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Single Unit Blood Transfusion Guideline for Laboratory Staff

Single Unit Blood Transfusion Guideline for Laboratory Staff. Based on the Patient Blood Management Guidelines Be SINGLE m inded. Single Unit Transfusion Guideline. Applies to: The stable, normovolaemic inpatient who is NOT actively bleeding is NOT in an operating theatre

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Single Unit Blood Transfusion Guideline for Laboratory Staff

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  1. Single Unit Blood Transfusion Guideline for Laboratory Staff Based on the Patient Blood Management Guidelines BeSINGLE minded

  2. Single Unit Transfusion Guideline Applies to: • The stable, normovolaemic inpatient who • is NOT actively bleeding • is NOTin an operating theatre • Haemoglobin as defined in the Patient Blood Management Guidelines

  3. The Guideline Transfuse one unit, then reassess the patient for clinical symptoms before transfusing another • If the patient’s symptoms are relieved, don’t transfuse more units • Every unit is a new clinical decision • Base decision on patient symptoms, not only on haemoglobin

  4. Single Unit Transfusion Guideline WHY Current practice does not align with evidence-based recommendations • Prescribing a single unit of blood may reduce the risk of an adverse event: • Harm from transfusion is dose dependent • Transfusion is an independent risk factor for increased morbidity, mortality and length of stay. • There is a lack of evidence for benefit of transfusion in a non-bleeding patient. Five Drivers Shifting the paradigm from Product-focused Transfusion Practice to Patient Blood Management” Axel Hofmann, Shannon Farmer, AryehShander. The Oncologist 2011;16(suppl 3):3-11 Strategies to preempt and reduce the use of blood products: an Australian perspective. Hofmann, A et al. CurrOpinAnesthesiol 2012, 25:66-73.

  5. BeSINGLEminded HOW When blood is ordered for a patient… ASK: • Is the patient actively bleeding? • What is the current haemoglobin? * EXPLAIN: • Only one unit will be issued, in compliance with the Patient Blood Management Guidelines • *If Hb <70 g/L a 2 unit request likely to be acceptable • Note: Hb<80g/L for patients with acute coronary syndrome Hb<100g/L for renal patients.

  6. Indications for a Second unit • Active blood loss • Hb< 70g/L for general patients • Hb <80g/L for cardiac patients* * See Patient Blood Management Guidelines for other patient groups • On going chest pain • Less than 8g/L rise in haemoglobin following first unit

  7. Single Unit Transfusion Empowered Staff: Laboratory staff can “gate-keep” compliance. • Guideline document is accessible in laboratory – prompt for questions about compliance. • Inclusion criteria for a second unit is defined. • Support from champions to resolve challenges to requests: (medical staff, haematologists)

  8. BeSINGLEminded Refer disputes to medical staff / champions: • Politely suggest that the request is outside the guidelines • Re-confirm that the inpatient is NOT actively bleeding or NOT in the operating theatre • Provide blood if the patient is bleeding • Remain calm, polite and professional, and refer the caller to appropriate medical support staff.

  9. BeSINGLE minded

  10. Single Unit Transfusion Policy Benefits: Safer, evidence based transfusion PLUS: • Reduced risk for non-infectious adverse events • Reduced demand on limited blood supply • Reduced risk from new infectious agents Be SINGLE minded

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