Organisation-wide governance and quality systems are used to ensure safe and high-quality care for patient’s own blood, and to ensure that blood product requirements are met. (ACSQHC; 2017)
This criterion is closely aligned with and should be read in conjunction with the Clinical Governance Standard and the Partnering with Consumers Standard. An organisation wide, systematic approach is required to meet the criterion.
Actions and their requirements in this criterion are:
Integrating clinical governance 7.1
This committee plays a significant role in the health service clinical governance and quality improvement to support blood management. This document includes responsibilities and suggestions for membership, agenda and executive engagement.
An assessor’s guide to conducting blood product clinical competency for enrolled nurses. This should be used in conjunction with the EN transfusion competency template and local health service requirements.
An example template that can be modified to suit local health service requirements, to assess enrolled nurses blood product transfusion clinical competency. This should be used in conjunction with the EN transfusion competency guide.
This provides a framework to assist health services to identify the requirements for nurse practitioners to include blood and blood product transfusion prescriptions into their scope of practice.
The National Blood Authority has developed a National blood supply contingency plan (NBSCP) to ensure a rapid response should there be threat to the safe and adequate supply of blood.
It is expected that health services have an emergency blood management plan to ensure an appropriate response should the NBSCP be activated. The template is designed to be modified by health services to suit local requirements, while meeting the intention of the NBSCP.
Blood management/transfusion nurses and safety officers are a key component of the quality improvement and risk management system for blood. This generic template provides a typical example of the specified requirements of such positions.
Transfusion trainers are a key component of the quality improvement and risk management system for blood in smaller organisations where only small amounts of blood are used. This generic template provides an example of the requirements of such positions.
The handbook is aimed at providing blood management/transfusion nurses, trainers and quality officers with information fundamental to the role.
It aims to:
- assist with understanding the context of blood and blood products in Australia
- provide structure and guidance to achieve best practice in blood management and transfusion practice.
- the Barwon Health procedure for dispatching (issuing) blood to the clinical area for use and the process for ensuring correct identification processes for both the patient and the product for patients who are transferred to Barwon Health with externally crossmatched blood products.
Risk management should be undertaken in conjunction with the Risk Management Team using the local Risk Management Framework and procedures.
Applying quality improvement systems 7.2
This includes blood management quality performance indicators, quality and safety improvement, and quality surveillance.
- blood management transfusion nurses/safety officers are a key component of the quality improvement and risk management system for blood. This generic template provides an example of the specified requirements of these positions.
- transfusion trainers are a key component of the quality improvement and risk management system for blood in smaller organisations where only small amounts of blood are used. This generic template provides an example of the specified requirements of these positions.
- the handbook is aimed at providing blood management transfusion nurses/trainers and quality officers, to understand the context of blood and blood products in Australia. It also provides structure and guidance to achieve best-practice in blood management and transfusion practice.
Quality improvements should be monitored and reported through the relevant governance committee, such as blood management committee or executive quality committee.
It also provides an overarching context of blood management in Victoria.
These reports are produced twice a year.
The data is:
- benchmarked with peer health service
- reported to individual health services.
The audit reports are published with recommendations and discussion.
- guidance on appropriateness of red cell, platelet and FFP transfusions
- transfusion information
- information on cumulative phlebotomy loss
- a quick anaemia assessment.
Partnering with consumers 7.3
It is important that patients and carers are actively involved in their own care.
Treatment plans should be developed with patients and carers.
Consumer information should be provided about the risks and benefits of blood and blood product transfusion, the risks of not having a recommended transfusion, as well as alternatives that may be available or that can reduce the need for a transfusion.
Consumers should have an opportunity to ask questions and the provider of the information should ensure the recipient has understood the information. Information (written and verbal) for consumers needs to be in a format the consumer can understand.
Consent and refusal of blood
Informed consent is defined by the Australian Health Practitioners Regulatory Authority (AHPRA) in the Code of conduct for registered health practitioners (2014) as 'a person’s voluntary decision about their health care that is made with knowledge and understanding of the benefits and risks involved'.
- Millions of people receive blood transfusions each year, but many will not be fully aware of the risks. In this journal article - Anne-Maree Farrell and Margaret Brazier argue for a formalised consent procedure for blood transfusion.
The law supports a person’s rights when it comes to medical treatment in Victoria in the following ways:
- a person has the right to refuse medical treatment in most circumstances
- the medical practitioner must usually seek the person’s consent prior to carrying out medical treatment
- a person’s capacity to consent is assumed unless there are indications otherwise
- a competent person can refuse treatment in relation to a current or future condition under the Medical Treatment Planning and Decisions Act by completing a valid instructional directive
- likewise, the person’s medical treatment decision maker can consent to or refuse treatment on their behalf if they no longer have the capacity to do so themselves.
The steps for health practitioners to follow when a patient does not have decision-making capacity to make their own medical treatment decision is set out in the Act.
The Jehovah’s Witness community is known to refuse blood transfusions and have a number of resources regarding management of patients without the use of allogenic blood. The covers clinical strategies for:
- avoiding blood transfusion in surgical patients
- avoiding blood transfusion in obstetrics and gynaecology
- managing acute gastrointestinal haemorrhage without blood transfusion
- avoiding blood transfusion in critically ill patients.
Many Victorian Jehovah’s Witness patient carry a 'no blood' card. It provides brief information on how to access their Advance Care Directive. An example of the Advance Care Directive and No Blood card are provided in the .
- a general guide to blood transfusion: Information for patients and families
- a general guide to iron and iron deficiency: Information for patients, families and carers
- information for children.
The examples provided may assist health services to develop their own resources to support this criterion. Some of the resources have been developed by Blood Matters, while others are documents used in health services.
Reviewed 28 April 2023