alternatives to transfusion

[tkakin]

I have been doing an audit that includes the question "Are alternatives to transfusion discussed with the patient?" The answer is no, they need blood. Their H&H is low. Do any of you have information that is given to the patients discussing the alternatives? I understand it is the physicians responsibility to give that info, because it is so dependant on patient diagnosis, but if there was a general pamphlet that would allow them to raise questions to the physician, it would be better than nothing.

Any ideas suggestions?

Thanks

Teresa

[Mabel Adams]

Your local Jehovah's Witness elders probably have a pamphlet. I have seen the ones here and they have some useful info. Also, try the SABM website and Dr. Hannon's site (name escaping me). AABB site also has a blood management section now.

[tkakin]

Thanks Mabel, does anyone encorporate this info into the signed consent documentation?

[Eagle Eye]

It depends , I know NJ states requires lots of this on the informed consent so the consent in NJ is really long outlining the Risk & benefit of blood transfusion.

[Malcolm Needs ☆]

I think that I'm correct in saying that alternatives are discussed routinely as part of the consent in the UK (but my hospital colleagues could answer this better than can I).

[John C. Staley]

I have been doing an audit that includes the question "Are alternatives to transfusion discussed with the patient?" The answer is no, they need blood. Their H&H is low. Do any of you have information that is given to the patients discussing the alternatives? I understand it is the physicians responsibility to give that info, because it is so dependant on patient diagnosis, but if there was a general pamphlet that would allow them to raise questions to the physician, it would be better than nothing.

Any ideas suggestions?

Thanks

Teresa

 

I'm curious, What are you looking for by including this question in an audit?  Actually I'm perplexed.  Being old and set in my ways I'm finding it difficult to understand why the transfusion service would want to get involved in this.  I am assuming that you do work in the blood bank/transfusion service and this has fallen on your shoulders. Please enlighten me.

[pstruik]

To follow on from Malcolm's comments, in the UK this is theoretically discussed with the patient before transfusion although when I discussed this with junior MOs in training sessions they clearly weren't equipped with sufficient knowledge to do this effectively, and it really isn't clear that it is ever really done (and is thus the subject of audits)

John's question, above, is interesting, but it always seemed to me that, perhaps paradoxically, it was the responsibility of our Hospital Transfusion Committee to write the 'Alternatives to Transfusion' section of our hospital transfusion guidelines.

Having completed the task it became increasingly apparent to me over the years that we were probably the only ones who ever read it.

(Cynical ? Moi ?)

[Likewine99]

You know how it is John, you mention the word blood transfusion and it automatically becomes our responsibility.  

[John C. Staley]

You know how it is John, you mention the word blood transfusion and it automatically becomes our responsibility.  

 

One of the things that frustrated me the most towards the end of my career in blood banking was being thrust into the position of the "blood police".  We really were not in a position to accomplish a number of the tasks that were forced down out throats.  Trying to explain why this was not a good idea only got us labeled as not being team players.  This is about the only aspect of blood banking I don't miss! 

[Malcolm Needs ☆]

One of the things that frustrated me the most towards the end of my career in blood banking was being thrust into the position of the "blood police".  We really were not in a position to accomplish a number of the tasks that were forced down out throats.  Trying to explain why this was not a good idea only got us labeled as not being team players.  This is about the only aspect of blood banking I don't miss! 

 

We are beginning to have a campaign for Biomedical Scientist's Empowerment in the UK, which, to give them the credit they fully deserve, is being backed to a large extent by our Transfusion Clinicians.  That notwithstanding though, I'll believe it when I see it.

[AMcCord]

If you are an ARC customer they can provide you with a patient information pamphlet that does discuss alternatives to transfusion...or at least an older version I've seen does.

[Eoin]

This is supposed to be discussed by clinician when getting consent. How often does it happen? Probably rarely.

We are considering separate consent fr transfusion - one of the best I have seen is -

http://www.urmc.rochester.edu/urmcmedia/hh/services-centers/blood-transfusion-center/Documents/Consent-for-Blood-Transfusions-419BT.pdf

 

See what you think. I would also be interested in other replies.

Cheers

Eoin

[John C. Staley]

Eoin, I like it.  Short, sweet and to the point, as long as I'm (the blood bank) not responsible for explaining it and getting it signed or making sure it gets signed.  This is a clinician responsibility. 

Edited April 30, 2013 by John C. Staley

[Eagle Eye]

It should be on your consent and when you (blood bank ) audit them your question should read : is signed consent available?

Put some more responsibility on clinicians!!

Edited April 30, 2013 by Eagle Eye

[Mabel Adams]

The sample above does not include things like treating anemia with EPO or Fe therapy as is now being recommended at least for pre-op anemia. It also doesn't mention the risk of TRIM etc. that have recently been defined as the push behind patient blood management.  I think it has been around since before those issues came forward.  It is succinct and clear otherwise.

[tkakin]

_{I'm curious, What are you looking for by including this question in an audit?  Actually I'm perplexed.  Being old and set in my ways I'm finding it difficult to understand why the transfusion service would want to get involved in this.  I am assuming that you do work in the blood bank/transfusion service and this has fallen on your shoulders. Please enlighten me.}

 

_John,

_{Sorry I didn't reply sooner, Yes I do work in transfusion service.  I do the audit that includes this question, because it is highly recommended by Blood Systems and because I attend the Transfusion Committee meeting.  I would like to improve patient safety. I feel if the pateint's are more informed, then they can make a more informed choice about their medical needs.  Maybe it would seem more like a choice in most cases then doing it because the Dr. told them to.  I also hope that by improving the education of alternatives to transfusion it will trickle down into the blood usage.  I have no intention of approaching this as a repremand, but more of an opportunity to provide information to improvme on what is in place.  I do see your concern with the the hospitals reaction to being audited.  They may kick me to the curb, but I am still going to try.}

 

_Eoin,

 

_{Thank you so much for sharing.  I do like it,  and I can include Mabels suggestions.  AmcCord I will check out what ARC has.}