Prescribing and clinical use of blood and blood products

The clinical use of blood and blood products is appropriate, and strategies are used to reduce the risks associated with transfusion.

National Safety and Quality Health Service (NSQHS)

National Safety and Quality Health Service Standards standards, hospital guide 2017 provides overarching patient blood management/transfusion-related guidelines, policies and procedures are found in the clinical governance section - 7.1.

In this section are resources to assist health services address the actions in this criterion, which are:

• Optimising and conserving a patient’s own blood - information can be found in the section marked patient blood management - 7.4
• Documenting - 7.5
• Prescribing and administering blood and blood products - 7.6
• Reporting adverse events - 7.7 and 7.8.

Optimising and conserving patient’s own blood 7.4

Resources for this section of the standards can be found on our patient blood management page:

• The examples of charts, checklists and forms relating to the administration of blood products are used to promote complete transfusion documentation.
• These can assist health services to support processes for prescribing and clinical use of blood and blood products.

Documenting 7.5

Resources available include:

Austin Health - Blood Prescription and Administration Form - a comprehensive form developed by Austin Health. It is an example of a form used for blood and blood product prescription and administration, consent documentation and adverse reaction reporting as well as providing guidance on blood administration safety, and the pre-transfusion checking requirements.

Barwon Health - Blood product prescription form - developed by Barwon Health, this prescription form includes a transfusion decision algorithm.

Royal Melbourne Hospital - Blood component prescription (includes consent) 2018 - this form is the one used by Royal Melbourne Hospital prior to implementing an electronic medical record.

Royal Melbourne Hospital - Blood order and administration form 2020 (7.5 and 7.6) - used when the electronic medical record is not available.

Western Health - Blood and blood product consent and prescription form - 2016 (7.3, 7.5 and 7.6) - developed by Western Health the form is used for prescription, administration and documenting consent.

Prescribing and administering blood and blood products 7.6

Useful resources include:

• The Blood Matters 30 minute 4 hour rule poster:

• The Blood Book: Australian Blood Administration Handbook is a comprehensive resource to assist with safe bedside transfusion practice. Australian Red Cross Lifeblood.
• Blood Matters - Two-person independent checking for safe transfusion poster 2019 - these posters are designed to assist health services with best-practice for blood administration.
• Blood Matters and Macopharma - How to spike a blood bag (poster and swing tag) 2017 - the posters and swing tags can be used to demonstrate how to safely and effectively spike a blood component bag for administration.
• Australian Red Cross Lifeblood transfusion website (7.6, 7.7 and 7.8) - the website provides information for clinicians on a range of blood related topics.
• The Australian and New Zealand Society of Blood Transfusion (ANZSBT) and the Royal Australian College of Physicians (RACP) have developed a Top-Five Recommendations on low-value transfusion practices. This is useful guidance for clinical transfusion practice.
• Prophylactic use of RhD immunoglobulin for RhD negative women: RhD immunoglobulin administered to pregnant RhD negative women can help prevent haemolytic disease of the fetus and newborn.
  • To promote best practice and the provision of relevant information Blood Matters has developed the infographic:

Reporting and adverse events 7.7 and 7.8

Australian Red Cross Lifeblood - Classification and incidence of adverse effects (7.7 and 78) - provides information for clinicians on adverse events and incidents. This includes the classification of transfusion reactions and estimated incidence.

• The Serious transfusion incident reporting (STIR) is a voluntary reporting, state based system for reporting serious blood management and transfusion practice errors and transfusion reactions.
• Eastern Health - Acute transfusion reaction flow chart - (7.7 and 7.8) - a flowchart developed by Eastern Health showing the required management of suspected acute transfusion reactions.
• Eastern Health - Delayed transfusion reaction recognition chart - (7.7 and 7.8) - a flowchart developed by Eastern Health showing the required management of suspected delayed transfusion reactions.
• Royal Melbourne Hospital - Transfusion related adverse event form (7.5, 7.7 and 7.8) - developed at RMH for reporting transfusion reactions to the Transfusion Laboratory and includes the order for subsequent blood testing. This form is now only used when the EMR is not available.
• St Vincent's Health - Transfusion reaction notification investigation form (7.6) - the blood component compatibility report used at St Vincent’s Health, contains details of the compatibility of the blood component (the form is blank), and on the reverse side it has the blood checking requirements and a summary of possible adverse reactions. This is an example of the form that is sent with the unit of blood, blood product.
• Western Health - Acute transfusion reaction flowchart (7.7 and 7.8) - a flowchart developed by Western Health showing the management of suspected acute blood, blood product reactions in adults.
• Western Health - Delayed adverse transfusion reaction flowchart (7.7 and 7.8) - a flowchart developed by Western Health showing the management of suspected delayed blood, blood product reactions in adults.
• Western Health - Transfusion reaction investigation eform (7.7 and 7.8) - the form was developed by Western Health to report suspected transfusion reactions for investigation.