Clinical Governance
In all situations where blood component therapy is given, a quality management system is needed. 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; and
- Staff responsibilities and the training required for these procedures.
It is the responsibility of the prescribing doctor to ensure 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 usage of blood is monitored, reviewed and actions are taken to ensure that blood is used safely and appropriately. There should be a clinical/management group, such as a Hospital Transfusion Committee, which reports to the hospital executive and is responsible for the following:
- Reviewing transfusion policies and procedures;
- Reviewing the arrangements for training/continuing education of staff in transfusion policies and procedures;
- Reviewing adverse transfusion events, including near misses e.g. identified clerical errors;
- Reviewing the appropriateness of blood transfusion and making recommendations about the proper use of blood and blood components; and
- Recommending corrective action in transfusion practice.