Quality Management
Quality
Management was foreseen in as ‘Quality Management Trainings’. This area was,
however, later addressed by a more multi-dimensional method, aiming to develop
longer lasting concrete grounds for ‘Quality’ in the Blood Transfusion
Services.
National Standards and Guidelines for BTS
The first edition of the Standards and
Guidelines for Blood Transfusion Services was published by the Ministry of
Health, Government of Pakistan in August 1999. It was compiled by a team
comprising senior members of Pakistan Society of Haematology, the programme
managers of Blood Transfusion Services from all the provinces of Pakistan,
officers of the National AIDS Control Programme and the WHO representative in
Pakistan at that time. A major portion of the first edition of ‘National
Standards and Guidelines for BTS in Pakistan’, was, however, adopted from the
latest edition of ‘Guidelines for BTS in the UK’ at that time. The approved
National Standards and Guidelines, despite being widely distributed, remained
un-implemented, the blood transfusion services of Pakistan remained fragmented
and of poor quality at large. A revision of the document took place by the
Technical Cooperation Team. The document provides Standards and Guidelines for BTS,
including those for (1) Blood Donor Selection; (2) Blood Component Preparation
and Storage; (3) Testing of Blood Donations; and (4) Pre-Transfusion Testing.
Each chapter consists of two sections, i.e. Section A states the minimum
standards while Section B comprises guidelines on how to meet the standards.
The document has been developed by a team of experts (Task Force) through several
technical meetings and consultations.
SOP
Flyer
A flyer providing a structured listing of
the SOPs along the entire vein to vein transfusion chain was developed,
segregating the essential SOPs in terms of their application in the relevant
structures (RBC, HBB and Hospital Ward) as well as their functional areas.
Standard
Operating Procedures (SOPs) Manual
Standard Operating Procedures are an
integral part of a quality system, as they facilitate consistency in the
performance of procedures in accordance with standards. The SOP manual details all the operational procedures along the entire
vein to vein transfusion chain. The manual covers all testing procedures and
working procedures. These SOPs have been generated with a novel
methodology. The process started with a field analysis, in which the SBTP team
collected all available SOPs from a sample of public and private blood banks,
listed them in relation to the key domains addressed and documented both
availability and gaps. The development of new SOP templates was planned as a
joint collaborative effort. The clear breakdown of the transfusion chain
domains into consecutive procedures, as outlined in the flyer, served as a
reference for the identification of suitable working groups. Members of the
working groups represent their respective specialties, but at the same time
share the wealth of their regional experience. This bottom up approach is
expected to have resulted in SOP templates of high practical value, though both
international literature and a previous version of SOPs for Pakistan were
consulted in the process. Instead of copying existing international manuals, a
participatory approach was chosen with the intention to draw on existing
expertise in the country, which would increase the likelihood of formulating
procedures that can and will be followed in Pakistan. Six mixed working groups
(Haematologists, Blood bank incharges, Blood Bank Technicians) were
established, working on the sub-sections of the process chain. The participants
of these working groups have become the authors of the new SOP Manual, which is
thus based on real life experiences from various well reputed blood bank
establishments all over the country, mostly from secondary or tertiary
hospitals. The 62 SOPs collected in the Manual will also be printed for wall
display as a permanent reference tool for the staff.
Urdu Translation of
National SOP Manual by USAID-Jphiego
The
SBTP developed a National SOP Manual for blood banks with the help of national
experts in 2013. The document provides step by step technique of all the
procedures performed in the blood banks. As part of the SBTP-Jhpiego
collaboration, this document has also been translated in Urdu by Jphiego (2017).
The document is being used for trainings to the blood bank personnel in
Interior Sindh and also in rest of the country. It is available on the SBTP and
IBTA websites.
Training
Curriculum
The
extremely diverse educational background of blood bank technicians (either
formally educated or just trained on the job in pathology laboratories and
blood banks) strongly reflects the ‘fragmentation’ of the blood transfusion
system in Pakistan. The SBTP has deepened the analysis of the curriculum
development required and focused on strategies of standardization, while the
actual development of training curricula remains pending. The curriculum should
be based on an appropriate needs analysis of the blood transfusion modules in
Pakistan. A ‘round table meeting’ with ten Blood Bank paramedical staff
provided information about the content of existing curriculum for blood bank
technicians. The areas completely neglected in the curriculum include quality
control and quality assurance, quarantine of blood, issue of blood and
inventory control whereas the relatively well covered sections include
anticoagulants, blood grouping and cross-matching.
The need
for a general
and standardized curriculum was
recognized across the
sector, as current
training courses cater
for specific audience with
insufficient training and according to
the specific academic
environment through
Inadequately trained
instructors. When addressing the community of scholars,
Teachers and
practitioners, the Safe Blood
Transfusion Programme (SBTP)
received an overwhelming response.
A national Working Group was formed with more than 160
members who supported the design work with feedback based on ground realities
and needs. The Group provided recommendations
for the structure, contents, target groups and academic pathway
to be followed. SBTP contributed through a small team of international and
national experts, who were developing the structure and writing up the curriculum.
Inventory of
Institutes, Programmes and Curricula in Pakistan
Concomitantly with
the development of
the properly structured, well
organized and uniform curriculum,
the Programme collected
data and curricula for an “Inventory of Institutes, Programmes and
Curricula in Pakistan”, which is published as a separate document.
Development
of National QC Guidelines 2017
The Programme through an extensive
national consultation developed the National Guidelines on Quality Control in
Transfusion Medicine in 2017. The document aims
to encourage blood banks and transfusion services to develop strong quality
assurance programmes, organize scheme of management and employ training and
competency evaluation programmes. Standardized forms developed by the Programme
are also provided which must be routinely used in the blood centres. The guideline draws from the documents of the World
Health Organization, European Union, International Haemovigilance Network and
Technical Manual of American Association of Blood Banks. The guidelines
complement the earlier documents developed by the Programme through the TC
component. The Programme endeavours to implement these guidelines through capacity
building workshops so that by the end of 2017 at least 100 blood centres have
adopted these guidelines in earnest.
National
Data Collection
One of the main challenge in developing
the national plans and strategies is the absence of credible national statistics.
To address this critical programmatic gap, the SBTP initiated a national
exercise in 2016 to collect the 2015 data directly from the blood centres in
the country. The SBTP thus generated a National Data Collection Report in 2016
which documented and analyzed data received from public and private sector
blood centres. Similar reports were also compiled in 2017, 2018 and 2019. The
latest report is covering almost 2.7 million donations collected from 650 blood
centres.