Transfusion Medicine Committees: Purpose and Pitfalls Vein to Vein Symposium March 17 th, 2017 Susan Nahirniak MD, FRCPC
Objectives Following this presentation, participants should be able to: 1. Understand what standards require of hospital based transfusion medicine committees (TMCs) 2. Discuss the goal (s) of TMCs and how these may impact membership of individual committees 3. Recognize common pitfalls associated with these committees and be able to suggest methods of resolution
Disclaimer The Transfusion Medicine Committee in Edmonton has been a frequent reason for citation for CPSA, CAP and AABB inspectors
Are you a member of a TMC?
What is the thing your TMC does best?
What is the biggest weakness of your TMC?
What are TMCs supposed to do?
WHAT DO THE STANDARDS SAY? Those relevant to my facility include: AABB CSA CSTM CPSA
AABB Standards 2016
CSA Z902-15
CSTM Standards for Hospital Transfusion Services Version 3 Feb 2011
Comparison between AABB and CSA/CSTM - Similarities AABB Recommended activities include: 1. Monitor ordering practice 2. Monitor usage and discards 3. Monitor Blood Administration policies 4. Monitor the ability of the service to meet patient needs 5. Monitor appropriateness of use 6. Monitor Adverse events 7. Monitor Near miss events CSA/CSTM Recommended activities include: Set criteria for: 1. Evaluation of ordering practices 2. Usage (including discard) 3. Administration policies 4. The ability of the service to meet recipient needs 5. Define blood transfusion policies as appropriate to the local clinical activities 6. Evaluate reports of adverse transfusion events 7. Evaluate reports of all transfusion errors
Comparison between AABB and CSA/CSTM - Differences AABB No recommendations as to membership No recommendations as to frequency. CSA/CSTM Recommendations as to membership Required to meet at least quarterly Recommended activities include: 1. Review of relevant federal and provincial reports on adverse transfusion events. 2. Review alternatives to allogeneic blood transfusion and make recommendations on their use. 3. Disseminate transfusion medicine and education
Comparison between AABB and CSA/CSTM Same or Different? AABB Recommended activities include: CSA/CSTM Recommended activities include: 1. Monitor patient identification 2. Monitor sample collection and labelling 3. Monitor compliance with peer review recommendations 4. Monitor clinically relevant laboratory results 1. Regular evaluations of blood transfusion practices are conducted 2. Recommend corrective measures, if necessary
What does AABB 3.5.2 say?
So where are the pitfalls????
Are your pitfalls one of the following: 1. Identification of Key Stakeholders? 2. Frequency of Meetings? 3. TMC members understanding of the Purpose/ Goals of the committee? 4. Lack of either the appropriate structure/data/ authority to meet those purpose/goals? 5. Lack of knowledge of how to perform audits? 6. Lack of understanding as to what is appropriate practice? 7. Inability to access federal and provincial adverse event reports?
Key Stakeholders Large group versus Small Group Functionality versus inclusiveness Are all opinions being heard to make effective decisions? Passion versus Peaved Off? Volunteer versus Voluntold
Frequency of Meetings http://memeshappen.com/meme/angry-baby/another-meeting-are-you-kidding-me-70882
Purpose and Goals: A. There may be confusion of members regarding identity and roles! 1. AHS s Provincial TM Network? Since this group guides policy in Alberta, do hospital TMCs just implement? 2. Blood Utilization Committees? -AABB refers more to this, are they the same? Are report card grades all that clinicians/units/scns/cities care about? 3. Patient Blood Management Committees? - High focus at international meetings regarding PBM are they the same? Is it just a catch phrase?
Purpose and Goals: B. Not all TMC TOR are the same Aargh! http://www.transfusionontario.org/media/transfusion%20committee%20toolkit.pdf
Structure/ Data / Authority Hospital versus Zonal versus Provincial Data Transfusion data from the LIS may not link to the Clinical Information service or vice versa Authority - Who can actually make a decision if it impacts more than one department/division?
Audits? https://s-media-cache-ak0.pinimg.com/736x/77/1f/65/771f6565b6dc642a1c505c8590e8c73f.jpg
Appropriate Practice?
Access to Federal and Provincial Adverse Event reports
So after all that can TMCs work?
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Questions?