To download this video, with or without subtitles, please right-click on one of the following links and select "Save Link As..." (Chrome and Firefox), "Save target as..." (Internet Explorer), "Save linked content as..." (Opera) or "Download Linked File As..." (Safari). Show Quick links to sections on this page: Patient Blood Management GuidelinesVisit Patient Blood Management Guidelines to access the latest modules in the Guidelines or click on the images below to go directly to the relevant module. What is PBM?Patient Blood Management improves patient outcomes by improving the patient’s medical and surgical management in ways that boost and conserve the patient’s own blood. As a consequence of better management, patients usually require fewer transfusions of donated blood components thus avoiding transfusion-associated complications. The National Blood Authority is funding and managing the development of evidence-based, Patient Blood Management Guidelines. A multidisciplinary team determines, with the patient, the specific management plan, which makes every reasonable endeavour to optimise the patient’s own blood volume, minimise blood loss, and optimise the patient’s physiological tolerance of anaemia. There are various techniques to ensure this. For example, the Three Pillars of PBM [1] model depicted below helps to show how various practices can be initiated during pre-, intra- and post-operative stages of surgery. The rationale for patient blood management addresses evidence-based transfusion medicine practice and stewardship of donated blood, to:
Implementing the PBM GuidelinesVisit Implementing the Patient Blood Management Guidelines to access the latest tools and information to support health providers implementing PBM strategies. On this page you will also find the NBA's National Patient Blood Management Implementation Strategy 2017-2021. Patient Blood Management Advisory Committee (PBMAC)The Patient Blood Management Advisory Committee replaces the previous Patient Blood Management Steering Committee. The Patient Blood Management Advisory Committee (PBMAC) was established in 2019 to provide advice and guidance to the NBA in relation to the implementation of PBM in Australia consistent with the NBA's responsibilities specified in the National Blood Authority Act 2003 and the National Blood Agreement (135.16 KB). The committee was established by the NBA Chief Executive under Section 38 of the National Blood Authority Act 2003 and is comprised of individuals with expertise and knowledge in the health sector, blood management, education, quality and safety, and consumer issues. The PBMAC Terms of Reference (ToR), the PBMAC Membership and Section 38 Instrument are approved by the NBA's Chief Executive and detail the governance arrangements. For more information All health care practitioners who administer blood or blood products must complete specific training for safe transfusion practices and be competent in the transfusion administration process. Always refer to your agency policy for guidelines for preparing, initiating, and monitoring blood and blood product transfusions. These guidelines apply to adult patients only. The transfusion of blood or blood products (see Figure 8.8) is the administration of whole blood, its components, or plasma-derived products. The primary indication for a red blood cell (RBC) transfusion is to improve the oxygen-carrying capacity of the blood (Canadian Blood Services, 2013). A health care provider order is required for the transfusion of blood or blood products. RBC transfusions are indicated in patients with anemia who have evidence of impaired oxygen delivery. For example, individuals with acute blood loss, chronic anemia and cardiopulmonary compromise, or disease or medication effects associated with bone marrow suppression may be candidates for RBC transfusion. In patients with acute blood loss, volume replacement is often more critical than the composition of the replacing fluids (Canadian Blood Services, 2013). Transfusions can restore blood volume, restore oxygen-carrying capacity of blood with red blood cells, and provide platelets and clotting factors. The most common type of blood transfusion is blood that is donated by another person (allogeneic). Autologous transfusion is the transfusion of one’s own blood (Perry et al., 2014). Figure 8.8 Red blood cells and blood IV tubingTransfusion therapy is considered safe, and stringent precautions are followed in the collection, processing, and administration of blood and blood components. However, transfusions still carry risks such as incompatibility, human error, and disease transmission, and blood transfusion must be taken seriously at all times. Incompatibility can be decreased by using irradiated red blood cells or leukocyte-reduced blood. The majority of blood transfusion complications are a result of human error (Perry et al., 2014). Compatibility testing is vital for all recipients of blood or blood products. Recipients must be transfused with an ABO group specific to their own blood type or ABO group-compatible. There are three types of blood typing systems: ABO, Rh, and human leukocyte antigen (HLA). For more information on these, refer to the online resources at the end of this chapter. It is vital to understand what types of blood groups are compatible for transfusions (Canadian Blood Services, 2013). When administering blood and blood products, it is important to know the patient’s values and beliefs regarding blood products. Some groups of individuals, mainly Jehovah Witnesses, will refuse blood transfusions or blood products based on religious beliefs. These individuals will refuse transfusion of whole blood and primary blood components but may accept transfusion of derivatives of primary blood components such as albumins solutions, clotting factors and immunoglobulins. Always assess each individual preference to establish if a blood component is an acceptable treatment to manage their illness or condition (Canadian Blood Services, 2007). When managing blood transfusions, it is important to prevent complications from occurring and to identify issues promptly to manage reactions effectively. Transfusion reactions (mild to life-threatening) may occur despite all safety measures taken. All transfusion reactions and transfusion errors must be reported to the hospital’s transfusion services (blood bank). It is imperative to know what signs and symptoms to look for, and to educate your patient on what to report and when to report potential transfusion reactions. Mild to severe reactions may include (Canadian Blood Services, 2011):
For more information on types of reactions, signs and symptoms, and treatments, review the article adverse events related to blood transfusions, or see the online resources at the end of this chapter. If patient has a blood transfusion reaction, always follow agency policy to manage mild to severe blood reactions. In general, if a reaction occurs, follow the steps outlined in Checklist 73.
In preparation for a blood or blood product transfusion (Alberta Health Services, 2015a, 2015b; Perry et al., 2014; Vancouver Coastal Health, 2008), the steps listed in Checklist 74 must be completed. These steps must be completed before obtaining the blood or blood product from the blood bank.
Checklist 75 provides steps to administering blood and blood products safely in the acute care setting.
|