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The National Blood Transfusion Programme (NBTP), Ministry of Health, with technical support from GIZ, recently organized a 3-day Training Workshop on ‘Clinical Use of Blood’ recently at a local hotel in Islamabad. The workshop was attended by clinicians and hematologists from six teaching hospitals of Islamabad and Rawalpindi including PIMS, F.G. Polyclinic Hospital, Capital Hospital, Holy Family Hospital, DHQ Hospital, and Benazir Bhutto Hospital.
The Workshop was facilitated by Dr. Johan van der Does, an experienced clinical hematologist from the Netherlands, Dr. Lubna Naseem, Incharge of BTS at PIMS, and Dr. Hasan Abbas Zaheer in representation of the National Blood Transfusion Programme.
The goal of the Workshop was to sensitize key stakeholders, which normally comprise prescribers, bed site nurses and blood bank laboratories, on quality criteria for hospital transfusion processes. In Pakistan, training on blood transfusion guidelines does normally not form part of the basic education curriculum of medical doctors, so that a framework of quality criteria and guidelines on ‘rational use’ of blood is missing.
According to the strategy developed by Dr. van der Does, medical associations representing the different specialties will be brought together in a ‘National Commission for the Development of Standards and Guidelines’, so that a reference document reflecting the ground realities of Pakistan would become available. Specific hospital transfusion guidelines then would be developed in respect of the national guidelines.
In the opening session, Dr. Hasan Abbas Zaheer, National Programme Manager, NBTP gave a brief overview of the recent blood safety reforms in the country and the project introduction. He informed that in the recent past, Ministry of Health has taken concrete steps in restructuring the blood transfusion services in the country with support from the German Government. NBTP is actively holding National Steering Committee (NSC) meetings and is setting up NSCs at provincial level also.
Dr. Johan van der Does gave a brief on the “Clinical Interface”. Speaking on Quality in the Hospital Transfusion Process, he said that the morbidity and mortality resulting from the transfusion of incompatible blood components is due to human error and entirely preventable through a quality system. The blood transfusion system or blood bank should ensure that the hospital has SOPs (Standard Operating Procedures) for all stages of the clinical transfusion process and all staff members should be trained to follow it.
He further informed that the correct identification of the patient is the most important means of preventing a potentially fatal, incompatible transfusion. Blood samples for pre-transfusion testing should never be labeled before the specimen is taken but at the time of taking the sample.
The final patient identity check is the last opportunity to detect an identification error and prevent a potentially incompatible transfusion. The blood transfusion system and blood bank should not accept any requests for blood unless patients’ details of the blood sample match those of the blood request form, he added.
In his presentation on “Policy and Guidelines of the Clinical Use of Blood”, Dr. Hasan Abbas Zaheer demonstrated that policies and guidelines will help to improve the quality of the clinical transfusion practice.
He outlined that it included policy on the clinical use of blood; guidelines on the appropriate clinical use of blood; role of the BTS in the development of a policy and guidelines on the appropriate clinical use of blood and role of a hospital transfusion committee. The BTS should play a key role in the development of a national policy and guidelines on the clinical use of blood in collaboration with national health authorities and clinical specialists. He stressed that transfusion committees both national and hospital-based should be formed to ensure policy making and proper monitoring, he added.
The Dutch expert, Dr. van der Does, emphasized that clinicians as prescribers of blood are the prime group to ensure the appropriate clinical use of blood. Together with the blood bank teams, they can work in the development of plans and strategies to improve the transfusion process. The appropriate clinical use of blood is a chain of integrated events that begins with the correct decision that the patient needs blood or not and ends with an assessment of the clinical outcome of the transfusion.
He also emphasized that documentation is key to any quality system. It helps to ensure consistency of processes and procedures, with good documentation indicating a good quality system. The documentation may be written procedures, instructions, records, quality control procedures and recorded test results involved in providing services or the manufacture of products.
Dr. Lubna Naseem, PIMS, presented the topic of in-hospital clinical guidelines. She said that the appropriate use of blood and blood products means the transfusion of safe blood products should be used only to treat a condition leading to significant morbidity or mortality that cannot be prevented or managed effectively by other means.
Earlier, group activities were carried out which included (i) Developing a transfusion process flow chart; (ii) Terms of Reference for Hospital Transfusion Committees (HTC); and (iii) standardized uniform blood request forms. Results were presented and discussed after the group work.
Regarding the HTC, it was proposed that it should include clinicians from specialties in the hospital that utilize blood transfusion, for example haematology, intensive care, surgery and obstetrics as well as staff from the nursing section, blood bank and pharmacy. It should also have the authority to determine hospital policy in relation to blood transfusion.
It was decided to form a core group of facilitators for the development, promotion and dissemination of the guidelines on clinical use of blood supported by a resource center.
Dr. Hasan Abbas Zaheer, in his vote of thanks at the conclusion of the workshop, appreciated the active participation of the clinicians and acknowledged the support from the GIZ Technical Cooperation Team. He invited the participants to work in close coordination with the National Blood Transfusion Programme in the development of Blood Transfusion Guidelines to make this initiative operational and convert it into a lasting success.
Mr. Lundy Keo, Programme Manager, GIZ Health Sector Support Programme, in his concluding remarks thanked the National Blood Transfusion Programme for having made an important contribution to enhance blood safety in the country with inputs from the facilitators and the participants. He underlined that the prime responsibilities for sustainability of system reforms lay with the national actors. One strategy suggested to enhance the likelihood of sustainability would be the establishment of a ‘resource facility’ under the NBTP, which would function as a central repository for knowledge management beyond the timeframe of inputs by the German Development Cooperation.