Irradiation of blood components for the prevention of transfusion-associated graft-versus-host disease RIGHT COMPONENT TO RIGHT PATIENT SURVEY
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1 Irradiation of blood components for the prevention of transfusion-associated graft-versus-host disease RIGHT COMPONENT TO RIGHT PATIENT SURVEY Presented by Andrea Blest Transfusion Liaison Nurse 20 th November 2007
2 Irradiated Blood Components Right Blood to Right Patient The BCSH Guidelines on gamma irradiation of blood components for the prevention of transfusion-associated graft-versus-host disease (1996) states: Gamma irradiation is currently the only recommended method for TA-GVHD prevention. Leucodepletion by current filtration technology is inadequate for this purpose. For at-risk patients, all red cell, platelet and granulocyte transfusions should be irradiated.
3 SHOT report incidents / reports related to irradiated blood components Actual incidents 106 Near miss reports 45 SHOT recommendations in 2004 and 2005 have emphasised that: Mechanisms must be put in place for appropriate and timely communication for information regarding special transfusion requirements Robust systems for noting patients special requirements should be developed together with a policy of empowering patients to be more aware of their own special needs
4 Irradiated Blood Components Right Blood to Right Patient Survey The survey was sent to hospitals in England, Wales, Northern Ireland and Scotland (via the blood services). In England, the results were collated by the RTC administrators. In Wales, Northern Ireland and Scotland results were collated by the blood services. Policies Mechanisms Communications Documentation Patient Information
5 Country England (inc North Wales) Wales 8 Northern Ireland 4 Scotland 15 Total 163 Responses received 136 (133 / 3 ) NHS 14 Private 2 private hospitals responded that they did not use irradiated blood products. Therefore the results given are for 161 responses.
6 Who receives irradiated blood components? Yes n=161 Policy Allograft 151 (93.8%) 125 / 151 (82.8%) Autograft 153 (95.0%) 124 / 153 (81.0%) Purine Analogues 158 (98.1%) 126 / 158 (79.7%) Hodgkins 154 (95.6%) 127 / 154 (82.5%)
7 Variation in duration Purine Analogues - Duration n=124 3 months (2) 6 months (17) 1 year (4) 2 years (5) Indefinitely (90) Other (7) Allogeneic - Duration n= months 6 months 1 year 2 years Indefinitely Other
8 When is the laboratory informed? When is the laboratory informed? (n=161) Immediately 121 (75%) Wait 23 (14%) Both 9 (5.5%) Neither 8 (5.5%)
9 How is the laboratory informed? Methods of informing the laboratory Method Series1 Policy Series2 Telephone Paper Auto download Speak directly Fax Other
10 How is the requirement for irradiated blood components recorded? (36%) not identifiable on front of notes 31 (19%) general entry in notes only no specific documentation area 14 (9%) No entry in medical notes Front notes - hand written Front notes - sticker Specific area in notes General entry in notes Other
11 What about the nursing notes? Only 42 / 161 (26.7%) stated that there was a specific area of the nursing documentation where the requirement for irradiated blood components is documented.
12 Does your hospital blood administration policy state that special requirements must be checked as part of the final bedside check? Yes 120 (74.5%) No 34 (21.2%) DNA 7 (4.3%)
13 Does the laboratory IT system flag up the need for irradiated blood components? n=161 Yes 142 (95.4%) No 6 (3.0%) DNA 3 (1.6%)
14
15 Are patients informed that they need irradiated blood components? n=161 Yes 138 (85.7%) No 18 (11.5%) DNA 5 (2.8%)
16 Who informs patients? n=138 (patients are informed) Series1 Series2 Policy Consultant Other Medic Nurse Practitioner Other Nurse Other
17 Are patients given any written information? n=138 (patients are informed) Yes 130 No 8
18 What written information is used? NBS 1 Policy Own 2Policy
19 Are patients given an alert card to carry? n=161 Yes 115 (71.4%) No 38 (23.6%) DNA 8 (5%)
20 Shared care : do you have a mechanism for informing other departments / hospitals within your Trust? Mechanism shared care within own Trust n = 161 Yes 78 (48.4%) No 64 (39.8%) DNA 19 (11.8%)
21 Shared care : do you have a mechanism for informing other Trusts? Mechanism shared care with other Trusts n = 161 Yes 62 (38.5%) No 86 (53.4%) DNA 13 (8.1%)
22 Failures of the mechanisms in place Failures within own Trust n = 16 1 Yes 104 (64.6%) Actual incidents / near misses No 52 (32.3%) n = 161 DNA 5 (3.1%) Yes 122 (75.8%) No 26 (16.1%) DNA 13 (8.1%)
23 Failures of the mechanisms in place Failures from own Trust to other Trusts n = 161 Yes 32 (19.9%) Failures No 110 from (68.3%) other Trusts to own Trust n = 161 DNA 19 (11.8%) Yes 70 (43.5%) No 72 (44.7%) DNA 19 (11.8%)
24 How many incidents have occurred? 12 months actual NK DNA 12 months near miss NK DNA 5 years actual NK DNA 5 years near miss NK DNA
25 Very poor in practice Additional comments poor documentation Time scales vary and are dependant on clinician This survey has exposed how woefully inadequate our policy is.. Main system failure is failure to notify blood bank No formal mechanisms.
26 National and regional reports are being produced. available soon
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