An essential measure towards improving the quality of the transfusion process is the rational clinical use of blood. As the initial step, the SBTP team designed a standard training module for clinicians and nurses on clinical use of blood based on a WHO template and conducted a pilot workshop in Islamabad (2011). The major outputs of the workshop included the development of a standardized blood request form and TOR for hospital transfusion committees (working group activities). Moreover, the pilot seminar brought forward the requirement of a more thorough, step-wise intervention in this area.
An essential measure towards improving the quality of the transfusion process is the rational clinical use of blood. Effective clinical use of blood requires clinical transfusion guidelines to be in place. In this priority area, the SBTP team facilitated the formulation of a task force from representatives of the Medical Associations. The task force consisted of a ‘Core Group’ and ‘Corresponding Members’. The core group representing haematologists and one or more members from each of the medical associations of Pakistan dealing with haemotherapy (oncology, anaesthaesia, surgery, gynaecology, paediatrics, orthopaedics, neurosurgery, medicine and cardiac surgery) held several Technical Meetings for this purpose in Lahore. The first edition of the guidelines for the clinical use of blood in Pakistan was developed in 1999 which remained un-implemented. During development of the document, a special emphasis was placed on the applicability of the document to most facilities in Pakistan. An effort has been made to include all of the common clinical situations requiring the use of blood/blood components. These guidelines are, however, not absolutely binding and situations may arise in which deviations based on the clinical judgment may be required. The purpose of this document is to assist clinical decisions about the transfusion of blood and blood components. Many of the conventional and widely taught indications for the transfusion of blood components are not justified, resulting in irrational use of blood and wastage of this scarce resource. The document is intended for all clinical staff dealing with blood and blood components including nurses, ward and theatre staff. The document is divided into four parts. The first one provides background and the rationale for the development of the guidelines. The second one provides guidelines for the storage, issuance and transport of blood and components. The third section contains guidelines for the transfusion of blood and components. The fourth section provides guidelines for the use of other blood products. In the month of September 2012, a workshop was held in which these guidelines were approved formally and a work plan was formulated for the implementation of these guidelines which included the institution of the hospital transfusion committees (HTCs) and incorporation of these guidelines in the medical curricula. The primary target groups of the CUB Guidelines developed are the clinicians of the 60 hospitals included in the current phase of the project. However, as the guidelines are intended to be ‘national’ the dissemination process will ideally be beyond the group of 60 public hospital blood banks and eventually include hospitals outside this sub-system as well as teaching institutions.
Hospital Transfusion Committees will play a key role in the dissemination and adoption of the CUB guidelines. HTCs are very suitable for this purpose, as their members typically include blood bank, hospital management and clinical people, and their regular meetings allow a well-documented follow-up and learning process under the concept of haemovigilance. The SBTP team has prepared TOR for the smooth functioning of the committee and is promoting the institutionalization of HTCs in the hospitals though advocacy, sensitization and also through the BTAs.
A network has been created in a workshop in Islamabad. The founding members have agreed to extend the knowledge gained to other potential members. The network will guide the management of haemovigilance data which includes the identification and documentation of all adverse reactions, notification of Serious Adverse Reactions and Events (SARE) by Blood Centres. The scope of haemovigilance will, however, eventually have to be extended to donors and to the surveillance of products/processes.
Handbook of Clinical Transfusion Practices
The Safe Blood Transfusion Programme derived a ‘Handbook of Clinical Transfusion Practices’ from the WHO’s The Clinical Use of Blood with the permission of the WHO. The pocket handbook is designed for quick reference to promote rational use of blood components and avoid unnecessary blood transfusions. The Handbook is not designed to replace the conventional textbooks or to provide a definitive text on the clinical use of blood. Rather, its purpose is to provide an easily accessible learning tool that will assist prescribers of blood to make appropriate clinical decisions on transfusion and contribute to wider efforts to minimize the unnecessary use of blood and blood products. It is expected that the use of this document in the Pakistan healthcare system will significantly improve the blood transfusion practices in our hospitals. It will also help overcome to a large extent the chronic shortage of blood and blood components in our blood centers and promote the rational and judicious use of blood and blood components.