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Stewardship of the bloodline: driving safety and efficiency along the transfusion continuum.

The demand for providing safe, compatible blood at an ever-increasing pace is growing in hospitals and other healthcare facilities around the world. Every two seconds in the United States, someone, somewhere, needs a blood transfusion. What it takes to make sure that safe blood is constantly available, compatible, and free of disease is a complex balance of driving efficiency to keep pace with the workload of a busy lab and unyielding prioritization of protecting the life of the patient at the end of the bloodline.

Today's transfusion medicine laboratories--like many other areas in hospitals and other healthcare facilities--are learning to do more with less. Funding and personnel are reduced, and resources are scarcer, but there are more requests to be met, more type and screen testing to be completed, and more patients to be served. Yet the focus on protecting the precious life that will receive a unit of blood remains the foremostfocus of blood bankers everywhere. As the pressure rises, labs are finding ways to be efficient andhemovigilant, while never losing sight of the real person at the end of the bloodline.

The challenge of skills shortage

During the last 20 years, there has been a continued decline in the number of skilled workers choosing medicaltechnology and medical science careers. In fact, in a recent study,143 percent of clinical laboratories across the United States reported difficulty finding qualified candidates.

For a number of reasons, including fewer certification programs across the United States and a low awareness profile for the types of jobs available in medical laboratories, there are simply fewer students going through laboratory training programs, leaving hospitals and healthcare facilities to face tough competition for the few highly skilled individuals available in the workforce. And, in addition to having fewer people enter the field, laboiatory managers also are facing the challenge of having a workforce with an average age of about 50, which means that a retirement boom may further exacerbate the problem. (2)

Automation and standardization

Today, the majority of blood banks around the world are still using manual testing methods in the laboratory. However, to help meet the growing demands for safety and efficiency--and to address the fact that there are fewer people with the traditional skills and experience required for the field--automation is becoming a standard part of blood bank laboratories. Automation can help eliminate the labor-intensive, timeconsuming manual testing processesthat require specialized skills and significant experience to master, such as infectious-disease testing on donor units, patient and unit typing, antibody screening, and cross-matching.

Automating the testing process can also ensure that a skilled technologist has more time to focus on time-sensitive emergency situations, difficult patient work-ups, and quality improvement processes. Ultimately, automated testing can increase the lab's capacity, allowing it to serve more patients while helping it operate more efficiently--and the difference can be dramatic. A study from Ortho Clinical Diagnostics found that on average, one operator using the automated ORTHO ProVue[R] analyzer was able to perform the same serological testing previously performed by two technical staff members, while reducing total processing time by 40 percent(3)

In addition to automating many routine testing processes for the sake of efficiency, many laboratories find that standardizing testing methods on an automated instrument platform can increase the effectiveness of their processing methods and allowthemto better meet rigorous compliance guidelines. For example, technologies such as Column Agglutination (CAT) are generally easier to use than traditional manual tube testing, and can help reduce the opportunity for error and variation among technologists and tests by providing stable and clear endpoints that are highly precise while delivering objective, consistent results.

Predictive monitoring

Operating at peak performance in an automated environment requires expert services and support, along with technologies that help reduce the potential for instrument downtime and prevent workflow interruptions to ensure that instruments are available when needed. One example of tools that help achieve these goals is Ortho's e-Connectivity(sup.TM) service (availability of e-Connectivity is dependent on device platform and local registrations/approvals) which can provide a real time, secure, twoway interactive connection between instruments and a technical support team. Using a mix of sophisticated predictive software and human operators, monitoring centers keep watch over the function of instruments, proactively alerting lab managers when a problem might arise and scheduling all maintenance visits during off-peak hours in order to maximize instrument "uptime."

Emerging standards and roles

One out of seven hospital patients requires a blood transfusion, and that translates into 4.5 million patients who need blood every year in the United States.4 In each of these instances, there are myriad quality control processes that must be upheld, spanning everything from screening and storage to delivery.

Hospitals and other healthcare institutions around the world are developing ways to meet new standards--both by instituting their own rigorous policies and by understanding and implementing the guidelines from organizations that oversee the safety of the world's blood supply.

For example, the United Nations Millennium Project includes goals for blood safety and availability, including measures to reduce the risk of receiving infected blood through a transfusion, protocols to avoid unnecessary blood transfusions, and policies to exclude high-risk donors, which must be met internationally by 2015.5 Additionally, the United Kingdom's Serious Hazards of Transfusion program and the U.S. Centerfor Disease Control and Prevention's (CDC) National Healthcare Safety Network (NHSN) suggest voluntary reporting structures intended to create a reliable source of information for the medical and scientific community about blood transfusion issues. NHSN, launched in 2010, is a collaboration between government and non-government agencies designed to confidentially track adverse reactions and incidents associated with blood collection and transfusion. (6)

In addition, industry groups are engaging in efforts to improve patient care and safety while maximizing the efficiency of the healthcare system. For example, AABB collaborates with the U.S. Dept. of Health and Human Services on biovigilance activities, including programs directed at a variety of different domains such as donor hemovigilance and transfusion recipient hemovigilance. Through the collaboration, the organizations are gathering and analyzing data to help find trends and establish best practices intended to lead to safer, more efficienttransfusions and transplants. (7) Similarly, the International Society of Blood Transfusion (ISBT) and the European Haemovigilance Network (EHN) began a working group in 2004 focused on creating a common set of definitions for issues in the field, which would enable global benchmarking and is intended ultimately to increase the safety of blood donors and recipients around the world. (8)

Among the blood banks we serve, we have observed new roles and processes to address these standards and to facilitate collaboration among medical, technical, paramedical, and nursing personnel focused on strategies for hemovigilance.

The trending rise in demand for blood and blood components suggests that additional quality control personnel will be needed to promote transfusion safety across departments; oversee institutionwide hemovigilance, error and accident reporting; provide education on transfusion reactions; implement guidelines; perform safety training; and identify newtechnology for enhanced safety. In some institutions, the position of Transfusion Safety Officer (TSO) is emerging as a resource to facilitate universal performance standardsfor sample collection and blood administration to prevent common transfusion errors. (9)

A shared commitment

Recently, Ortho Clinical Diagnostics launched a campaign to celebrate the work of transfusion medicine professionals. "Bloodlines" is our way of connecting the scientific and workplace demands of blood banking and transfusion medicine to the human being who receives the transfusion. Our customers never forget that there is a person at the end of the bloodline--and neither do we. For more than 70 years, we have been dedicated to the science of safe, efficient solutions that help protect the transfusion chain between donor and patient.

References

(1.) Garcia E et al. American Societyfor Clinical Pathology's 2011 Vacancy Survey of U.S. Clinical Laboratories. LabMedicine. 2011;42:199-206.

(2.) Garcia E, et al.

(3.) Casina TS, Sorenson L, Fobare S. Transfusion. 2002; 4(suppl):131S.

(4.) BloodSource. Blood Facts: quick facts. http://www.bloodsource.org/BloodFacts/Theneedforblood.aspx. Accessed October 28, 2011.

(5.) Millennium development goals--intervention by area. http://www.unmillenniumproject.org/docu-ments/MainReportChapter19Appendixes-lowres.pcff. Accessed November 28,2011.

(6.) National hemovigilance program launches to track adverse events associated with blood transfusion [press release] 2010. http://www.aabb.org/pressroom/pressreleases/Pages/prl00218.aspx. Accessed November 28. 2011.

(7.) Biovigilance program. AABB website. http://www.aabb.org/programs/biovigilance/Pages/default.aspx. Accessed November 28, 2011.

(8.) Standard for surveillance of complications related to blood donation. ISBT.EHN. http://www.isbtweb.org/fileadmin/user_upload/WP_on_H0emovigilance/ISBT_StandardSurveillanceDOCOJOO8__3_.pdf. Accessed November 28, 2011.

(9.) Fridey JL. The Transfusion Safety Officer presentation. Paper presented at AABB annual meeting. San Diego, CA. Ortho Clinical Diagnostics Blood Management Symposium. October 24,2011.

John Meckles, MT (ASCP), is regional vice president, North American Transfusion Medicine Sales, for Ortho Clinical Diagnostics (OCD). John has more than 28 years experience in the diagnostics industry, spanning both laboratory and commercial roles.
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Author:Meckles, John
Publication:Medical Laboratory Observer
Article Type:Cover story
Geographic Code:1USA
Date:Jan 1, 2012
Words:1489
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