Document Control Title Authorisation Blood Components for Transfusion by Registered Practitioners Policy Author Haematology Clinical Nurse Specialist Author s job title Haematology Clinical Nurse Specialist Directorate Clinical Support Services Department Clinical Haematology Version Date Issued Status Comment / Changes / Approval 0.1 30.11.15 Draft Draft for consultation 1.0 Dec 2015 Final Approved by Transfusion Committee 15 th Dec 2015 Main Contact Haematology Clinical Nurse Specialist Office 1 Seamoor Corridor North Devon District Hospital Raleigh Park Barnstaple, E31 4JB Lead Director Director Nursing Superseded Documents None Issue Date Dec 2015 Review Date Dec 2018 Consulted with the following stakeholders: (list all) Head Workforce Development Haematology Consultants Hospital Transfusion Committee Review Cycle Three years Approval and Review Process Hospital Transfusion Committee Local Archive Reference G: Pathology Local Path Transfusion Team\Policies & Guidelines folder Filename Authorisation Blood Components for Transfusion by Registered Practitioners Policy v1.0 15Dec2015.doc (right click above text, to update to new filename) Policy categories for Trust s internal website (Bob) Haematology Tags for Trust s internal website (Bob) Blood Transfusion, Components, Authorisation, Registered Practitioners, Non-Medical Page 1 19
CONTENTS Document Control... 1 1. Purpose... 3 2. Definitions... 3 3. Responsibilities... 3 Role Registered Practitioner... 3 Consultant Supervisor and Assessor... 5 Role the Hospital Transfusion Committee 5 4. Selection Criteria... 5 5. Training... 6 6. Monitoring Compliance with and the Effectiveness the Policy... 6 7. Equality Impact Assessment... 7 8. References... 7 Appendix 1 Portfolio evidence 8 Appendix 2 Log transfusions 17 Appendix 3 Record supervised authorization Blood Components 18 Appendix 4 Declaration Competence Form 19 Page 2 19
1. Purpose 1.1. The purpose this document is to detail the process for a senior Registered Practitioner, working in a relevant specialist role, who wishes to undertake the authorisation blood component transfusions. 1.2. The policy applies to all non-medical staff. 1.3. Implementation this policy will ensure that: Any Registered Practitioner wishing to develop their role to include authorisation blood component transfusion will have completed the relevant training and competency assessment. The Registered Practitioner who takes on the role blood component authorisation will need continued support and mentorship with a period supervision prior to completion competency assessment to allow independent practice. 1.4. The authorisation a blood transfusion must only occur when NDDH policies and guidelines are followed and when there are no alternatives to transfusion. 1.5. That non-medical authorisation is not suitable for all registered practitioners and should only be taken on within agreed governance structures the Trust after consideration service and clinical need and at the recommendation the designated consultant supervisor and assessor. 2. Definitions Blood components consist red cells, platelets, fresh frozen plasma and cryoprecipitate. 3. Responsibilities 3.1. There must be an identified service need within the specific department to implement the non-medical authorisation blood components 3.2. Role Registered Practitioner The registered practitioner is responsible for ensuring that they meet the selection criteria and will be supported by both the lead haematology consultant for transfusion and the designated consultant supervisor and assessor. Page 3 19
The Registered Practitioner is responsible for: Maintaining accurate documented evidence training and practice. Ensuring that they are familiar with current national and local guidelines and policies by accessing the relevant courses and maintaining training and competency. Must comply with the NMC Code Practice or equivalent Health Care Practitioner Code Practice. The Practitioner will be responsible for obtaining adequate knowledge and experience in authorising blood components including a period supervision prior to assessment competency The practitioner is responsible for keeping training and skills up to date throughout their working life and a duty to practice within their own area competence. The practitioner may only authorise blood components in their specific clinical area or identified group patients and are responsible for their own actions. The practitioner will undertake the extended role solely within a clearly defined clinical management plan 3.3. Consultant Supervisor and Mentor There must be a consultant practising in the specialist area in which the practitioner is employed. The mentor should regularly authorise blood transfusions and make decisions to transfuse and with whom the practitioner can work alongside for learning and assessment purposes. The mentor is responsible for and supporting the practitioner through the work-based learning and assessment. The mentor has a critical and highly responsible role in educating and assessing the practitioner in undertaking authorisation blood products They are responsible for assuring competence the practitioner by providing them with supervision, support and opportunities to develop competence in authorisation blood components during the work based learning. They are up to date with all mandatory training as per NDDH Trust mandatory training requirements They have completed the safe blood transfusion e-learning modules 1 & 2 plus consent part 9 and reactions part 11 module the Learn Blood Transfusion e-learning programme Page 4 19
The mentor is responsible for the final agreement to practice. They are required to provide and signed statement competence at the end the period study. They should do this after reading the pressional code conduct. 3.4. Role the Hospital Transfusion Committee The Hospital Transfusion Committee is responsible for: Reviewing and approving the policy in line with the National Guidance. 4. Selection Criteria Any registered practitioner applying to undertake authorisation blood components must: 4.1. Be currently registered as a practitioner with at least 3 years post-registration experience and have at least one year working in the Trust within the relevant specialty 4.2. Have a case-load patients or work as part a clinical team managing patients needs 4.3. Be trained to a level to include skills history taking, physical examination, advanced communication and clinical reasoning and decision making. 4.4. Identify need for the competency that will benefit their patient caseload. 4.5. Be up to date with all mandatory training as per trust mandatory training requirements, have completed the e-learning modules Safe Transfusion practice Part 1 & 2 plus consent part 9 and reaction part 11 on Learn Blood Transfusion e-learning programmes. 4.6. Have completed all competency assessments for pre-transfusion blood sample taking, and administration blood and blood components if required for their role. 4.7. Successfully complete the approved training programme such as the NHS Blood & Transplant Non-Medical Authorisation Blood components course. 4.8. The candidate must have documented approval from their service manager and mentor. Page 5 19
5. Training 5.1. The candidate must submit a portfolio evidence to demonstrate knowledge and competence to the mentor 5.2. The period supervision will be at the discretion the mentor depending on the needs the individual. The period supervision must include the authorisation blood components which must be recorded. 5.3. On completion training and competency assessments, a competency declaration form with all the support must be completed and sent to the service manager, lead clinician for transfusion, the blood transfusion specialist nurse and Workforce Development for logging on ESR. 6. Monitoring Compliance with and the Effectiveness the Policy Process for Implementation and Monitoring Compliance and Effectiveness 6.1. The Hospital Transfusion Team and Hospital Transfusion Committee will ensure that patient safety and clinical effectiveness is not adversely affected by introduction extended practice by monitoring patient safety incidents and clinical audit by the practitioner. 6.2. All incidents will be fully investigated and re-training initiated where appropriate as detailed in the policy. Non-medical authorisers may need to be re-competency assessed following an incident and cease to authorise until this has been completed. The Hospital Transfusion Team will inform them and their mentor the need for this following an incident. 6.3. The practitioner must ensure they keep themselves up to date with the policies and procedures associated with transfusion and maintain their competencies to authorise transfusion. 6.4. The practitioner must complete trust mandatory training on transfusion in line with Trust requirements and complete learn blood transfusion modules every 2 years. 6.5. The practitioner is required to audit their transfusion practice. 6.6. As a user blood components the practitioner should attend the Hospital Transfusion Committee meeting a minimum once a year following completion to present their audit. Page 6 19
7. Equality Impact Assessment Table 1: Equality impact Assessment Group Age Disability Gender Gender Reassignment Human Rights (rights to privacy, dignity, liberty and non-degrading treatment) Marriage and civil partnership Pregnancy Maternity and Breastfeeding Race (ethnic origin) Religion (or belief) Sexual Orientation Positive Impact Negative Impact No Impact Comment 8. References J Green RN and L. Pirie RN. A Framework to Support Nurses and Midwives Making the Clinical Decision and Providing the Written Instruction for Blood Component Transfusion. 2009 Denise Watson Regional Lead: Patient Blood Management Team NHSBT Newcastle Upon Tyne. Implementing Nurse Authorisation Blood Components Blood and Transplant Matters information for hospitals served by NHS. Blood and Transplant Mat 2013 issue 39 p 5. Kirsty Dalrymple Jill Martin, Kerri Davidson and Elisabeth Pirie. Extending the role a senior haematology or oncology nurse. October 2011; Cancer Nursing Practice: volume 10 number 8. All Wales policy for Non-Medical Authorisation Blood Component Transfusion. September 2013. Policy Template for the Authorisation Blood Component Transfusion by Advanced / Specialist Nurses Caring for Adult and/or Paediatric Patients Requiring Transfusion London and South East Regional Transfusion Committees Non-Medical Authorisation Blood Components Working Group September 2014 http://www.transfusionguidelines.org.uk/uk-transfusion-committees/regional-transfusioncommittees/london/policiesrelateddocuments Page 7 19
Appendix 1 Portfolio evidence to support Registered Practitioners in making the clinical decision and providing the written instruction for blood component transfusion NAME (CANDIDATE NAME (CONSULTANT MENTOR) Job Title: Job Title: Hospital: Hospital: Ward/Dept: Ward/Dept: Study Completion Details Safe transfusion Practice 1 Date Copy certificate Attached to Portfolio Safe transfusion Practice 2 Consent Module 9 Reaction Module 11 Non-medical authorisation course Trust Mandatory Individual Training Matrix Page 8 19
Understanding Knowledge & Competencies Evidence Submitted Signed Practitioner Mentor Date Patient Assessment and clinical decision making How to take a patient history Accounting for comorbidity Consent issues Prescribing concomitant drugs Understand the requirement to accurately document all actions and conversations with the patient Ability to make appropriate referral if the patient refuses blood transfusion or has an advanced directive Ability to take a medical history Ability to link the clinical picture with the interpretation blood results Understands how to explain the risks and benefits transfusion and available alternatives Know to provide patient information leaflets Can assess the patient is fit for transfusion i.e take account comorbidities, day case or in-patient Know which concomitant drugs may be required Page 9 19
Understanding Knowledge & Competencies Evidence Submitted Signed Interpreting blood results Can demonstrate knowledge and understanding: Of normal, variations normal and abnormal haemoglobin and platelets counts & clotting results Ability to interpret results and initiate treatment Know if more tests and/or further evaluation is required Writing the Instruction to transfuse the blood component Demonstrates knowledge that the written instruction includes Patient s full name Date birth Hospital number Product description The route administration The length time the transfusion is to take place The number units/volume Any special requirements Concomitant drugs that need to be administered Page 10 19
Understanding Knowledge & Competencies Evidence Submitted Signed Practitioner Mentor Date Constituents blood components Gain insight into the production from whole blood : Red cells White cells Platelets Plasma Has knowledge : Storage Safe handling Temperature control/cold chain requirements Understanding Knowledge & Competencies Evidence Submitted Signed Practitioner Mentor Date Understanding anaemia Can define the types anaemia Understands physiological process for iron deficiency anaemia Knows when to refer patients for further investigation and treatment Knows how to order appropriate investigations Understands the different types iron therapies Understands the use EPO Page 11 19
Understanding Knowledge & Competencies Evidence Submitted Signed Practitioner Mentor Date Pre-transfusion testing process Can demonstrate an understanding the: Pre-transfusion sampling process Sample labelling requirements BSCH guidelines for pre transfusion testing Time limits surrounding the validity samples in storage The laboratory processes for pretransfusion testing including how long testing takes Indications for the use Platelets Demonstrates a clear understanding for the use platelets (including platelet count) Uses local policy and national indication codes to demonstrate appropriate use Can demonstrate in which conditions their use is not appropriate Page 12 19
Understanding Knowledge & Competencies Evidence Submitted Signed Practitioner Mentor Date Indications for the use red cells Demonstrates a clear understanding for the use red cells Uses local policy and national indication codes to demonstrate appropriate use Indications for the use Fresh Frozen Plasma Demonstrates a clear understanding appropriate use FFP in the context correction deranged INR results in the face bleeding or invasive procedures which may cause bleeding Can demonstrate the indications for which FFP is not used Uses local policy and national indication codes to demonstrate appropriate use Aware normal and abnormal clotting results Page 13 19
Understanding Knowledge & Competencies Evidence Submitted Signed Practitioner Mentor Date Special Transfusion Requirements Demonstrates knowledge and understanding : Which patient groups will have special blood requirements and why Understands the process to prevent these patient s receiving the wrong blood Transfusion guidelines and protocols Can demonstrate knowledge and understanding : SABRE/SHOT HSC Better Blood Transfusion 1998/224, 2002/009, 2007/001 BSCH guidelines Blood Safety and Quality Regulations 2005 including traceability requirements Patient information leaflets Page 14 19
Understanding Knowledge & Competencies Evidence Submitted Signed Practitioner Mentor Date Legal responsibilities Record keeping Has knowledge and understanding NMC Standards conduct, performance and ethics Can explain why the reason for transfusion should be recorded in the patient s notes Can explain why all actions must be documented Ordering blood components Has knowledge local guidelines for ordering blood components and the need to provide the following details: Full name patient Date birth Hospital number When the patient is to be transfused How many units and any special requirements Where the patient is to be transfused Diagnosis Indication code Appropriate for overnight transfusion or not Contact name / bleep number Page 15 19
Understanding Knowledge & Competencies Evidence Submitted Signed Practitioner Mentor Date Risks and adverse events associate with transfusion and how to deal with them Demonstrates knowledge and understands the risks transfusion and describe the management the following: Transfusion and transmitted bacterial and viral infections Transfusion Related Acute Lung Injury (TRALI) Acute haemolytic transfusion reaction Wrong blood to wrong patient Fluid overload Anaphylaxis Iron overload Page 16 19
Appendix 2 Log transfusions Hospital Number Location Number units Diagnosis Rationale for the transfusion Any other medication prescribed Comments Signature RP Signature Mentor Hospital Number Location Number units Diagnosis Rationale for the transfusion Any other medication prescribed Comments Signature RP Signature Mentor Page 17 19
Appendix 3 Record supervised authorisation Blood Components Date Patient Hospital Number Component Rationale for transfusion Comments on review transfusion episode Mentor signature if transfusion was satisfactory Page 18 19
Appendix 4 Declaration Competence Form Registered Practitioner Authorisation and Written Instruction Blood Components I have met the knowledge and competency criteria and I am pricient to undertake the I have met the knowledge and competency criteria and I am pricient to undertake the authorisation and written instructions for red cells and platelets authorisation and written instructions for red cells and platelets Name.. Name.. Signature Signature Clinical Area / Specialty:. Clinical Area / Specialty:. Date:. I have assessed the above practitioner and deem them pricient to undertake the authorisation and written instructions for red cells and platelets. If practitioner is a nurse I have read the NMC code conduct http://www.nmc.org.uk/standards/code/read-the-code-online/ Name: Signature: Date:. Lead Haematology consultant for transfusion: I agree the above practitioner pricient to undertake the authorisation and written instructions for red cells and platelets Name:... Signature: Date: Please send a copy this form with Appendix 1, 2 and 3 to: - Your clinical manager The Transfusion Practitioner Workforce Development for logging on ESR Keep the original for your own records. Copy form will be returned to all individuals by BTNS Page 19 19