Governance principles

Within Australia, the Australian Health Ministers endorsed the National Safety and Quality Health Service Standards in September 2011. These standards provide a clear statement about the level of care consumers can expect from health services.(1) Incorporated within the standards is a specific element for the clinical transfusion process – Standard 7 Blood and Blood Products.(1)

A quality management system is needed in all situations where blood component therapy is given.

Quality in the clinical use of blood components implies administering the right amount of the right component in the right way to the right patient at the right time.

Quality also includes adequate documentation of both the transfusion process and outcomes.

All institutions that transfuse blood products should implement national and local policies and written procedures for:

  • Appropriate prescription of transfusion based on clinical guidelines

  • Provision of patient information to enable informed consent

  • Requests for blood transfusion

  • Collection of blood samples for pretransfusion compatibility testing

  • Collection of blood components from the hospital blood bank or other storage site

  • Storage of blood components

  • Delivery of blood components to where the transfusion is to be given

  • Administration of blood and blood components

  • Documentation of transfusions

  • Care and monitoring of transfused patients

  • Management and reporting of adverse events

  • Staff responsibilities and the training required for these procedures.

The prescribing doctor is responsible for ensuring that blood component therapy is only given when the benefits of the transfusion outweigh the risks; and, that the patient is appropriately monitored during the transfusion procedure.

There is an organisational responsibility to ensure that use of blood is monitored and reviewed; and, that actions are taken to ensure that blood is used safely and appropriately.

There should be a clinical management group (eg, a Hospital Transfusion Committee) who reports to the hospital executive. This group is responsible for:

  • Reviewing transfusion policies and procedures

  • Reviewing the arrangements for training and continuing education of staff in transfusion policies and procedures

  • Reviewing adverse transfusion events, including near misses (eg, identified clerical errors)

  • Reviewing the appropriateness of blood transfusion and making recommendations about the proper use of blood components and fractionated products

  • Recommending corrective action in transfusion practice
     
References
  1. Australian Commission on Safety and Quality in Health care. National Safety and Quality Health Service Standards. [cited 2011 Dec1]. Available from: http://www.health.gov.au/.