Confirmed Minutes of the London Regional Transfusion Committee London Blood Transfusion Forum (RTC Business Meeting) held on 9 May 2017 at The Education Centre, Present: Dr Phil Kelly (Chair) Abdul Adamu Whittington Hospital Aisha Ali Shubha Allard Barts Health & NHSBT Vivienne Andrews TDL Katie Ayscough Parkside Hospital Namal Bandara Kings College Hospital Helen Barber Barnet & Chase Farm Hospitals Chetan Bhatt Whittington Hospital Catherine Booth Alison Brownell Basabi Chatterjee Whipps Cross Hospital Vashira Chiroma Imperial NHS Trust Gavin Cho NHSBT Milee Choudhury Royal Marsden Hospital Fatts Chowdhury St. Mary s Hospital Sarah Clark Royal Free Hospital Moira Daines Nobles Hospital, Isle of Man James Davies Helena Day Harefield Hospital John Dick Christy Doughty Emma Fosbury Royal Free Hospital Matt Free St. George s Hospital Lucy Frith NHSBT Vanessa Fulkes Guy s & St. Thomas NHS Trust Diana Gabriel Newham University Hospital Champika Gamlath Princess Royal Hospital Lisa Gibb Great Ormond Street Hospital Sara Hammond Barts Health NHS Trust Kazi Hashem Whipps Cross Hospital Elizabeth Hibbert Barnet General Hospital Mandy Hobson Barnet & Chase Farm Hospitals Steve James Dharshana Jeyapalan Imperial NHS Trust Lisa Jones Dorothy Kasibante HCA Healthcare UK Sara Kerins Cherrelle Lawrence RCI, NHSBT Michelle Martin Barking, Havering & Redbridge NHS Trust Alexander Martinez Homerton University Hospital Josephine McCullagh Whipps Cross Hospital Denise McKeown Imperial NHS Trust Wendy McSporran Royal Marsden NHS Trust Sujata Mehta Royal Marsden NHS Trust Alek Mijovic Anne Minogue Rachel Moss Great Ormond Street Hospital Nathalie Muller Whittington Hospital The London Regional Transfusion Committee
Joe Nanuck Steve Owen Shehan Palihavadana Ketan Patel Smita Patel Rebecca Patel Reshma Patel Deidre Patience Illangage Perera Benedict Philips Victoria Potter Nithya Prasannan Gill Rattenbury Nirupa Rawal Fiona Regan Andrew Retter Eve Richards Sally Sharp Petra Singh Chris Steward Xiaohui Tang Keisha Thomas-Bogle Sophie Todd Tracey Tomlinson Hannah Turner Katie White Steve Wiltshire Vikki Woollett-Calnan Ayan Yusuf Julia Mahesan Clare Denison Jennifer Heyes Angela Pumfrey Queen Elizabeth Hospital Woolwich Royal Brompton Hospital North Middlesex Hospital Harefield Hospital NHSBT Colindale London Northwest Healthcare North Middlesex Hospital Guy s & St. Thomas Hospital Whipps Cross Hospital Parkside Hospital BMI London Independent Hospital NHSBT Guy s & St. Thomas NHS Trust NHSBT Colindale Harefield Hospital St. George s Hospital National Hosp of Neurology & Neurosurgery NHSBT Colindale Hillingdon Hospital St. George s Hospital King George Hospital CSM, NHSBT PBMP, NHSBT PBMP, NHSBT RTC Administrator, NHSBT 01/17 Welcomes and Introductions PK welcomed everyone to the meeting and informed them of the housekeeping arrangements. Minutes of Last Meeting (14 th October 2016) Any amendments, please send to London RTC Administrator, Angela Pumfrey. Otherwise, the minutes will be accepted as a true record. Action: AP to arrange for the minutes to be uploaded to JPAC website. 02/17 NBTC & RTC Chairs Meeting Feedback The March meeting was split into the RTC Chairs meeting and an education workshop. PK gave a presentation. NBTC Update Audits: Several audits currently ongoing with some identified for the future. Results of the sickle cell audit will be published this month. NICE Quality Standards: NBTC can only support Statement 3 in cases of single unit transfusion, not for multiple units. Standards in Transfusion Labs: The BMS degree is not adequate in providing trainees who are fit for the job. Experienced lab staff are leaving and being replaced with inexperienced staff Consultant Clinicial Scientist posts: Currently 3 NHSBT trainees on the course. Need to finalise what their role will be. Education Working Group PBM app has been released. Will be trialled on
student doctors first, before trialling on junior doctors. Patient Involvement Working Group: There is a helpful consent video on You Tube Anaemia Management Working Group: Vifor Pharma wanted to be involved in driving this, but NBTC would prefer to do it themselves. Indication codes app is out. RTC Chairs Update There are many national meetings, but it is the same people attending. There are staffing problems across the country - staff cannot get away to attend events. Experience draining away from labs as experienced staff leave. Pressure on staff is getting worse. Education Workshop Topic was education and training Transfusion and PBM poorly covered in medicine training junior doctors are not getting sufficient training. Who should take this on NBTC can give guidance. Guidance on blood testing needed for junior doctors. Nurses and midwives receive this training on the Nurse Authorisation Course. Challenge to get junior doctors to do things correctly. They need to be aware that lab staff have procedures to follow. In one Trust, errors made by junior doctors are put on their training record. This has resulted in a drop in the number of incidents. Junior doctors think senior doctors are picking on them. Improvements have been made in both under and post-graduate training, but what can we do as a region to improve the situation further? London RTC Update New RTT Members: Ravi Raobaikady-Consultant Anaesthetist, Ciara Donohue- Consultant Anaesthetist and Fatts Chowdhury-Consultant Haematologist. Trauma day to be held on 17 May at St. George s Hospital LoPAG Group: Summer (Edition 7) newsletter will soon be sent out. BMS Empowerment: Petra Singh is the new Chair of the BMS Education Group BMS Empowerment study days were held in February 2017. 2018 workshops will be held in November 2017, rather than February 2018. 03/17 NHSBT Update \\nbscol23\shared\ 010 PCS\005 Hospital Julia Mahesan gave an NHSBT update, a summary of which is below. Full Face Labelling: Labels are too cluttered with information so it is not easy to see the critical information. Survey carried out to rank the criticality of each piece of information. Three options to choose from Option 3 was the most popular. The transition label is being worked on. It is very similar to the new label, but will keep the linear barcode so that hospitals can make an easier transition. What scanners to use: Currently going through Procurement, but you will need a 2D scanner that can concatenate. NHSBT are aiming to introduce the transition label by the end of the year, with
maybe one specific product. Ensure your LIMS suppliers are aware. One member highlighted that electronic tracking will be affected by these changes. It was further highlighted that they do not link to other auxillary systems used in hospitals. If you have anything in your hospital that scans the barcodes, please inform Clare Denison, Jen Heyes or your CSM. Anti-CD38: Please inform RCI of any patients treated with Anti-CD38 and the reason. Washed Red Cells: Red cells will now be manually washed and re-suspended in SAGM they now have a 14 day shelf life. Price Changes: Red blood cells - 124.46 Pooled platelets - 178.19 Apheresis platelets - 219.30 (if hospitals order and NHSBT supply them) If hospitals order apheresis platelets, but are supplied pooled, or vice versa, the pooled price will apply. Management of Orders: Please consider drip feeding orders for special components as it helps Hospital Services to locate them. Does not apply to standard components. Review of Viral Risk: The requirement to produce plasma components from repeat donors only has been removed. Therefore plasma can be taken from male first-time donors. Click and Collect Charge From this month, there will be a 11 Click and Collect charge per order If you are ordering special components, you can ask for them to be delivered on the return delivery, so you will not get charged. JM does understand that hospitals would prefer to amalgamate their orders rather than drip feed if they ae going to be charged per order 04/17 Neonatal Blood Audit James Davies presented results from an audit on iatrogenic anaemia in neonates performed at Kings College Hospital. \\nbscol23\shared\ 010 PCS\005 Hospital The audit looked into the causes of neonatal iatrogenic anaemia, and the total volume of blood extracted and how many blood transfusions received during the patient s hospital stay. The results show that, for some babies, we are extracting more blood than their total volume for testing, resulting in them needing repeated blood transfusions. There will be a re-audit sometime in the future to see if changes have been made. The aim is to see a reduction in RBC by 15-20%. It was asked if BSH could have a template attached to each guideline so that people can remember what actions to take. SA will take this forward. Action: SA to take forward inclusion of templates to BSH. 05/17 London Regional Consent Service Evaluation The RTT chose to do a service evaluation on consent. The survey will be sent by email. WM explained to the group how to complete the survey and that it should take no longer than 10 minutes.. 06/17 HEV Negative Blood Components It was explained what the Hep E virus is and how it is contracted. A lot of blood donors are not aware that they are infected. SaBTO reviewed their guidance in November 2016 which stated that universal screening of blood components should be introduced. NHSBT has now moved to 100% testing. Blood donors who test + for HEV will be deferred from donation for 6 months.
Apheresis platelet donors and rare blood group donors can be re-tested at 6-8 weeks. In OBOS, boxes will be greyed out for the time being, but permanently removed in September. Non-screened components currently in stock must not be discarded. They will be distributed amongst hospitals in preference to screened stock until it has been used up. Unscreened cryo has been almost used up, but a large stock of FFP remains. Hospitals asked to only request HEV negative FFP as needed. Consultants will be responsible for making the decision if patients need an HEV screened product 07/17 Ask the Audience a) Recall Close Out Letters Are not being received. Should have a close out letter for everything. There has been a hitch with this, but FC said things should improve in a couple of weeks. b) Renal Transfusion Patients at How to test for Anti-D in these patients and how much Anti-D should be given. Renal transfusion guidelines say 500UIM Anti-D for RhD +ve donor and ve patient, given 24 hours from time of transfusion. Should get answer back within 24 hours as to whether to give more Anti-D. Take another sample at 48 hours after transfusion. c) How to Increase HTC Attendance The following suggestions were made: Review the format of the agenda and what topics are discussed Make the agenda and items to be discussed more user friendly Hold meetings quarterly rather than monthly Clinicians have to attend 3 out of the 4 meetings. If they are unable to attend, must send someone in their place. Have a link nurse in attendance who is instrumental in helping with competency assessments Need to invite the right people to the HTC so decisions can be made. If the clinicians ask a member of staff to attend the HTC, they are more likely to attend. At HCA Healthcare their six hospitals are in competition with each other. This has increased the attendance at HTC meetings because they want to attend to discuss their own hospital. d) Transfusion Reactions & BSH Guidelines How many transfusions are stopped because of a mild reaction, but then restarted? There can be a delay of many hours before a Haematologist sees the patient which results in the rest of the bag being discarded. How much blood is thrown away due to this? RM said that nurses often try stopping the transfusion for 30 mins, give Paracetamol and then restart, rather than call medical staff to see the patient. It was thought that maybe 70-80% of transfusions do continue following a reaction. WM will send the guidelines to Nobles Hospital, IoM. Action: WM to send BSH guidelines to Nobles Hospital e) Bringing About a Culture Change Management of anaemia was given as an example where a change in culture is needed. The following points were brought up: At King s College it is difficult to get a large number of Consultants to come to an agreement on anything. Joined up thinking is not happening. Individuals want to do their own thing. You can encourage people to do the right thing, but it is too easy to exist outside of guidelines. There is an issue with physicians, both senior and junior, taking responsibility for
their actions. We need to see who prescribed the blood and why, so that they can be challenged. You must be able to challenge people if you think they are not doing something in the best interest of the patient. The most influential people involved in prescribing blood are nurses because they teach the junior doctors. If you get the nurses involved, the culture will change. Prescribing blood is the same as prescribing drugs. At one hospital they did not allow junior doctors to prescribe blood unless they had training and were deemed competent. Doctors who are not competent, should not be prescribing HCA Healthcare have started mandatory training for Consultants for their validation. Transfusion training is included in this training. How do you challenge people? Would a policy help? Staff need to be backed up by other staff. There are TP s who do challenge and it is very effective. 08/17 Any Other Business None