Clinical Transfusion

10. The Role of The Transfusion Practitioner

Introduction

The Transfusion Practitioner (TP) or equivalent (e.g. Transfusion Safety Officer, Haemovigilance Officer, PBM Practitioner/Nurse, etc - herein referred to as TP) has a critical role to play in developing a patient blood Management (PBM) culture within healthcare establishments. Although only one part of the team needed to develop and implement the required PBM strategies (see below), they have a multifaceted role to play in engaging with both scientific, laboratory and clinical colleagues. PBM requires a multi-disciplinary approach and a primary role of the TP is to promote safe and appropriate use of blood to clinical colleagues within and outside of the laboratory.  Very often the TP is the conduit for information pulling together available resources both financial and personnel, reviewing activities undertaken by transfusion colleagues in other centres, collecting audit data and evaluating how these activities might be beneficial within their own healthcare establishment. 

TPs have made a significant contribution in helping to improve transfusion practice at a local, regional and national level by promoting safe transfusion practice

It is widely understood that the TP has a very valuable role to play within PBM. To do this, information must be taken to clinical colleagues to engage with them and plan strategies. The many different elements that make up PBM can be tailored for the different clinical specialties that use blood transfusion services and through good clinical leadership, the TP can coordinate a number of initiatives and work streams such as pre-surgery optimisation, medical use of blood in iron deficient anaemia or electronic solutions for blood ordering and prescribing blood and blood components. The TP should not lead these projects as it would seem best practice that they are owned and managed at a local level by the users of blood, but the TP has the essential role of having a global view of PBM and the benefits it brings. 

Evidence base to support

Currently there is a lack of evidence on the role of the TP within Patient Blood Management and much of the information collected below is anecdotal. It is acknowledged that a greater focus of the role of the TP in PBM is needed within the printed material and resources available, however it is widely understood that the TP has a very valuable role to play within PBM.

In the UK the TP role was recommended as part of the Department of Health Better Blood Transfusion strategy, highlighted within three Health Service Circulars published between 1998-2007 [2-4]. It was expected this role would work as part of Hospital Transfusion Team, made up with the Transfusion Laboratory Manager and Consultant in charge of blood transfusion. Over the intervening years most UK Trusts appointed to the Transfusion Practitioner role, employing experienced staff with a Nursing, Midwifery or Biomedical Science background. 

Red cell use between 1999 and 2009 fell by 18%

As shown by repeated surveys in the North East of England (population 2.85M). The change was entirely due to a reduction in use of surgical patients. Over the same period there was also a wide spread introduction of TPs as liaison between Blood Transfusion Laboratories and wards [5]. However, no evidence exists of the direct impact of TP introduction during these years. A 2010 TP survey in England and North Wales stated that TPs have made a significant contribution in helping to improve transfusion practice at a local, regional and national level by promoting safe transfusion practice, the appropriate use of blood in medical and surgical patients, reducing wastage and increasing patient and public involvement ensuring that Better Blood Transfusion (the UK Department of Health initiative before PBM) has become an integral part of NHS care. 

In Scotland TPs took up post in 2003 and by 2013 the Scottish National Blood Transfusion Service saved 105,000 units of blood through reduced use [6]. A number of other interventions were also implemented during this time. Dalrymple and Watson [7] wrote an article covering 10 years of TPs and Better Blood Transfusion and highlighted where TPs added value with changes that have taken place with regards to training and education, transfusion safety and clinical practice. 

Hospital Transfusion Committees play a key role in blood conservation of which TPs play a major role

TPs play a major role within Hospital/Trust Transfusion/ Blood Committees (HTC, also known as Blood Utilisation Committees and some rebranding occurring to be called PBM Committees). HTCs play a key role in blood conservation [8]. Evidence does exist for improved use of blood components due to interventions such as transfusion policies, clinical audits, education of clinicians [8].

Australia has established strong networks of transfusion practice improvement with collaborative working at state and territory level to focus on PBM. Establishing the hospital TP role was a key component of the early work of the collaborative. An active network of TPs exists across Australia and New Zealand, who share ideas and best practice and provide support for those new to the role [9]. Again, no clear evidence on the TP role and contribution to PBM was evaluated. RBC use has fallen significantly in Australia however this is not published in the peer review literature but has been presented at a number of conferences. This is also a common trend in New Zealand and USA.

TPs added value with regards to training and education, transfusion safety and clinical practice

The role of the TP is recognised as a driver to implement and drive PBM with the support of medical staff [10]. There are varying ways that the PBM responsibility is being established in Australia by either creating dedicated PBM positions or incorporating it as part of the responsibility into existing roles e.g. TP role or the pre- anaesthetic clinic nurse role. 

Data from the Serious Hazards of Transfusion Scheme (SHOT) shows a growing safety culture in hospitals with respect to transfusion with the number of deaths directly attributable to transfusion reducing from 12 in 1996 to 1 in 2009. Red cell usage also fell by 15% from 2002 to 2007, thought largely due to a reduction in inappropriate use. Through the work of the Hospital Transfusion Team, of which the TP is a key member, Trusts have been able to contribute to higher levels of compliance with respect to audit and inspection, such as the NHS Litigation Authority (NHSLA) Risk Management Standards and so contributing to significant financial savings for the NHS. 

Data from one of the Australian haemovigilance programs STIR. (Serious Transfusion Incident Reporting) [11] also supports the key role that the TP plays in the management of haemo - vigilance in the healthcare setting including the investigating, reporting and provision of education.

However, it also indicated that the role and responsibility of the TP varies widely and has changed significantly for most since it was introduced. There is significant variation in how TPs spend their time whereby 87% of TPs surveyed spent less than 10% of their time on reducing inappropriate use and 91% spent less than 10% of their time implementing alternatives to transfusion [12]. Another survey on PBM practice by the NBTC in 2013 found that 75% of TPs spend 30% or less of their time on PBM activities [13]. There was not an analysis on the impact of PBM related to these figures in the survey. 

Through the work of the Hospital Transfusion Team, of which the TP is a key member, Trusts have been able to contribute to higher levels of compliance with respect to audit and inspection, therefore, leading to significant financial savings

Useful Resources

A book by the AABB ’Transfusion Medicine’s Emerging Positions: Transfusion Safety Officers and Patient Blood Management Coordinators’ is intended to provide guidance on such positions (whether hospital-based or blood-centre-based), the professionals who make good candidates, the scope of their responsibilities, their key role in improving patient outcomes and the influence they have on various hospital departments.  

  1. The 2013 Annual Serious Hazards of Transfusion (SHOT) Report PHB Bolton-Maggs (Ed) et al on behalf of SHOT Steering Group 2014.
  2. Department of Health’s Better Blood Transfusion (BBT) Health Service Circular - Better Blood Transfusion, Safe and Appropriate Use of Blood. HSC 2007/001 . 2007.
  3. Department of Health’s Better Blood Transfusion (BBT) Health Service Circular - Better Blood Transfusion, Safe and Appropriate Use of Blood. HSC 2002/009 . 2002.
  4. Department of Health’s Better Blood Transfusion (BBT) Health Service Circular - Better Blood Transfusion. HSC 1998/224 . 1998.
  5. Ten-year pattern of red blood cell use in the North of England. Tinegate H, Chattree S et al. Transfusion 2013, 53 (483).
  6. A Decade of Blood Transfusion in Scotland. NHS National Services in Scotland (Powerpoint presentation at BBTS). Cottrell S et al. 2013
  7. Ten years of transfusion practitioners and better blood transfusion in Scotland. Dalrymple K and Watson D. Nurs Manage 2014; 20 (10), 27-30.
  8. The role of hospital transfusion committees in blood product conservation. Haynes SL et al. Transfus Med Rev 2004: 18 (2), 93-104.
  9. The role of the transfusion nurse in the hospital and blood Centre. L. Bielby et al. ISBT Science Series 2011; 6(2), 270–276.
  10. The Evolving Role of the Transfusion Practitioner. Miller K et al. Transfus Med Rev 2015; 29 (2), 138-144.
  11. Serious transfusion incident report 2009-11. Dept. of Health. 2011.
  12. 2010 TO survey in England and North Wales. National Blood Transfusion Committee. 2011.
  13. National Blood Transfusion Committee (2014). . .
Rachel Moss

Rachel Moss

author

E-mail
United Kingdom

Amanpreet Dhesi

Amanpreet Dhesi

author

E-mail
United Kingdom

Disclaimer

The content of this resource has been developed and reviewed by members of the ISBT Clinical Transfusion Working Party and should be used at the discretion of healthcare professionals utilising this clinical resource. The authors or the International Society of Blood Transfusion cannot accept legal responsibility for the content of this resource.