11. The Role of The Transfusion Practitioner

The TP role has been in place in some countries for many years [1,2], and more recently other countries are implementing the role. Much of the TP work is focused on education, transfusion governance, monitoring practice, adverse events management and patient blood management (PBM) [3]. Very often the TP is the conduit for information, pulling together available resources, 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.

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. TPs play an important role in developing a PBM culture within healthcare establishments. They work with the PBM team engaging scientific, laboratory and clinical colleagues to understand the importance of PBM and are often involved in implementing the strategies to support it.

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

There are many different elements that make up PBM, some of which include [4]:

promoting appropriate transfusion practices in line with guidelines
single‐unit transfusion
reducing practices that lead to iatrogenic anaemia
implementing pre‐operative anaemia management pathways and/or anaemia clinics
minimizing surgical blood loss and bleeding
promoting tolerance of anaemia and
use of electronic decision‐making and prescribing tools

TP knowledge and skills allow them to drive some of the above strategies either independently, or working as part of an organisation‐wide team to implement change. Support and endorsement of the multidisciplinary team is required for the TP to drive such changes (4). While the TP has a key role to drive change, experience has shown that where possible the change projects are best lead and owned by the local areas for ongoing success.

Literature supporting the TP role

While the TP role was established in early 2000, peer reviewed literature about the role was some years later. In 2011, Bielby et al. published “The role of the transfusion nurse in the hospital and blood centre” [5]. Puca & Johnson with the support of AABB compiled a book.

‘Transfusion Medicine's Emerging Positions: Transfusion Safety Officers and Patient Blood Management Coordinators’ in 2013 [6].

Miller et al. in 2015 discussed “The Evolving Role of the Transfusion Practitioner” exploring the transition of the TP focus from a quality and safety focus to incorporate PBM [7]. This was followed by Freedman’s publication in 2016 reporting the successes of the Ontario ONTraC (Ontario Nurse Transfusion Coordinators) program where the Transfusion coordinators develop and implement a peri-operative patient blood management program [8].

2018 saw publications from Bielby and Moss [9] “Patient blood management and the importance of the transfusion practitioner role to embed this into practice”, and Bielby et al. “The role of the transfusion practitioner in the multidisciplinary team”[10]. Deelen et al. in 2019 published “Disaster planning: the role of the transfusion practitioner” again highlighting how the TP works with teams to improve health outcomes [11].

To better understand the TP role across ISBT member countries, Dhesi et al. undertook an international TP survey which concluded “the TP is present in many countries; however, the role functions and the activities they undertake are varied” [12]. In 2019, ISBT Science Series highlighted the importance of the TP role in managing anaemia [13].

Much of TPs work is included in reports and publications that are readily available, but TPs are encouraged to share and publish their work in peer reviewed literature.

Blood management/Hospital transfusion committees play a key role in blood conservation of which TPs play an important role

TPs play an important role within the Blood management/Hospital transfusion committees (BMC) structure [14] and more information about these can be found on the ISBT Blood Management Committee pages ISBT: Clinical Transfusion Evidence does exist for improved use of blood components due to interventions such as transfusion policies, clinical audits, education of clinicians [12].

Promoting the TP role

Since 2015 ISBT has supported the TP role by creating a TP Forum (under the umbrella of the Clinical Transfusion Working Party). This forum, led by a small Steering Group, provides support and information for all TPs, and those institutions who are planning on implementing the role, through both online resources and TP sessions at Congress. ISBT appreciate the significant contribution that Transfusion Practitioners make to patients and the health care professionals managing all parts of the transfusion process.

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

The role of the TP is recognised as a driver to implement and drive PBM with the support of medical staff [9]. 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) [15] 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, organisations have been able to contribute to higher levels of compliance with respect to audit and inspection.

Data from one of the Australian haemovigilance programs STIR [16] also supports the key role that the TP plays in the management of haemovigilance in the healthcare setting including the investigating, reporting and provision of education.