Standard Operating Procedure for Patients Referred for Blood Transfusion to Louth Clinical Decision Unit by General Practitioners.

Transcription

1 Standard Operating Procedure for Patients Referred for Blood Transfusion to Louth Clinical Decision Unit by General Practitioners. Reference number: G_CS_87 Version: 1 Ratified by: LCHS Trust Board Date Ratified: 10 th October 2017 Name of originator/author: Julie Smith Matthew MacKenzie Name of responsible committee/individual: Effective Practice Assurance Group Date approved by responsible committee 18 th September 2017 Date issued: November 2017 Review date: September 2019 Target audience: Distributed via: All staff undertaking Blood Transfusion Website - 1 -

2 Standard Operating Procedure for patients referred for blood transfusion to Louth Clinical Decision Unit by General Practitioners. Version Control Sheet Version Section/Para/ Appendix Version/Description of Amendments Date Author/Amended by 1 New Document July 2017 Julie Smith Matthew MacKenzie Copyright 2017 Lincolnshire Community Health Services NHS Trust, All Rights Reserved. Not to be reproduced in whole or in part without the permission of the copyright owner

3 Contents 1. SOP statement Procedure for referral of patients for blood transfusion to the Clinical Decision Unit at Louth Hospital 6 3. Appendix A Referral form for the Clinical Decision Unit Appendix B Timescale for blood sampling and schedules for transfusion Appendix C Blood Transfusion preparation flowchart Appendix D Blood transfusion administration flowchart

4 Standard Operating Procedure for patients referred for blood transfusion to Louth Clinical Decision Unit by General Practitioners. Document Statement Background Statement Responsibilities Training Dissemination Resource implication The purpose of this document is to provide operational guidance for the acceptance and management of patients referred to Louth Clinical Decision Unit (CDU) by General Practitioners (GPs) for blood transfusion. This document takes into account the local blood transfusion policy and national guidance and aims to ensure that patients referred for blood transfusion are those that can be safely managed in the community hospital day unit setting. Implementation and compliance with this standard operating procedure will be the responsibility of all staff. There are no additional training requirements associated with the implementation of this SOP. All managers should ensure staff are working within the current legal and regulatory framework governing blood transfusion. Lincolnshire Community Health Services Website: Resources for safe blood transfusion within Lincolnshire Community Hospitals NHS Trust exist in line with local policy for transfusion and national guidelines. There are no additional resource implications

5 SOP comes in to August 2017 effect SOP review date August 2019 Purpose of Procedure To outline a pathway of referral that ensures that patients referred for blood transfusion are those that can be safely managed in the community hospital day unit setting. Relevant staff All clinical staff involved with requesting, prescribing or administering of blood products. This includes, but is not restricted to: GPs Ward doctors Qualified nurses All such staff should have documented competence to undertake these tasks Related Documents Lincolnshire Community Health Services Blood Transfusion Policy P_CS_11 NICE guideline [NG24] Blood transfusion Published date: November 2015 British Committee for Standards in Haematology (BCSH) guideline for pre-transfusion compatibility procedures (2012) Online training (via Electronic Staff Record - ESR) 000 Blood Transfusion 02: Blood components and Indications for use 000 Blood Transfusion 09: Consent 000 Blood Transfusion 10: Safe blood sampling for transfusion 000 Blood Transfusion 11: Acute transfusion reactions - 5 -

6 Procedure for referral of patients for blood transfusion to the Clinical Decision Unit at Louth Hospital The GP is responsible for ensuring that referrals are appropriate and safe. 1. The GP identifies that the patient requires a blood transfusion and falls within the recommended targets and thresholds for transfusion as outlined in the NICE guidance (NG24) for blood transfusion. The haemoglobin level which the referral is based upon should have been taken within the last 5 days. If it has been longer than 5 days the GP should repeat the blood test (to ensure they are requesting the correct number of units of blood to bring the patient back to their appropriate target haemoglobin). If a repeat haemoglobin test is required the GP should ensure that blood for group and save is taken at the same time to ensure timely transfusion. Patients without a historic blood grouping on the pathology transfusion system will need two samples taking (see guidance below). All requests for blood for transfusion must follow the 2 sample rule. You will require 2 confirmed blood groups/tested samples on record to receive cross matched blood. 1 st sample can be historic or taken on the same day as the 2 nd. 2 nd sample must be a separate venepuncture event, with separate patient ID confirmation. This should be done by a different staff member unless absolutely unavoidable. British Committee for Standards in Haematology (BCSH) guideline for pre-transfusion compatibility procedures, 2012 (

7 2. GP provides verbal and written information to patients (and their family members or carers as appropriate) explaining : The reason for the transfusion The risks and benefits The transfusion process Any transfusion needs specific to them Any alternatives that are available, and how they might reduce their need for a transfusion That they are no longer able to donate blood That they are encouraged to ask questions. The GP should document these discussions in the patient s medical notes. (As per NICE guidelines NG24) 3. GP establishes that the patient has a known cause of anaemia and is physiologically stable. Patients should be referred to an acute hospital (not Louth) if they have Anaemia without an established cause Evidence or suspicion of gastrointestinal bleeding or other acute bleeding Evidence of haemodynamic instability Palliative patients who are receiving end of life care, who are not going to be investigated or have escalation of treatment, will be accepted for blood transfusion at Louth as part of supportive management/symptom control. These patients should have a Do Not Attempt Cardiopulmonary Resuscitation (DNA-CPR) order in place and be on the Gold Standards Framework. The patient (and their family and carers) should be aware that the transfusion is part of symptom control only

8 4. GP completes paper referral to the Clinical Decision Unit (see Appendix A). The referral should state The cause of anaemia Whether the patient has had a previous transfusion and, if so, the date of last transfusion. How many units of blood are required and if diuretic cover is needed. The GP should inform patient that if more than 2 units of blood are required they will be expected to attend on 2 consecutive days as the unit is only open on weekdays between 09:00 and 17:00. This timing will not allow transfusion of more than two units of blood within working hours. GP to be aware of timescale for blood sampling and schedules for transfusion (Appendix B). 5. GP telephones the CDU to inform them of pending referral. 6. GP faxes referral through to CDU. 7. Nurse in charge of CDU will call GP surgery to confirm that we will proceed with the transfusion. 8. Nurse in charge of CDU telephones the patient to arrange any required blood sampling and the transfusion as per the Transfusion Preparation flow chart. (Appendix C) 9. Patient attends CDU as arranged and the transfusion is prescribed and administered as per the Blood Transfusion Pathway (administration). (Appendix D) 10.The patient is discharged back to the care of their own GP - 8 -

9 Appendix A REFERRAL FORM FOR THE CLINICAL DECISION UNIT LOUTH HOSPITAL Telephone: Fax: Contact details of referrer (Please ensure that referrer is contactable for advice / update) Please ask the patient to agree to share their records. Create Systmone share NEWS Score (Must be 4 or less) For resuscitation? Yes No Patient Name: DOB: NHS Number: Address: Patient Tel no: Past Medical History: Specific reason for referral: What would you like us to do for the patient? i.e. specific investigation, work up for condition, treatment for condition, etc. Please ensure that all patients are aware that they may require admission/ transfer to a different care setting Relevant other: If the patient needs transport then please arrange and ensure that they are in the unit by 15:00 at the latest. (Referrals can be made for the following day if necessary) Please ask the patient to bring their mobility aids and medication with them. Patient must be ambulatory and able to sit in a chair. Please telephone CDU and then fax referral - 9 -

10 Appendix B Timescales for blood sampling and schedules for transfusion Step 1. Blood sample(s) taken for Group and Save/Crossmatch (Time minutes) Step 2. Blood samples are collected from GP surgeries / Louth Hospital and delivered to the transfusion laboratory in Grimsby (Time 30 minutes to 4 hours from sampling time to arrival in laboratory depending on where and when the sample was taken *see explanatory note) Step 3. Sample is processed and blood units are issued. This is done as routine rather than urgent for the stable patients referred to the Day Unit A straightforward crossmatch with no antibodies or need for specially treated blood can be processed and the units ready to leave Grimsby in 2.5 hours. Specially treated blood or blood with multiple antibodies has to be sent to Sheffield for processing and issue of the units. This can take up to 24 hours. (Time hours) Step 4. Units of blood are transported from Grimsby to Louth Hospital Blood Bank (via switchboard or, during opening hours, Louth laboratory) (Time 30 minutes) Step 5. Blood transfusion takes place. Each unit is prescribed at a rate between 2-4 hours. The slower rates are needed for patients who will not tolerate a sudden fluid load (frail, elderly, renal or heart failure). Transfusion time will depend on how many units are needed and the rate the blood is prescribed. Usually only 2 units will be issued for transfusion on one day. A patient needing 3 units will need to attend on 2 consecutive days) (Time 2-8 hours) With good communication a transfusion can usually be arranged the next working day after samples have been taken for Group and Save/Crossmatch. The following information must be taken into account, especially if referring before a weekend/ Bank Holiday - Patients who have had a recent transfusion may be mounting an immune response to blood group antigens and therefore must be tested on an up-to-date sample. Transfused within previous Specimen to be taken no more than 3 to 14 days 24 hours before transfusion 15 to 28 days 72 hours before transfusion 29 to 90 days 7 days before the transfusion

11 * Explanatory note Blood sample(s) taken for Group and Save/Crossmatch. If, at the point of referral, the patient has a historic blood group/ tested sample on the transfusion system then only one further sample needs to be taken for Group and Save/ Crossmatch. If the patient DOES NOT have a historic blood group or tested sample on the transfusion system then two samples must be taken. [The samples can be taken on the same day but must be separate venepuncture events, with separate patient ID confirmation. The samples should be taken by a different staff member unless absolutely unavoidable.] Samples taken at GP surgeries, or by community staff in the patient s own home, will be requested as a Group and Save. Once the date for transfusion is arranged with the patient, the staff on the Day Unit will arrange crossmatch from the Group and Save sample. Samples taken in the community are collected from the surgeries and delivered to Louth Hospital. Collection times from Louth Hospital to Grimsby are 12:00, 14:50, 16:15 & 20:30. Journey time to Grimsby is 30 minutes. Some patients may prefer to attend the Day Unit to have the sample(s) taken for crossmatch. These are sent directly from the hospital to Grimsby laboratory. Appendix C

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13 Appendix D