Targeting good transfusion practice: a special interest

Almost 100 delegates comprising biomedical scientists, transfusion practitioners and NHS Blood and Transplant (NHSBT) representatives were present in Birmingham recently for a day of discussion, learning and interactive debate on the subject of blood transfusion. ‘Patients at the Core’ was the theme for the first session, which concentrated on the sometimes controversial subject of informed consent for blood transfusion. ‘Consent and SaBTO Guidelines: so far so good, or so what?’ was the intriguing title of the first presentation, delivered by Simon Goodwin (Surrey & Sussex Healthcare NHS Trust), who considered that the actual consent to transfusion is an inherently flawed process from the offset, as by its very nature it differs from patient to patient. Factors such as the severity of illness, the urgency of the transfusion, the patient’s knowledge of the transfusion process, and their individual personality traits all have to be considered, and key to this is forming a supportive partnership between clinician and patient.

Looking at the drivers for informed consent, Simon stated that we should “first do no harm”. British Committee for Standards in Haematology (BCSH) guidelines, Better Blood Transfusion policies, cost and legal considerations, particularly in relation to informing the patient of the potential risks of any transfusion, must be taken into account, but the new Advisory Committee on the Safety of Blood, Tissues and Organs (SaBTO) recommendations are now helping to clarify the situation and deliver a more consistent approach to consent. Now, SaBTO recommends that valid consent for all transfusions should be obtained and documented in the patient’s notes, with a modified form of consent for the multitransfused patient. Additionally, SaBTO also states that there should be a standardised information resource for clinicians to follow, indicating all the key transfusion issues. Simon concluded by emphasising that the new SaBTO guidelines “would have regulatory teeth” and that we should always remember to involve patients in the transfusion process and to treat them as individuals, not just as a haemoglobin result.

Charis Joyce (University Hospital of Wales, Cardiff) continued the shared transfusion decision-making theme with her presentation ‘Deciding With Me, Not For Me’. “Healthcare is changing,” she stated, adding that patients now know their rights and want to be more involved in their transfusion treatment. Charis outlined how a toolkit known as an ‘Option Grid’ had been introduced in her region to help guide clinicians and patients through the tricky transfusion consent process. Constructed around frequently asked questions and evidence-based transfusion medicine, the system is already delivering successful outcomes, particularly in relation to whether or not to transfuse, in the form of a collaborative agreement between healthcare staff and the patient. Charis concluded that the system certainly supports the informed transfusion consent process and urged delegates to consider introducing similar processes in their own regions.