Governance principles

The National Safety and Quality Health Service (NSQHS) standards provide a clear statement about the level of care consumers can expect from health services.

Incorporated within the standards is a specific element for the clinical transfusion process – Standard 7 Blood Management.

The intention of Standard 7 is to "...identify risks, and put in place strategies, to ensure that a patient's own blood is optimised and conserved, and that any blood and blood products the patient receives are appropriate and safe...".

A quality management system is needed in all situations where blood component therapy is given.

Quality in the clinical use of blood components implies administering the right amount of the right component in the right way to the right patient at the right time. It also includes adequate documentation of both the transfusion process and outcomes.

All institutions that transfuse blood products should implement national and local policies and written procedures for:

appropriate prescription of transfusion based on clinical guidelines
provision of patient information to enable informed consent
requests for blood transfusion
collection of blood samples for pretransfusion compatibility testing
collection of blood components from the hospital blood bank or other storage site
storage of blood components
delivery of blood components to where the transfusion is to be given
administration of blood and blood components
documentation of transfusions
care and monitoring of transfused patients
management and reporting of adverse events, and
staff responsibilities and the training required for these procedures.

What are the responsibilities?

The prescribing doctor is responsible for ensuring that blood component therapy is only given when the benefits of the transfusion outweigh the risks and that the patient is appropriately monitored during the transfusion procedure.

There is an organisational responsibility to ensure that use of blood is monitored and reviewed, and that actions are taken to ensure that blood is used safely and appropriately.

There should be a clinical management group (e.g. a Hospital Transfusion Committee) who reports to the hospital executive. This group is responsible for:

reviewing transfusion policies and procedures
reviewing the arrangements for training and continuing education of staff in transfusion policies and procedures
reviewing adverse transfusion events, including near misses (e.g. identified clerical errors)
reviewing the appropriateness of blood transfusion and making recommendations about the proper use of blood components and fractionated products, and
recommending corrective action in transfusion practice.