CELL SALVAGE IN TRENT A Coordinated Approach to Training and Practice

1. CELL SALVAGEIN TRENTA Coordinated Approach to Training and Practice Malcolm Chambers Transfusion Practitioner / Autotransfusion Course Coordinator, Queen�s Medical Centre, Nottingham

2. Background Trent Pilot (2002) Aimed to identify both the keys to successful cell salvage practice and hindrances. Developed and implemented solutions to promote the use of intra-operative cell salvage within Trent

3. Better Blood Transfusion (HSC 2002/09) Appropriate Use of Blood Trusts should review and explore the appropriate use of autologous blood transfusion.

4. More widespread use of ICS means we can no longer rely on the local enthusiast to set up and run a service. Scrutiny by clinical governance bodies

5. Coordinated Approach to Training Trent Pilot identified lack of availability of trained operators as a key hindrance to implementing the wider use of intra-operative cell salvage University Hospitals in Leicester and Nottingham began to address this by developing training packages.

6. Trent Training Strategy Group Develop a training framework to train personnel to operate cell salvage equipment to defined adequate standards Work towards a framework to identify personnel competent and confident under workplace conditions

7. Existing Standards  American Association of Blood Banks (www.aabb.org) Standard 2.1 : �This standard requires that individuals be trained, initially and at appropriate intervals, and that the organization assess their competence. Records of qualification, training and competence assessments must be maintained. Published UK guideline (Br J Anaesth 78,768-771)

8. Role of Equipment Providers Training delivered by company representatives usually in the workplace. Duty to provide training and evidence of training, but no formal mechanisms for assessing competence. High standard of technical training Less effective in ensuring background knowledge and confidence under clinical conditions

9. TACTICSTraining and Competency in Trent for ICS Three main strands to the work: Establish performance competencies Develop an open learning package using adult learning principles (Pre-course) Develop Practical Course

10. Establish Performance Competencies Skills for Health Linked to NHS Knowledge and Skills Framework Definition of: knowledge required performance criteria

11. (S for H) Competencies Two Groups Non Registered HCA�s (PCS 19,20). Registered Practitioners (PCS 21,22). Prepare Equipment Operate Equipment (S for H web site) Perioperative Care Support

12. ICS Learning Framework Phase 1 Background education and theory Phase 2 Practical machine specific training Practice in real or simulated situations Phase 3 Assessment in the workplace Phase 4 Refresher/update training for CPD

13. Optional Routes for Learning Framework

14. Phase 1 Learning Background education and theory Four units making up a knowledge dependence sequence Basic haematology Blood conservation Autologous transfusion Intra-operative Cell Salvage

15. Phase 1 Learning Delivered as an open learning package E learning Hosted by a professional learning management company who will control access to the package Includes a learner knowledge assessment and issues a certificate of evidence of training Booklet format Same content and knowledge assessment

16. Example from On line Course

17. Knowledge Assessment Example Question 24 Contamination with either meconium or urine would contraindicate intra-operative cell salvage Question 25 The presence of which of these would contraindicate the use of intra-operative cell salvage? A Citrate B Heparin C Aviten Question26 Within how many hours of initiating the collection should an auto-transfusion set, blood collection system and packed red blood cells be used?

18. Intra-operative Cell SalvageE-Learning programme Open to all grades of Staff Free until end December 2005 BBTS accredited CPD Points Administered by the NBS e-mail lydia.nicholls@nbs.nhs.uk

19. Phase 2 Training Delivery of Machine Specific Training In Nottingham in the Trent Simulation and Clinical Skills Centre at QMC (BBTS Accredited CPD Points) By other training groups (Trusts)

20. TACTICS at QMC Course Design Day 1 Interactive session to confirm knowledge base Practical sessions with machine Day 2 ICS in special circumstances Guided discussion of case scenarios High fidelity simulation of real-life situation

21. Phase 3 - Assessment Outside scope of the TACTICS project Difficulties include: Validity of assessment tools Definition of essential knowledge and performance criteria Lack of process for formal accreditation Need for accountability at Trust level

22. ICS � Keys to Successful Practice Committed clinical leadership Clear and easily accessible standard operating procedures Availability of competent operators (Named and held on a local register) Routine consideration in the surgical set-up

23. Coordinated Approach to Practice Trent Transfusion Alternatives Group Representation from hospitals throughout Trent Reports to Trent Regional Transfusion Committee Acts as a source of expertise and a conduit to share information Shares protocols for cell salvage Developing a database of cases

24. Standard Operating Procedures Relative and absolute contra-indications Rules about labeling Rules about expiry times Warnings about surgical contaminants

25. Keys to Successful Practice Audit of Cell Salvage Recording event for individual patient System for monitoring safety System for collecting data for activity analysis and to inform use

26. Coordinated Training and Practice Define standards Toolkits for users Training and competency framework Shared database for audit and research

27. Future of TACTICS E-Learning Package to be available on National level through NBS/ DOH One day Courses to be rolled out within other Trusts in the Trent region (UK) National Autotransfusion Practise Development Group

28. THANK YOU