decision. The BBT Toolkit is to become Transfusion Practice, presently in draft. The JPAC website will be changing shortly The Integrated Transfusion Services (ITS) project is continuing with more Desktop Pilots, including Bedford in this region. Pilots will be asked to implement suggested changes and feedback results. NHSBT is in the process of production of MB treated pooled Cryo for patients born after 1 st January 1996 and would be interested to hear of anticipated need from hospitals. The Scout trial is in the pilot stage and concerns cardio-thoracic patients and the optimisation of patients prior to organ donation. There was discussion about cases of life support patients being given red cell transfusions or other procedures to optimise organ donation, in some cases with no prescription, no traceability and no regard for local protocols. ML said she felt sometimes retrieval teams are reluctant to ask for local help. West Midlands had developed a transfusion training passport and London decided to develop a similar document as part of the Skills for Health Core Clinical Skills passport. ADh would like feedback on this document attached with these minutes NHSBT are currently running a course on nurse authorisation of blood products. Note this is not prescribing because blood is not in the BNF. Some TPs are attending for information but it is mostly attended by nurse prescribers. There is no reason why training and assessment cannot take place locally, but it should follow a transfusion plan. No one present had a local policy so it was suggested a regional policy could be formatted starting with a half day workshop explaining the framework. With regard to other NHSBT led training, EO said she was aware that a survey regarding training was sent to TLMs but not other staff groups. There is a link to the training section of the Hospitals and Science website at the end of The Update, perhaps actual courses offered could be put there instead, especially when new. Following the pilot of the audit of patient consent, EO said the questionnaire to patients could easily raise issues about the lack of information given and it was felt there was some ambiguity in the questions. ML said Papworth withdrew from the pilot. It was agreed that patients should be informed about transfusion at the time they have a Group and Save sample taken. 4

5 There was discussion as to what development aspects Kairen Coffey should cover and if she could tailor her presentation for this group. It was agreed to make it a full day meeting with just a brief business session at the beginning. Action: ADh to liaise with KC concerning dates and format. 6. Patient Consent and information: JE said East & North Herts now have information for ongoing transfusions plus retrospective information for those who may not have known they had a transfusion as part of their treatment. The South West RTC have developed consent for continued transfusion, circulated at the meeting and attached with these minutes. NHSBT have developed a leaflet for patients who have received an unexpected transfusion, available through Access O dear what can the matter be EO gave a presentation on London air ambulances carrying Group O negative red cells, previously given at the BSMS road shows. The London air ambulance service is based at the Royal London and runs 24 hours a day, 365 days a year with rapid response cars taking over at night. 4 units of Group O RhD negative blood are carried in a Golden Hour box which contains a data logger and which are validated for hours. However, the contents of the boxes are changed daily and there has been 100% traceability of units and no inappropriate transfusions. All equipment in both the helicopter and cars is checked every 12 hours. Patients transfused at the scene or en route have a pre hospital admission transfusion bracelet fitted. JP said the air ambulance service covering NNUH is also going to start carrying blood. 8. Hospital Updates: ML asked if other hospitals used paediatric samples in ITU and wondered if the laboratory technology required changing because manual aspiration is required. She also reported that the transfusion link practitioners at Papworth have recently won an award for achieving excellence as a team. The group have quarterly meetings with an education element. JP said NNUH are participating in the ABLE trial (Age of BLood Evaluation) as new hospitals are being recruited. No-one else attending is participating at present. GB asked if anyone present is using paperless blood ordering using Sunquest ICE, where the label produced at the patient s bedside by the handheld blood tracker becomes the order. ES said that following their MHRA inspection, L& D have received funding for Bloodhound, the tracking system from MSoft. The Lister are getting the same system. ML said on an audit of patients refusing blood, there was a case of a patient who would accept certain components but her refusal of one product on an advance directive meant she wouldn t have received any. CAt said that QEHKL have bleeding plans in the back of patients notes. Action: DK to send to JO B for circulation 9. A.O.B: 5

6 West Herts Trust are taking mandatory training out of induction. CAt said MHRA insist on training but only for laboratory staff. ES asked if medical students are allowed to take G & S samples. Those present agreed that they are if they have been competency assessed AG asked if any hospitals represented have 24 hour IOCS cover. Some present said they do where all ODPs are trained in it s use. The meeting closed at 2.20 pm Future meeting dates: RTC: 31 st October 10 am to 1 pm, St John s Innovation Centre, Cambridge TP Network: 16 th January 10 am to 3 pm, Cambridge Donor Centre. Attachments with minutes: PBM and NHSBT update: PowerPoint, Claire Atterbury, Aman Dhesi (to be distributed at a later date) Transfusion Training Passport: London TP Group Consent for continued transfusion: SW RTC Withholding consent plus bleeding plan: Claire Atterbury, QEHKL Blood transfusion course flyer: NHSBT Newcastle. NB: Kaye Bowen did this course and is very happy to discuss it with you if you are interested. She will also give some feedback about it at a future meeting. Actions: Action Responsibility Due date/status Ascertain which hospitals would be JO B interested in A5 versions of the ATR algorithm printed Complete worksheet exercise and forward Carried forward to CAt if not already done Send transfusion section of training book EO at Barts health to JO B for circulation Review attached Transfusion Training All 7 th November Passport and return comments to JO B Liaise with Kairen Coffey re format of TP ADh ASAP Development and Leadership sessions Send QEHKL Bleeding Plan to JO B for circulation DK Complete, attached with minutes 6

Patient Blood Management An Overview. Denise Watson Patient Blood Management Practitioner 11 th January, 2016

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