- Email: [email protected]
Quality in blood collection
264
Transfus. Sci.
Vol. 15, No. 3
analysis of both successful and unsuccessful donations at all stages. The overall responsibility for the conduct of blood or apheresis donor sessions rests with the Regional Transfusion Director but the immediate responsibility is that of the sessional doctor or senior nurse. Each Transfusion Center should prepare a detailed procedures manual, adhering to available guidelines, that includes Standard Operating Procedures for all relevant tasks. This should ensure correct donor, donation and sample identification, selection and handling of the correct blood packs, proper determination of the donor hemoglobin and performance of venepuncture. It is now accepted that suitably trained nurses may take charge of donor sessions. In the South West Region we are replacing Sessional Medical Officers with Nurse Team Managers. They must be suitably trained and a detailed and demanding program is provided. This covers aspects of general education in the purpose and practices of the Transfusion Center as well as an understanding of patient needs and the use of blood products. Specific training in donor selection and care, sterile technique, venepuncture and other aspects of sessional management is given. A certificate of professional competence is given to nurses who successfully complete written and practical tests. Training for doctors undertaking Sessional Medical Officer duties is less comprehensive. Although proper selection of donors is essential, many of the criteria used are purely arbitrary and differ markedly, e.g. between current UKBTS guidelines and AABB standards in some aspects. Different donor selection criteria apply to apheresis donors (lower age; more tests; frequency of donation). In addition, specific guidelines regarding cell separator type, maintenance, type of procedure and citing of procedures help to ensure both donor safety and the quality of collected platelets and plasma. Training and certification of apheresis operators (doctors, nurses, apheresis assistant or technical staff) is essential. QUALITY IN BLOOD COLLECTION J.A. Jenkins, V.J. Mar-dew Mersey and North Wales Regional Blood Service, Liverpool, U.K. The quality chain of events in blood collection proceeds from the planning and publicity of a session through to the actual venesection of the selected donor. Everyone involved in this chain needs to appreciate their ownership of quality in order to effect continual improvement, and this is being reinforced through internal and external audit. This poster describes some of the activities that the Mersey and N. Wales Blood Service (MNWBS) have undertaken in order to improve quality in blood collection. Session Site Selection l l l
Availability of sites/use of mobile collection vehicles. Target population-performance figures for area. Audit of sites through: Initial visit by organizer (documented). Feedback on session site information form. Environmental monitoring (external). Internal quality audit. Medical Officer’s report. Periodic donor questionnaire.
Intemational Forum
Public Relations Bilingual material. Advertising-posters, media, radio etc. Targeting schools and 18-year-olds on the electoral register. Questionnaires to monitor effectiveness of campaigns. Special correspondence with donor. Session Layout Signposting and directions, inside and outside. Adequate segregation and logical flow of activities-allocation screening particularly for privacy for donor questioning. Prominently displayed notices and information.
of space and
Donor Enrolment Ability to communicate with all donors including those with hearing, sight and speech difficulties and those who may be illiterate. Specific training is being sought for hearing difficulties. Braille NBTS 110 form and AIDS leaflets are available in MNWBS. MNWBS employ local Welsh speaking people for blood collection in N. Wales, essential in the Gwynnedd region. Initial positive donor identification, general health and travel questions by Clerk. Routinely further questioning is carried out by Team Leader and Medical Officer. Questionnaires are being trialled in N. Wales involving interview by Medical Officer/Registered Nurse, and donors’ opinion is being sought. Feedback has been mostly positive so far, but there are difficulties when the mobile collection bus is used. Confidential medical referral system allows further investigation and correspondence between the Centre Consultant and the donor’s GP (1989). Donor document (session slip) revised to provide traceability of personnel and actions (1993). Hemoglobinometry Verify donor’s identity and confirm that donor is healthy and not on any medication. Confirm donor has eaten. If not donor is referred for refreshment before proceeding. Control and documentation of copper sulphate screen/Hemocue. Northern Division Audit initiative - local applications of copper sulphate screen (Trial; drop: volume ratio 19921, (Trial; timed drop 1993). Films of all abnormal counts reviewed by Consultant Hematologist for communication to GP. Blood Collection Cleanliness of hands and equipment-microbiological monitoring have enabled a standard to be set for this centre. Check weighing balances-automated device trial ( 1992). Reassure donor/put at ease-person to person training. Confirmation of identity and general health. Check blood pressure ( 1989).
results
265
266 i”zmsfus.Sci. Vol. 15,No. 3
Prepare and disinfect arm-results of pre- and postdisinfection demonstrate effectiveness of procedure. Venepuncture by trained staff-audit of incomplete donations effectiveness (2% reduction in 1992). Record donation codes/fate on session slip. Post Donation
monitoring to measure
Care
Rest and escort donor to refreshment area. Monitor donor closely and offer any advice as appropriate. Donor/Donation
Documentation
and Quality Checks
Au independent check that labels on the session slip, blood packs and sample tubes are identical for each donation and that documents are completed fully. Any anomalies referred back to the Team Leader. Temperature records (min/max) for the session period, and the number of donations to be returned to the centre. Batch records of critical items-blood packs, local anesthetic and copper sulphate.
QUALITY IN PROCESSING AND AUTOMATION N.P. Tandy, D. Edhondson Regional Blood Transfusion Service, Bristol, U.K. Demands placed on the Transfusion Service for increasing numbers, and improved purity of therapeutic platelet concentrates has involved significant and profound logistic changes to platelet production. More recently there is an increasing requirement to remove contaminating leucocytes from platelet products, to reduce adverse effects in the recipient population, these are (1) viral reactivation (2) HLA alloimmunization and (3) immunomodulation, caused through multiple donor exposure. A consensus report produced by the Royal College of Physicians of Edinburgh, has indicated that a residual level of <5 x lo6 leucocytes per “dose” of platelets will ameliorate or prevent the onset of these adverse reactions. A “dose” (or adult therapeutic dose] is estimated as 3.0 x 10” platelets (F.D.A. regulations) in 75% of product. This then sets the standard and quality of product required. Historically this has only been achievable by the filtration of platelets to deplete unwanted leucocytes, but this has attracted additional cost and administration problems. More recently the development of plateletpheresis systems has been encouraged which can produce product of the required standard (e.g. Cobe Spectra etc.) and in addition reduce the number of donor exposures to the recipient. The limitation on these procedures are primarily associated with donor availability, apart from the overall resources implications to staff and training. It is likely therefore that platelet production will still have to be derived from single blood donations, and interest is currently directed to the technique of buffy coat removal, pioneered by Pietersz. This has been developed into a routine larger scale “Bottom and Top” platelet production system by Hogman. A system of pooling 4 or 5 buffy coats, and separating “pure” platelets can now be achieved using automated or semi-automated procedures, i.e. Baxter Optipress, Biotrans separator, NPBI Compomat.
Transfus. Sci.
Vol. 15, No. 3
analysis of both successful and unsuccessful donations at all stages. The overall responsibility for the conduct of blood or apheresis donor sessions rests with the Regional Transfusion Director but the immediate responsibility is that of the sessional doctor or senior nurse. Each Transfusion Center should prepare a detailed procedures manual, adhering to available guidelines, that includes Standard Operating Procedures for all relevant tasks. This should ensure correct donor, donation and sample identification, selection and handling of the correct blood packs, proper determination of the donor hemoglobin and performance of venepuncture. It is now accepted that suitably trained nurses may take charge of donor sessions. In the South West Region we are replacing Sessional Medical Officers with Nurse Team Managers. They must be suitably trained and a detailed and demanding program is provided. This covers aspects of general education in the purpose and practices of the Transfusion Center as well as an understanding of patient needs and the use of blood products. Specific training in donor selection and care, sterile technique, venepuncture and other aspects of sessional management is given. A certificate of professional competence is given to nurses who successfully complete written and practical tests. Training for doctors undertaking Sessional Medical Officer duties is less comprehensive. Although proper selection of donors is essential, many of the criteria used are purely arbitrary and differ markedly, e.g. between current UKBTS guidelines and AABB standards in some aspects. Different donor selection criteria apply to apheresis donors (lower age; more tests; frequency of donation). In addition, specific guidelines regarding cell separator type, maintenance, type of procedure and citing of procedures help to ensure both donor safety and the quality of collected platelets and plasma. Training and certification of apheresis operators (doctors, nurses, apheresis assistant or technical staff) is essential. QUALITY IN BLOOD COLLECTION J.A. Jenkins, V.J. Mar-dew Mersey and North Wales Regional Blood Service, Liverpool, U.K. The quality chain of events in blood collection proceeds from the planning and publicity of a session through to the actual venesection of the selected donor. Everyone involved in this chain needs to appreciate their ownership of quality in order to effect continual improvement, and this is being reinforced through internal and external audit. This poster describes some of the activities that the Mersey and N. Wales Blood Service (MNWBS) have undertaken in order to improve quality in blood collection. Session Site Selection l l l
Availability of sites/use of mobile collection vehicles. Target population-performance figures for area. Audit of sites through: Initial visit by organizer (documented). Feedback on session site information form. Environmental monitoring (external). Internal quality audit. Medical Officer’s report. Periodic donor questionnaire.
Intemational Forum
Public Relations Bilingual material. Advertising-posters, media, radio etc. Targeting schools and 18-year-olds on the electoral register. Questionnaires to monitor effectiveness of campaigns. Special correspondence with donor. Session Layout Signposting and directions, inside and outside. Adequate segregation and logical flow of activities-allocation screening particularly for privacy for donor questioning. Prominently displayed notices and information.
of space and
Donor Enrolment Ability to communicate with all donors including those with hearing, sight and speech difficulties and those who may be illiterate. Specific training is being sought for hearing difficulties. Braille NBTS 110 form and AIDS leaflets are available in MNWBS. MNWBS employ local Welsh speaking people for blood collection in N. Wales, essential in the Gwynnedd region. Initial positive donor identification, general health and travel questions by Clerk. Routinely further questioning is carried out by Team Leader and Medical Officer. Questionnaires are being trialled in N. Wales involving interview by Medical Officer/Registered Nurse, and donors’ opinion is being sought. Feedback has been mostly positive so far, but there are difficulties when the mobile collection bus is used. Confidential medical referral system allows further investigation and correspondence between the Centre Consultant and the donor’s GP (1989). Donor document (session slip) revised to provide traceability of personnel and actions (1993). Hemoglobinometry Verify donor’s identity and confirm that donor is healthy and not on any medication. Confirm donor has eaten. If not donor is referred for refreshment before proceeding. Control and documentation of copper sulphate screen/Hemocue. Northern Division Audit initiative - local applications of copper sulphate screen (Trial; drop: volume ratio 19921, (Trial; timed drop 1993). Films of all abnormal counts reviewed by Consultant Hematologist for communication to GP. Blood Collection Cleanliness of hands and equipment-microbiological monitoring have enabled a standard to be set for this centre. Check weighing balances-automated device trial ( 1992). Reassure donor/put at ease-person to person training. Confirmation of identity and general health. Check blood pressure ( 1989).
results
265
266 i”zmsfus.Sci. Vol. 15,No. 3
Prepare and disinfect arm-results of pre- and postdisinfection demonstrate effectiveness of procedure. Venepuncture by trained staff-audit of incomplete donations effectiveness (2% reduction in 1992). Record donation codes/fate on session slip. Post Donation
monitoring to measure
Care
Rest and escort donor to refreshment area. Monitor donor closely and offer any advice as appropriate. Donor/Donation
Documentation
and Quality Checks
Au independent check that labels on the session slip, blood packs and sample tubes are identical for each donation and that documents are completed fully. Any anomalies referred back to the Team Leader. Temperature records (min/max) for the session period, and the number of donations to be returned to the centre. Batch records of critical items-blood packs, local anesthetic and copper sulphate.
QUALITY IN PROCESSING AND AUTOMATION N.P. Tandy, D. Edhondson Regional Blood Transfusion Service, Bristol, U.K. Demands placed on the Transfusion Service for increasing numbers, and improved purity of therapeutic platelet concentrates has involved significant and profound logistic changes to platelet production. More recently there is an increasing requirement to remove contaminating leucocytes from platelet products, to reduce adverse effects in the recipient population, these are (1) viral reactivation (2) HLA alloimmunization and (3) immunomodulation, caused through multiple donor exposure. A consensus report produced by the Royal College of Physicians of Edinburgh, has indicated that a residual level of <5 x lo6 leucocytes per “dose” of platelets will ameliorate or prevent the onset of these adverse reactions. A “dose” (or adult therapeutic dose] is estimated as 3.0 x 10” platelets (F.D.A. regulations) in 75% of product. This then sets the standard and quality of product required. Historically this has only been achievable by the filtration of platelets to deplete unwanted leucocytes, but this has attracted additional cost and administration problems. More recently the development of plateletpheresis systems has been encouraged which can produce product of the required standard (e.g. Cobe Spectra etc.) and in addition reduce the number of donor exposures to the recipient. The limitation on these procedures are primarily associated with donor availability, apart from the overall resources implications to staff and training. It is likely therefore that platelet production will still have to be derived from single blood donations, and interest is currently directed to the technique of buffy coat removal, pioneered by Pietersz. This has been developed into a routine larger scale “Bottom and Top” platelet production system by Hogman. A system of pooling 4 or 5 buffy coats, and separating “pure” platelets can now be achieved using automated or semi-automated procedures, i.e. Baxter Optipress, Biotrans separator, NPBI Compomat.