The administration of blood components: a British Society for Haematology Guideline
This guideline was compiled according to the BSH process at http://www.b-s-h.org.uk/guidelines/. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) nomenclature was used to evaluate the levels of evidence and to assess the strength of recommendations. The GRADE criteria can be found at http://www.gradeworkinggroup.org. This guideline represents the minimum requirements for the safe administration of blood component transfusions. These are intended to provide the foundations for organisations to build on when developing their own local policies and guidelines. However, it should be recognised that the more complex the procedures are, the more open to error they become. A search of the published literature was undertaken using MEDLINE, EMBASE, CINAHL, the Cochrane Library and the Internet using search terms (and relevant MESH terms) blood, transfusion, administration, documentation, patient, identification, safety, error, consent, authorisation, prescription, electronic, information technology, bar code, duration, 30 min, 4 h, bacteria, monitoring and observations. This search covered the period from January 2009 (since the last version of this guideline) to January 2015 and was limited to English language. There is very little high-quality evidence to prove the efficacy of many of the specific interventions and procedures to improve the safety of the administration of blood components, and so professional experience and expert opinion of the writing group were also employed. The review of the manuscript was performed by the British Society for Haematology (BSH) Guidelines Committee Transfusion Task Force, the BSH Guidelines Committee and the transfusion sounding board of BSH. It was also on the member section of the BSH website for comment. It has also been reviewed by the members of the British Blood Transfusion Society (BBTS), including the BBTS Transfusion Practitioner Special Interest Group, the Serious Hazards of Transfusion (SHOT) and the National Blood Transfusion Committee (NBTC), including the NBTC Patient Involvement Working Group and the Royal College of Midwives. These organisations do not necessarily approve or endorse the contents. Errors in the requesting, blood sampling, collection and administration of blood components (red blood cells, platelets and plasma components) lead to significant risks for patients. Since its launch in 1996, the Serious Hazards of Transfusion (SHOT) scheme has continually shown that ‘incorrect blood component transfused’ episodes are a frequently reported transfusion hazard. These wrong blood incidents are mainly due to human error leading to misidentification of the patient and can lead to life-threatening haemolytic transfusion reactions and other significant morbidities. The National Comparative Audits (NCA) of England and Wales (2003, 2005, 2009, 2011) have shown that patients are placed at risk of avoidable complications of transfusion through misidentification and inadequate monitoring. This guidance concerns transfusion of all blood components (red blood cells, platelets, fresh-frozen plasma, cryoprecipitate and granulocytes), regardless of whether patients are being transfused in hospital or in the community. This guidance does not relate to autologous cell-salvaged blood, for which additional aspects need to be considered (guidance is available from the UK Cell Salvage Action Group (UKCSAG) at http://www.transfusionguidelines.org/transfusion-practice/uk-cell-salvage-action-group). A key action point summary of this guideline is available in Fig. 1. For additional neonatal or paediatric guidance, refer to the BSH guidelines on transfusion for fetuses, neonates and older children (New et al., 2016). The Blood Safety and Quality Regulations (BSQR SI 2005 No.50 as amended) define blood components as a therapeutic constituent of blood [red blood cells, platelets, fresh-frozen plasma (FFP), cryoprecipitate or granulocytes], whereas blood products are derived from the whole blood or plasma [e.g. solvent detergent (SD)-FFP, albumin and anti-D immunoglobulin] and are classed as medicinal products. Blood components are excluded from the legal definition of medicinal products (The Human Medicines Regulations, 2012) and must be ‘authorised’ rather than ‘prescribed’ (Pirie & Green, 2008). Because SD-FFP is classed as a product, it must therefore be prescribed. However, the rest of the administration process for SD-FFP should follow the same guidelines as for blood components. It is imperative that patients are robustly and correctly identified at all stages of the transfusion process and that all spelling and number sequences on the patient ID band and all transfusion-associated documentation are correct and legible. For the purpose of this guideline, the term ‘patient ID band’ will be used to include all other terminologies (e.g. wristband) and any other forms of risk-assessed patient ID (e.g. photograph ID cards). Additional identifiers, such as address, middle name or gender, may be required according to the local policy and should be considered wherever core identifiers are referred to throughout this document. Initial patient ID on arrival to an outpatient or inpatient facility is a key step, ensuring that the right patient is issued with the correct ID band (Davies et al., 2006; Callum et al., 2011). There should be robust local policies the and of patient ID It may be to ID in patient (e.g. neonates or patients to may be It is that all patients a transfusion are identified using an patient ID band risk-assessed which is to the the patient ID band is for any it should be the of the it to it are available to improve patient ID The patient core identifiers may also on the patient ID band in an (e.g. bar or information patient safety (Davies et al., 2006; et al., et al., et al., et al., they should be robustly and to that patient safety is and that the are not open to any risks and do not to (Davies et al., 2006; et al., 2006; et al., et al., et al., et al., information on the of in transfusion is available in the BSH guidelines for the and of in hospital transfusion et al., to continually improve transfusion all significant or identified risks should be reported to the such as a at patient a ID with the gender, must be There must be robust for the and of ID and for the of any and transfusion are available in the BSH guidelines for the of et al., and the BSH guidelines for procedures in blood transfusion et al., ID are organisations should as Blood Transfusion Committee (NBTC), ID on a and patients in the It is imperative that the patient ID is and as correct at of the transfusion patients be to their name and last and of local policy they should also be to their their This must the information on the patient ID band and any other documentation required at that of the transfusion The ID number on their ID band must also This is the patient ID For paediatric it is to the to the is to For any patient is considered to or (e.g. paediatric patients are to or or is a additional in patient ID must be and local hospital ID policies should be and For organisations may of the patient ID to be from a or at the organisations blood should have a local policy or guideline that in the transfusion should be available the at the of the transfusion documentation in the should include the documentation should include the patient core The of transfusion to this information is Errors in the transfusion process inadequate and and as as with the patient, is a of safe and should be in to the risk of or that may with There is a that of all in the blood transfusion process the they are is for transfusion There is very little evidence to the of in to and a risk-assessed to such as of transfusion in their on their own should be with their other relevant and transfusion-associated error the may be for or should be at BSH guidelines that all in the transfusion process should for this was and on by the National Patient Safety Since this has to incidents and and has reported that being transfusion Transfusion the UK have reviewed and have their own for and are in 1. to the 2005 amended) that all in the collection and of blood components The Medicines and are for monitoring with in the UK have that the for blood components should be in a that is with the of risks with the process should be at Blood 2008). in the transfusion process should frequently than for blood and should be performed at for blood for in collection of blood from the with of as in with the for other in administration of monitoring of of all relevant through the Quality for Blood Transfusion a for all in the transfusion reviewed and the It has been recognised that the for all in the transfusion process is in and reported on by Blood Transfusion to the Transfusion Committee has been by requirements for and in transfusion should be in Patient Blood in blood components and their for for blood components. should their of transfusion that is relevant to their and be to evidence of this in their of relevant evidence of for in the transfusion by must be at a minimum of in the collection and of blood components should for this at The to must be on the of the patient and or The and for the to and the specific blood components to be transfused should be in the A more guidance for the of blood components is available in other BSH guidelines and in the of Transfusion There have been a number of incidents reported to to transfusion-associated and in patients patients with patients more than of and with that to including and The of the patient should include an of the and when the and of a transfusion and whether a should be prescribed. that a risk for should be performed as is the reported of and The of and risks and of of risk may by the of or the transfusion For patients identified at risk of a should be that the administration of blood components, specific should be to monitoring the patient for of including blood are for and for on for children or with do not have with to whether additional transfusion is The that of blood in by should be as an for a For of a of 4 of blood in will an of should be in according to the BSH guidelines on transfusion for fetuses, neonates and older children (New et al., and be in The of patient information to patients may have or have a transfusion is also by This guideline does not to provide specific guidance to the of or The from the for and for children of should be to 2008). The of for transfusion, as by should be for and transfusion of all or specific blood components is or an this should be in the and to all relevant procedures specific to be should be and Blood components are excluded from the legal definition of medicinal products (The Human Medicines Regulations, 2012) and must be ‘authorised’ rather than ‘prescribed’ (Pirie & Green, 2008). this guidance to of blood components and not There are legal to any and being to blood component to or blood components should be by the the to Blood components should not be to the transfusion for the and of blood components a and the and the transfusion should be in or to the risk of or that may be with for components are should be a for the transfusion which for with the in the of is in the BSH guidelines for the of et al., Transfusion should have a policy to be minimum requirements are not or inadequate patient leading to a for blood being or the wrong patient may in a of which have in complications or patients a blood must be The collection of the blood from the patient and the of on the blood must be performed as at the patient and and member of The core patient identifiers on the must on the and the patient ID the outpatient or patient ID may not be used at the of However, patients must be identified using a risk-assessed must be or from the patient or from the must not be used to transfusion blood for that are to the patient and to the at the of by the the blood are policies or guidelines should blood should be to and by the transfusion in a including and should also have a blood which of as in the BSH guidelines for procedures in blood transfusion et al., These guidelines also that patient ID are in a blood should be for of the group of a patient to transfusion, this does not the of blood components. 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should be at with to should last than h, and the the should be than platelets are from a the of to and of should be can be the same that any to or is than the These components, which are issued on a patient are at can be that patient the of that to correctly the of the blood component with the patient to administration patients at risk of the wrong blood Blood components must be by and must be to whether are available to the patient throughout the transfusion by are in the of transfused including transfusion reactions and the of on the and of transfusion et al., 2012) and that are of should be risk-assessed available and including should be with the same to patient the of or has that at must is a and are to safe transfusion, including all required patient in this However, it is to that is a risk of error at et al., et al., et al., is to should be to of transfusion to the A review et al., found evidence to a or There is evidence from to that is than local policy a should all the The 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The BSH Transfusion Task members at the of writing this guideline were and The the transfusion sounding board of BSH and the BSH Guidelines Committee for their in this The BSH the the writing of this have a of to the BSH and Task which may be on The members of the writing group have of to The members of the writing group will the writing group any evidence available that the strength of the in this or it The will be reviewed by the relevant Task Force, and the literature search will be to search for any evidence that may have been The will be and from the BSH guidelines website it are an will be published on the BSH guidelines website the and information in this guidance are to be and at the of to the and the BSH the any legal for the of this website for blood that have been of for than 30 and than the are to specific the of blood to 30 min, any in procedures to this must be by a risk by hospital to that are or This to the that such a risk and safe of procedures to the of blood These are than 30 is the for the of blood as for a patient or to that are that criteria are it is the that blood are not to be used they are as as 30 from of Transfusion to they to the hospital this so that they may be to from it to blood are they of blood It is that the required for to be are to many and hospital policy should 30 for with for 30 and the of the transfusion blood 30 blood to 30 will need to that core to to be identified as being the period and from being to a patient or being in for a minimum of any of the are required to be the period has been the should using an process to of blood to a patient in that blood are for core to this be by an blood it may be in to a that the to when a is placed and at it available for and many 30 an blood has this be by an blood it may be to a that when are to is identified and on the in The have to be and and procedures have to that been the not be for a of more than 30 There must be evidence with of blood of and of the of the of the any should be should be on blood on the or on the blood a is being this must be and available for the required period of are used to the of blood 30 and min, they must be to all including and and of