North East Regional Transfusion Committee

Confirmed

NORTH EAST REGIONAL TRANSFUSION COMMITTEE MEETING

Lecture Theatre, NHS Blood and Transplant, Newcastle upon Tyne

Wednesday 14th June 2017 1:30pm

Present:

Nini Aung (NA)Consultant Haematologist, North Tees and Hartlepool

David Bruce (DB)RCI, NHSBT

Lindsay Cairns (LC)Transfusion Practitioner, Newcastle

Carolyn Carveth-Marshall (CCM) Transfusion Practitioner, South Tees

Jill Caulfield (JC)Technical Manager for South of Tyne Laboratories

Andrew Charlton (AC) Consultant Haematologist, NHSBT

Joanne Curly (JCu)Ass. Transfusion Practitioner, North Tees and Hartlepool

Anne Davidson (AMD)Patient Blood Management Practitioner, NHSBT

Aman Dhesi (ADh)Patient Blood Management Development Manager, NHSBT

Allistair Dodds (AD)Consultant Anaesthetist and Chair of HTC, Sunderland - Chair

Chris Elliott (CE)Lead Scientist - Transfusion, South Tees

Adil Iqbal (AI) Consultant Haematologist and Chair of HTC, CDDFT

Simon Lyons (SL)Consultant Haematologist, Northumbria

Emily MacGregor (EMc)Blood Sciences Dept. Manager, CDDFT

Janet Nicholson (JN)Transfusion Practitioner, North Cumbria

Henning Pauli (HP)Consultant Anaesthetist and Chair of HTC, Newcastle

Janice Robertson (JR)RTC Administrator, NHSBT - Minutes

Kate Robinson (KR)SpR, Northern Deanery

Lianne Rounding (LR)Training Co-ordinator, NHSBT

Yvonne Scott (YS)Transfusion Laboratory Manager, Newcastle

Russell Urwin (RU)Transfusion Laboratory Manager, CDDFT

Karen Ward (KW)Transfusion Laboratory Manager, Northumbria

Luke Winn (LW)SpR, Northern Deanery

Apologies:

Aimi Baird (AB) Transfusion Practitioner, Newcastle

Robin Coupe (RC)Customer Services Manager, NHSBT

Martin Maley (MM)RCI, NHSBT

Dianne Plews (DP)Consultant Haematologist and Chair of HTC, South Tees

Karen Simblet (KS)QA Manager, NHSBT

John Sutton (JS)Transfusion Laboratory Manager, Cumbria

1. / AD welcomed the group and gave apologies.
2. / PRESENTATIONS
  • Survey of the fate (by category) of all O D negative red cell units in the region over a 4 week period
Presented by Andrew Charlton
  • Safe and APPropriate tools
Presented by Aman Dhesi
  • Update from delegates funded to attend BSH
Presented by Luke Winn and Kate Robinson
The group agreed they would like to continue to use RTC funds, to support delegates from the region to attend national events.
3. / MINUTES OF PREVIOUS MEETING 01.03.2017.
Minutes confirmed. Can be posted on website.
Matters arising
  • Regional Protocol for Major Haemorrhage Packs.

Send to HTC’s for feedback as to if we are happy to take up as a regional document.
Discussions ongoing about a prescription organisation sheet, which will be included in the pack.
  • Poster for BBTS Harrogate (o neg wastage and usage) paragraph for the Hospital and Science web page; this will not proceed.
/ JR
JR
4. / Blood Component use by RTC

5. / Update from NBTC 20th of March 2017
RTC Meeting
  • 0 D-negative working group: demand rationalisation and control
Analysis of the usage of O D-negative red cells amongst a wide rangeof Hospital Trusts has shown significant and unexpected variability. Dr Foukaneli, the chair of working group, delivered a presentation to the RTC chairs, which consisted of an attempt to rationalise and develop an empirical formula topredict appropriate O negative blood usage. In essence, the formula usesthe background regional prevalence of Group O D-negative, and uses a weighting to factor to calculate additional demand. Modifiers include:
1 Emergency departments
2 Major trauma centres
3 Helicopter services
4 Obstetric and paediatric units
5 Speciality services such as thalassaemia and sickle-cell.
6 Transplant unit
7 Supply to private hospitals
The modifiers are capped at a maximum of five percent uplift.
Feedback from all stakeholders was requested.
  • NBTC Education workshop.
Presentations were received from the College of Anaesthetists (which covered the transfusion curriculum well) and the College of Physicians (which included little transfusion medicine in the general training, andad hoc approach in those specialties which are higher users e.g. gastroenterology). A discussion about accessing foundation doctors took place; it became evident that due to the curriculum and job plans that it would be unrealistic to provide regional or national training opportunities. There was considerably more optimism regarding the provision of training to nurses at undergraduate level, the NHS BT provision was both well-regarded and keenly accessed.
NBCT meeting:
  • Audits:
A summary of the haematology audit was presented, and as you know details from your own Trust can be accessed via the NHS BT audit website. Re-auditing of this will occur in the Q3 2017.
  • NICE Quality standards and guidelines:
The NBTC was in broad agreement with a NICE quality standards. The only area of conflict was single unit transfusions, and the necessity to check the haemoglobin level between units in those patients who are subject to a chronic transfusion regimen.
  • UKTLC
The group received a report outlining many of the challenges facing laboratory practice including reduction in training opportunities, short staffing, a reduction in experience and skill base, and a perception of increasing stress levels and demoralised teams.
Possible avenues of action included re-raising the issues with CEOs, encouragingly CQC to include transfusion labs on the agenda to highlight challenges relating to staffing and safety to Trust executives. To improve University courses with a view to more practical transfusion and consider funded apprenticeships.
A discussion regarding closer co-operation between NHS BT and hospital laboratories was undertaken I can provide details if required.
  • Hepatitis E screening and platelet irradiation
As you know the Department of Health has instructed NHS BT to undertake universal screening of blood components with respect to hepatitis E. It was also suggested that universalirradiation of platelets may be beneficial toimprove shelf life and reduce wastage. There were some concerns that irradiation during the manufacturing may lead to a consequential reduction in platelet activity especially as they approach their expiry date.
It was felt that further research needed to be undertaken without the help of SaBTO.
  • Patient working groups
A YouTube video relating to consent and patient information can be accessed at
  • SHOT
The next shot annual symposium is on 12 July 2017 at Rothamsted Centre Hertfordshire a AL5 2JQ
The next annualreport will be available soon and each Trust will receive one printed copy in addition to Internet access. The cost of printing reports has placed a question mark over the viability of the printed document in the long term. An interim solution allows you to buy additional paper copies directly from the publishers for £30 plus £10 delivery.
  • NHS BT
There were updates on the supply chain modernisation, and consolidation of Leeds and Sheffield sites; everything is apparently progressing to plan.
Key performance indicators were presented, as expected, the total number of units of red cells and platelets issued continues to drop year-on-year. Targets have been met for Products issued on time and full, and average age of components. Some difficulties were encountered in the supply of Ro Components.
6. / Reports from HTC’s

7. / Progress with supply chain modernisation
  • Since the previous RTC meeting on 1st March, bacterial monitoring of platelets has been transferred from Newcastle to Manchester. This means all platelets collected / manufactured at NHSBT Newcastle are now being moved to Manchester for sampling and bacterial monitoring. Following completion of all testing, appropriate quantities of platelets are then sent back to the Newcastle stock holding unit for issue to our hospitals.
  • From 19/06/17, all blood collected by teams operating out of Leeds will be transferred to Manchester for processing. Currently this blood is sent to either the Newcastle or Sheffield manufacturing departments.
  • Transfer of the remaining manufacturing activity is proceeding in accordance with the timelines set out by Helen Mugridge, National Operations Modernisation Lead, at the previous RTC meeting.
  • In summary, these are:
Newcastle sessions transferring into Manchester: Anticipated 21 August 2017
Newcastle Manufacturing activity ceases: Anticipated 27 August 2017
Sheffield sessions transferring into Manchester: Anticipated 4 September 2017
Sheffield Manufacturing activity ceases: Anticipated 5 September 2017
Decommissioning activities to follow
  • Discussions are ongoing in relation to provision of components for the ABO incompatible cardiac transplant activity at Freeman Hospital (currently supported by washed red cells produced in Newcastle).
  • If you have any queries about the SCM project please contact Robin Coupe, Customer Service Manager at

8. / Relevant Clinical Quality Incidents
  • No update.

9. / Haemostasis and Thrombosis matters
  • No update

10. / Blood conservation / PBM working group
  • Putting together a ‘Regional O neg champions’ group, interested parties to contact AMD
/ All
11. / EDUCATION AND TRAINING
  • RTC Study Day 2017
Blood and Guts – Transfusion and Bleeding in the Medical Patient.
Tuesday 17th October 2017, Venue: The Durham Centre.
Free event
  • Scientific and Technical Training
Free places are available
12. / AUDIT
National Audits
  • 2016 Re-audit of PBM in adults undergoing elective, scheduled surgery –complete, audit report to follow
  • 2017 Re-audit of Red Cell & Platelet transfusion in adult haematology patients –starts July 2017
  • 2017 TACO Audit - started on Monday 6th March. List of participating sites and their RTCs plus copies of the audit tool are in the document libraries on the Committee Member Homepage.
  • Reports are available at
Usage of Idarucizumab – antidote for Dabigatran
  • Audit is ongoing, advise Nikki Redding or Laura Dunning if Idarucizumab used.
  • AD has contact HTC chairs with information relating to the survey
NE RTC Survey on the impact of Participation in NCA Audits

  • Group felt that the organisers of NCA need to understand that Trusts are resource poor, and participation in NCA’s mean that local audits are pushed back.
  • Forms should be redesigned to make audits easier to complete
  • Evaluations should be requested regarding
  • How much Trusts got out of the audit
  • How much time was involved in completing
  • AD to send message to John Grant Casey
Reviewing of National Guidelines / Research Papers
The following guidelines are out / anticipated soon
  • AAGBI guidelines
  • Cell Salvage
  • Management of Patients Who Decline Blood Product Transfusion (title to be confirmed)
  • BSCH guidelines
  • Administration and Pre-compatibility guideline
  • Policyfor patientswho refuse blood products
The PBMP team are trialling circulating a list of new and relevant papers to all TP’s / All
AD
13. / REPORTS FROM RTC GROUPS
Transfusion Practitioners Group
  • Last meeting Monday 22nd May 2017, a full day event which was well attended and evaluated. Group agreed to keep current format for future meetings.
  • Presentation from Ian Coates, Vifor Pharma - Benefits from PBM Programs
  • Presentation from Tandy Pickering and Nicola Norton -Blood Donation 2020
  • Presentation from Rose Gill -Fetal Genotyping
  • Presentation from Laura Jardine -Case Studies
  • Next meeting Tuesday 21stNovember 2017.
Newcastle Blood Centre Users Group
  • Last meeting Wednesday 17th May 2017.
  • Presentations from Erika Rutherford -NHSBT Reagents and Antenatal Update and Fetal RHD screening – Q&A Session – Erika has offered to visit interested Trusts.
  • Presentation from Chantal Morrell - O Neg audit at CDDFT
  • Presentation from Andrew Charlton -Survey of the fate (by category) of all O D negative red cell units in the region over a 4 week period.
  • Chris Robbie (MHRA) doing targeted analysis of regional incidents
  • K- units. Hospitals moving to ordering all stock units as K- or increasing stock levels to ensure K- units are available, which will lead to higher wastage. RC requested Trusts look at this practice as it is now flagged as a national issue.
  • Procedure for the Transfer of Blood Components Between Hospitals
Group agreed to ratify procedure version 1.7
  • Next meeting Wednesday 27th September 2017.
MHRA Blood Consultative Committee
  • No update and no meetings scheduled.
NBTC Laboratory Managers Group
  • Feedback form teleconference 17th May 2017
  • Albumin and Anti-D framework now operational, although still issues with supply from BPL.
  • Education and training – 250 places funded by HEE.
  • Developing eLearning opportunities, hopefully available before end 2017. There may be a small charge to access the system, but exploring option of funding via NCG or funded by extra charge on blood products.
  • TACT looking at free membership option to increase uptake.
Some trusts finding it difficult to use. Preference for a ‘middle’ option, rather than just red / green.
14. / AOB
AC
CE
CE
AD / NHSBT are collecting data for a National Granulocyte Registry (the study is known as ProGres). Ordering hospital clinicians will receive an email with a short questionnaire for each week that the granulocytes are ordered for a particular patient, followed by a 28 day and 3 month outcome form. There is no need for local ethics or R&D approval – all data is non-patient-identifiable and has been given national approval for collection without patient consent.
South Tees and Newcastle Trusts invited to participate in CRTOSTAT trail
South Tees Trust invited to participate in a randomised controlled trial of red cell rejuvenation for the attenuation of transfusion associated organ injury in cardiac surgery: The Redjuvenate Trial
Proposal from NBTC to remodel the structure of RTC’s, moving to zonal rather that regional meetings. North East RTC would be zoned with North West and Yorkshire & The Humber. Group agreed that they would not want to move forward with this. / AD
15. / Date and time of next meeting
  • 1st November 2017
  • 7th March 2018

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