Clinical Transfusion

2. Establishing and implementing a PBM strategy

The principles of PBM build on strategies for good clinical transfusion practice and lessons from haemovigilance. Many transfusion clinical practice improvement programs are already in place internationally.  It can be helpful to use established practice improvement frameworks, where these exist, and build on them further to establish a PBM strategy.

The World Health Organization (WHO) supports PBM and has identified a number of priorities for action at international, national and hospital level (see reference). WHO has also developed Aides-Mémoire on key topics in transfusion safety to convey important messages to ministries of health and health professionals around safe and appropriate clinical use of blood. These are available here. 

Establishing a PBM strategy needs leadership and support at all levels, from national and regional government policymakers and managers, to executive management and health professionals from various clinical disciplines within hospitals, and active participation by patients. Patient are at the centre of PBM and active participation of patients in the planning, implementation and evaluation of PBM programs is essential. 

A PBM strategy can be built on existing good transfusion practice!

Adapted from AABB.

At an operational level, the cornerstone of a PBM program is the multidisciplinary team.

General practitioners, surgeons, anaesthetists, nurses, haematology/transfusion medicine and laboratory staff all have important roles to play in surgical PBM and should be engaged in the development and implementation of the PBM strategy. In the non-surgical setting, PBM strategies also apply for paediatrics, haematology, obstetrics and other clinical specialties. Many examples of how to develop and establish a PBM strategy and supporting tools and other materials for patients and staff are available, including:

THE KEY ELEMENTS ARE:

At national/regional level:

1. Define a PBM strategy with department of health and executive support

2. Define key areas for action and the potential benefits

3. Define the framework with resources and personnel to support implementation

4. Identify standards that can be used to assess participation and compliance 

5. Develop guidelines and tools to support implementation and monitoring that can be adapted locally by hospitals

Approval received from National Blood Transfusion Committee & NHS Blood and Transplant– no further reproduction without approval.

At hospital level:

1. A hospital PBM policy based on national/regional guidance above supported by the Hospital Transfusion Committee with senior medical/ nursing/ management support

2. Hospital-wide awareness and education

  • Medical, nursing, laboratory staff, in all clinical areas that administer blood and components
  • Identify clinical champions in key disciplines
  • Include in induction for new staff
  • Clear messages: posters, intranet, newsletter

3. Guidelines promoting appropriate use of blood and components and alternatives

4. Inform and involve patients 

5. Review information technology available to support PBM to collect blood usage data, support audit, computerised physician order entry (CPOE) systems

6. Audit and data collection – consider benchmarking internally and externally; feed back data to all relevant teams

Shubha Allard

Shubha Allard

author

E-mail
United Kingdom

Erica Wood

Erica Wood

author

E-mail
Australia

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.