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LETTER TO EDITOR  
Year : 2014  |  Volume : 57  |  Issue : 2  |  Page : 352-354
Hospital transfusion committee: Role and responsibilities


Department of Transfusion Medicine, Government Medical College and Hospital, Chandigarh, India

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Date of Web Publication19-Jun-2014
 

How to cite this article:
Kaur G, Kaur P. Hospital transfusion committee: Role and responsibilities. Indian J Pathol Microbiol 2014;57:352-4

How to cite this URL:
Kaur G, Kaur P. Hospital transfusion committee: Role and responsibilities. Indian J Pathol Microbiol [serial online] 2014 [cited 2022 Jan 20];57:352-4. Available from: https://www.ijpmonline.org/text.asp?2014/57/2/352/134753


Sir,

Earlier, blood bank activities were restricted to the collection and issue of blood and blood components. Additional challenges and responsibilities coming up in the context of blood transfusion are: (i) Hemovigilance measures have to be organized; (ii) hospital transfusion committees (HTCs) are desirable; (iii) quality systems are needed.

In transfusion medicine, the vein to vein concept is the key. It encompasses the entire blood chain, stretching from donor to recipient, covering production segment and as well as usage (clinical) segment. Due to multistep involvement of multiple people, it is of paramount importance to ensure quality and safety of blood transfusion in the hospital. To meet these requirements of high standards of patient care, hospitals have been forced to elaborate strategies to oversee all aspects of blood transfusion within individual institution. According to the World Health Organization, "a transfusion committee should be established in each hospital to implement the national policy and guidelines and monitor the use of blood and blood products at the local level."

The HTC plays a pivotal role in promoting safety, efficacy, and efficiency of blood transfusion services. In the United States, a hospital-based peer review mechanism to ensure the appropriateness of blood transfusion therapy has been a requirement for accreditation by the College of American Pathologists and by the Joint Commission on Accreditation of Hospitals since 1982. [1]

In India, the blood system is different from the other developed countries. The need of HTC was considered in 2002 when national blood policy was established. One of the main objectives of national blood policy is "to encourage appropriate clinical use of blood and blood products." It was suggested every institution having a blood transfusion department should comprise HTC and its role was detailed.

This article highlights our journey of the development of HTC, performing various functions of the HTC in a resource poor setting.

Hospital transfusion committee is a multi-disciplinary team and involves all departments in the hospital that are involved in providing and prescribing blood and blood products. The members of HTC include medical superintendent of our institute as the chairperson, representatives from medicine, surgery, obstetrics, and gynecology, orthopedics and nursing superintendent as members. The convener of the committee is the head from transfusion medicine department. The HTC is a watchdog for promoting the safe and appropriate transfusion of blood and its components. On a simplistic level, the HTC sets appropriate policies and procedures, reviews and revise them and monitors practice against them.

Local policies and guidelines were developed at an institutional level from national guidelines. Different aspects of transfusion chain were covered: Indications, contraindications, transfusion triggers, dosage, technical aspects, alternatives, and documentation. Safety aspects of blood transfusion to be covered including identification of patient samples, bedside test, posttransfusion follow-up and measures in case of an adverse reaction, etc. The HTC should have authority within the hospital for determining hospital transfusion policy and resolving problems. [2]

Mark Friedman has stated that lack of knowledge regarding transfusion medicine among clinicians is possibly the major obstacle in making transfusion practices more consistent. He proposed education of end users to close the gap in medical education pertaining to transfusion medicine. [3] The serious hazards of transfusion initiative has consistently shown, since its inception in 1996, the main error occurs by transfusing the wrong blood to the wrong patient. There is therefore need to educate all clinicians to prevent such errors. We made an effort to educate our clinicians through regular interactive training programmes and printed education materials. In one such session, we conducted pre- and post-training assessment of participants pertaining to their knowledge related to safe transfusion practice. There was a statistical significant difference (P < 0.0001) in the mean score of pretraining (51%) and posttraining assessment (85.4%). We introduced new blood component request forms and distributed the "guidelines for requisition, handling, storage, and transfusion of blood and blood components," to provide training events and to develop a set of indicators. We carried out training proceedings for nurses also.

Audit is a continuous process and involves evaluation of ongoing practice with set standards. When such standards are not met, appropriate changes are implemented and their effect is monitored. Because evidence suggests that information and the appropriateness of transfusion is difficult to obtain retrospectively, audit should normally be performed prospectively. [4] We are conducting regular audits to review the appropriateness of blood and its components and make our clinicians familiar regarding transfusion triggers and indications. Authors have also reported over prescription of blood in 37.33% of blood requisitions, while reviewing their blood utilization. [5] Ansari and Szallasi have described their effective experience in increasing the appropriateness of red cell transfusion at their institution. [6] When transfusion criteria were not met, the clinicians were notified either by sending a letter of reminder or telephonic call. We feel that with our consistent attempts and unfailing efforts, we are able to attain nearly ideal (1.5-2:1) cross-match to transfusion ratio in different departments.

Hospital transfusion committee play a key role in dealing with hemovigilance and risk management, providing leadership and advocacy for transfusion practice and coordinating multi-disciplinary teams with clinical, quality, and risk management tools. In India, this program is recently initiated in December, 2012. [7] We are actively participating in this program on behalf of HTC to evaluate the incidence of adverse transfusion reactions including incorrect blood components transfused, to investigate the blood components involved, to monitor patient's clinical conditions and to contribute to the Indian hemovigilance network. We are encouraging clinicians to report each and every adverse event related to transfusion. The various tribulations faced in effective implementation of this program include noncompliance, lack of data compilation, analysis and reporting, and lack of feedback.

To conclude, we as transfusion medicine specialists agree that the challenge for improving the safety of transfusion chain rests primarily in designing and implementing systems that enhance the oversight of transfusion practices and seek to optimize patient safety and efficient utilization of a scarce resource. Central forum consisting of the multi-disciplinary team of professionals is needed to set forward discussion, consensus and to create a link between transfusion medicine staff and clinical staff.

 
   References Top

1.Haynes SL, Torella F. The role of hospital transfusion committees in blood product conservation. Transfus Med Rev 2004;18:93-104.  Back to cited text no. 1
    
2.Liumbruno GM, Rafanelli D. Appropriateness of blood transfusion and physicians' education: A continuous challenge for Hospital Transfusion Committees? Blood Transfus 2012;10:1-3.  Back to cited text no. 2
[PUBMED]    
3.Friedman MT. Blood transfusion practices: A little consistency please. Blood Transfus 2011;9:362-5.  Back to cited text no. 3
[PUBMED]    
4.Audet AM, Goodnough LT, Parvin CA. Evaluating the appropriateness of red blood cell transfusions: The limitations of retrospective medical record reviews. Int J Qual Health Care 1996;8:41-9.  Back to cited text no. 4
    
5.Kaur P, Basu S, Kaur G, Kaur R. An analysis of the pattern of blood requisition and utilization in a tertiary care center. Natl J Integr Res Med 2013;4:123-7.  Back to cited text no. 5
    
6.Ansari S, Szallasi A. Blood management by transfusion triggers: When less is more. Blood Transfus 2012;10:28-33.  Back to cited text no. 6
    
7.Bisht A, Singh S, Marwaha N. Hemovigilance program-India. Asian J Transfus Sci 2013;7:73-4.  Back to cited text no. 7
[PUBMED]  Medknow Journal  

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Correspondence Address:
Gagandeep Kaur
Department of Transfusion Medicine, Government Medical College and Hospital, Sector 32, Chandigarh - 160 030
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.134753

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