Changing the habits of a lifetime!
(Removing the transfusion compatibility report in a District General Hospital)
Authors: H Daniels, P Stewart, P Clinton, D Cameron, B Kyle, I Paterson, Dr P Paterson - NHS Lanarkshire, Monklands Hospital Transfusion Team
Background
• BCSH guidelines recommend a Compatibility Report (CR) be issued before or with the first blood component1
• SHOT has previously highlighted that reliance on this report is a contributory factor in transfusion of incorrect blood components (checking against
paper documents is often substituted for cross-checking against a wristband)2
• SHOT and NPSA (Safer Practice Notice 143) recommend that hospitals review their systems for issuing blood and either withdraw, or ensure the CR is
not used as part of final patient identity check
Table 2
Monklands Hospital, NHS Lanarkshire –
was change necessary?
A scoping exercise identified the exact use of the compatibility
report, and there were many! See table 1.
BLOOD TRANSFUSION – IMPORTANT UPDATE
As from 22nd October, the compatibility report will no longer be issued with blood, platelets,
FFP or Cryoprecipitate. In addition a new blood collection slip will now be used.
This change is an important safety initiative. It is an identified risk that staff may check the
patient details on the blood pack against this report. This should not be done as part of the
bedside checking procedure.
Table 1.
Blood Component Collection
Current function of CR
Comment
Delivered with 1 unit, signed by ward
staff upon receipt
Need new method to record
delivery and receipt
Taken to bedside with component,
potential to use as part of final
patient check
Despite transfusion policy and repeated
instructions to the contrary, audit
showed CR to be used at bedside. We
acknowledge that when documentation
is issued from the labs, it’s not ideal to
ask a nurse to ignore it
st
Used as collection slip for 2nd and
subsequent units of red cells
Need new collection slip. Need this to
be used for 1st and every unit. Current
practice very unsafe.
These comments are important, but
Comments for clinical staff eg transfuse
through blood warmer, irradiated blood could be printed on compatibility label
Notifies staff how many units are
cross matched
Information available on lab results
browser or call the lab direct
Following risk assessment, and a successful pilot project, we
decided to remove the CR from issue with all blood components in
Monklands Hospital and this was fully supported by the Hospital
Transfusion Committee (HTC).
Sign to record
delivery and then
return to the lab with
the blue tag
• Complete a new slip
per collection
request
• Use patient label
where possible,
ensuring slip
matches with
patient ID band
• Nursing and Medical
staff can complete
the slip
Do not use the slip as
part of the final
administration checks
Blood Component Administration
Any queries please contact:
Transfusion lab - ext 2102 page
228
Transfusion Practitioners
H Daniels or P Stewart - ext 2069
Sister I Paterson, ITU - ext 2399
You do not need the
compatibility report to
administer blood or
blood components
Match patient + ID band
+ component for safer
transfusion
• Essential lab comments
(previously printed on the
report) will now be printed on
the label
• The compatibility report will
be sent through internal mail,
after the transfusion. This
should be filed in the
casenotes
Do not use the yellow
slip as part of the final
administration checks
Complete all documentation
and return blue tags and
collection slip
This new procedure would impact on several key aspects of the
transfusion process. Significant changes were required as identified
in Table 1.
Outcome
• 7 months later, and this continues to run very smoothly with no
reported problems
Implementation
• All staff were informed well in advance, and posters were displayed
in all relevant areas, see Table 2
• All relevant areas visited several times by Transfusion Practitioners. Most staff comfortable with change; however some required extra re-assurance that the new procedure could be safe. A frequent
question at this stage “If we don’t get the form, how do we know
the patients blood group? Answer –“ its printed on the compatibility
label and always has been”
• The CR would now be issued through internal mail after the transfusion
• A further observational audit showed that staff have adapted very
well and the final patient check is being undertaken correctly
• We propose to repeat this exercise on one of our other sites
to standardise practice across our Board and further improve
patient safety
References
Acknowledgments
1. British Committee for Standards in Haematology Blood
Transfusion Task Force. “Guidelines for compatibility
procedures in blood transfusion laboratories”.
Transfusion Medicine 2004;14: 59-73
2. Serious Hazards of Transfusion. Annual Report 2005
Monklands Hospital -laboratory staff,
porters, Intensive Care Ward, Ward 15 and
Haematology Ward/Day unit
3. Safer Practice Notice 14 (9th Nov 2006) www.npsa.nhs
CTP.CHAHAB.51904.B