Emergency blood management arrangements, NHSGGC policy

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The development of a contingency plan to ensure the effective use of available blood when national blood stocks have fallen to very low levels is critical to ensuring support for essential transfusions based on greatest clinical need.

The following constitutes a plan for the management and control of                                  

blood shortages in Greater Glasgow and Clyde. The plan is based on the guidance in NHS HDL (2005) 25 and will be co-ordinated by the Greater Glasgow and Clyde Blood Management Group (EBMG).

The guidance is structured to provide a framework of actions for the Scottish National Blood Transfusion Service (SNBTS) and hospitals in 3 phases:

Green... “Normal” circumstances where supply meets demand.
Amber... Significantly reduced availability of blood for short or long periods of time
Red…... There is a severe prolonged blood shortage.

 

Aims

The overall aim of the Emergency Blood Management Arrangement (EBMA) is to ensure prompt reaction to a national blood shortage.

The main aims are to ensure:

  • Blood is available for all essential transfusions to patients equally across Scotland.
  • National pool of blood is available to support essential transfusions.
  • Overall blood usage is reduced to ensure that those patients with the greatest clinical need are treated.

The plan deals only with a shortage of red cells. SNBTS is currently defining the stock levels in relation to the blood shortage plan as:

Green…… > 2 days stock.
Amber…… < 2 days stock.
Red……… < 1 day’s stock.

It is envisaged that this plan could be activated under a variety of circumstances including:

  • Blood shortages resulting from short lived events such as bad weather. Following an outbreak of Influenza. Implementation of security measures that adversely affect blood donation. The introduction of additional measures designed to reduce the risk of Transfusion Transmitted Infections.

A key principle of the plan is that the incidences of blood shortages can be significantly reduced by optimising blood usage, avoiding inappropriate transfusions and reducing wastage.

 

EBMA plan overview
GREEN PHASE: “Normal” circumstances where supply meets demand.
  • The Green phase applies to “normal” circumstances when blood supply meets demand. Hospital actions in this phase relate to the successful implementation of the Better Blood Transfusion Team, which is coordinated by the Hospital Transfusion Committee (HTC). The key principle in this phase is that blood shortage can, in most cases, be avoided by reducing current usage of blood.
  • SNBTS continually monitors blood stocks and takes appropriate action to maintain these. However, if blood stocks fall, SNBTS will take action to increase collections from donors. If these actions prove unsuccessful, SNBTS will declare a blood shortage and communicate a move to the Amber or Red phase.
AMBER PHASE: Significantly reduced availability of blood for short or long periods of time. 
  • The SNBTS trigger point for amber is currently set at approximately two days stock. This may apply to a single blood group or to all blood groups.
  • The stockholding of blood in hospitals, according to wastage rate status, will be immediately reduced to approximately 67% of the average stockholding and of the percentage reduction in usage required will be achieved by reducing ordering to replace stock to the lower level.
  • If the shortage is more prolonged, SNBTS will communicate the need to reduce usage. 
  • Where the required reduction in usage will exceed that which could be achieved through the efficient use of blood in accordance with the BBT measures the EBMG may have to consider cessation of procedures for patients in Category 3. (see Table1 for more details)
RED PHASE: There is a severe prolonged blood shortage.
  • SNBTS will declare a red level shortage if there is a severe, prolonged shortage of blood, e.g. a 50% loss of donors, or, if an imminent severe threat of blood supply is identified.
  • SNBTS will communicate the required actions which in the first instance will be to reduce stockholding in hospitals to approximately 40% of the normal stockholding level. This may be accompanied by a further reduction in usage. In this case, it is likely that only patients in Category 1 (see Table 1 for more details) of the categorization of clinical need will be treated.
Emergency Blood Management Group

The EBMG is responsible for:

  • Reviewing, updating and amending the plan and following any blood shortage incident.
  • Considering the impact on the arrangements of new guidance, procedures and recommended changes as a consequence of national guidance, incident reports or judicial enquiries.
  • Activating the plan in times of blood shortage and ensuring the hospital meets the required reduction in blood usage.
  • Ensuring 24/7 availability of themselves or a deputy.

Emergency Blood Management Group Members and Deputies –Pan Glasgow

Title

Name

Contact Details

Deputy

Contact Details

Chair   

Dr Anne Morrison

 0141-354-9084

07729118265

On call Consultant

Haematologist,

South Glasgow

 Contact Via switchboard

Consultant

Haematologist

Dr Karen Bailie

0141-357-7704 

On call Consultant Haematologist

Contact Via

SNBTS dispatch

0141-357-7700

Acute Surgical Director

Mr Grant Archibald

0141-201-1206

Mrs Susan Groom

0141-201-5967

Acute Medicine Director

Dr David Stewart

0141-201-1311

Mr George Welch

0141-211-4304

Director of Nursing

Mr  Rory Farrelly

0141-201-1311

Mr John Stuart

0141-201-5402

General Manager for

Diagnostics – Laboratory Medicine

Ms Isobel Neil

0141-354-9233

None provided

 

Clinical Director

Obstetrics and Gynaecology

 

Dr Alan Mathers

0141-211- 5378

 

None provided

 

 EBMA group members and deputies for individual hospital sites see (Appendix 2)

Initiation of the EBMA plan

ACTIVATION OF EBMA BY SNBTS

The SNBTS will inform the hospital Transfusion Laboratory that the national blood stocks have reduced to the level where hospitals should implement their Amber or Red status contingency plan. The communication will indicate that stocks should be reduced to the pre-determined level & whether a percentage reduction in usage is required. The Transfusion Laboratory Manager or deputy will immediately contact the Consultant Haematologist with responsibility for Transfusion.

SNBTS will also notify the pan Glasgow EBMG group who would then send off pre determined e-mail informing all clinical staff of the blood shortage status (Appendix 3). The EBMA group will notify the Chief Executive and the Medical Director, who will notify relevant personnel. 

ACTIVATION OF HOSPITAL ARRANGEMENTS

The Consultant Haematologist will authorise the activation of the Hospitals Amber EBMA and initiate the communication cascade (see Appendix 1). The Consultant Haematologist will confirm the time for the first EBMG meeting and inform the chair of the EBMG who will contact all members regarding the shortage status and the time of the first meeting of the EBMG.

  • Flowcharts outlining the hospital plan are shown in Figure 1. Arrangements must be in place for this to operate in and out of regular hours. The process is the same for both Amber and Red.
  • The critical difference between Amber and Red is the clinical prioritisation of patients. In order to simplify the management of this process, national guidance has been provided which suggests dividing patients into three broad categories. See table 1 below:

Table 1. Guidance for red cell use:

Category 1 

Category 2

Category 3

Resuscitation of life threatening/on-going blood loss,  trauma and obstetric haemorrhage

 

 

Surgical support

Emergency surgery* including cardiac and vascular surgery** and organ transplantation. Cancer surgery, probably curative

Surgery/obstetrics

Cancer surgery (palliative)

Symptomatic but not lifethreatening post-operative or post-partum anaemia

Urgent*** but not emergency surgery

Surgery

Elective surgery which is likely to require donor blood support. Greater than 20% likelihood of patients requiring two or more units of donor blood

Non surgical anaemia’s

Life threatening anaemia including patients requiring in-utero support and high dependency care SCBU. Stem cell transplantation or chemotherapy ****

Severe bone marrow failure

Thalassaemias (but consider lower threshold)

Sickle cell disease crises affecting organs

Sickle cell patients aged

<16years with past history of CVA

ECMO

Non surgical anaemia

Symptomatic but not life threatening anaemia

 

*Emergency – patients likely to die within 24 hours without surgery

** With the exception of poor risk rupture aortic aneurysm patients who rarely survive  but may require large volumes of blood                       

*** Urgent – patient likely to have major morbidity if surgery not carried out

**** Planned stem cell transplant or chemotherapy should be deferred if    possible

It is advised that senior clinicians be involved in the decision to use blood during shortages and provide guidance to their staff. In the Red phase – all requests will require approval by Consultant staff.

REVIEW OF REQUESTS FOR BLOOD COMPONENTS

All requests for blood components will be reviewed by Blood Bank staff and assessed using the information given on the request form.

Blood Bank staff will review the request and prioritise the issue of blood following discussion with the Haematologist and take into consideration:

  • The Hospitals Maximum Surgical Blood Order Schedule (MSBOS)
  • Patient category (Categories 1-3 table 1)
  • Blood group of the patient and availability of compatible blood
  • Need for additional platelet and plasma support
  • Referral to Haematologist as required

In the event of difficulties in decision-making the Consultant Haematologist (or EBMG chair) will be the final arbiter. 

Roles and responsibilities of staff groups

The roles of the different staff groups are summarised below.

SNBTS

Responsible for:

  • Provision of relevant and timely information of shortage status to Blood Bank via fax.

LAB MANAGER OR DEPUTY

Responsible for: 

  • Informing Consultant Haematologist of shortage status.
  • Assisting with roles described for Blood Bank staff.

CONSULTANT HAEMATOLOGIST

Responsible for:

  • Informing Chair or Deputy of EBMG of shortage status.
  • Initially (i.e. before the EBMG sits), reviewing and restricting outstanding requests for transfusion in conjunction with the Laboratory Manager/ Local Blood Bank Managerand with input from the Chairman of the EBMG if required.

CHAIRMAN/DEPUTY OF THE EBMG

Responsible for:

  • Informing members of the EBMG of the shortage status.
  • Chairing the EBMG.
  • Monitoring of the integrity of the plan.
  • Acting as an advisor in the formulation and maintenance of the plan.
  • Making final decisions where areas of conflict exist.
  • Review impact of shortages.
  • Collating lessons learnt.
  • Producing the final report following recovery to normal service.

BED MANAGEMENT TEAM

Responsible for:

  • Leasing with the Consultants/Divisional operations staff to stop elective admissions based on clinical priorities and potential blood requirements.
  • Collection and correlation of cancelled operations and feedback of this information to Duty Managers

DUTY CONSULTANTS

Responsible for:

  • Reviewing and restricting blood requirements as per algorithms, MSBOS and EBMA criteria.
  • Liaising with relevant members of the clinical and management teams.
  • Feedback to Bed Management Team re clinical priorities/cancellations of patients.
  • Feedback regarding the impact of restrictions to EBMG via Surgical and Medical representatives.

BLOOD BANK STAFF AND TRANSFUSION PRACTITIONERS

Responsible for:

  • Return of blood from satellite fridges that have reached the 12-hour dereservation period.
  • Production, maintenance and control of a current log of bloodstocks, detailing group and age of units and provide this information at the EBMG.
  • Collation of blood requirements as received in the laboratory prior to the EBMG. To prioritise these with reference to time required. For requests required prior to the EBMG meeting, to provide supporting evidence of appropriateness of request i.e. whether patient is bleeding, Hb level etc, and present this information to the Consultant Haematologist.
  • To make available a meeting room for the EBMG on a daily basis during shortage and contact all members of the EBMG and notify them of the details of the meeting.
Recovery from shortage
  • On recovery from shortage, SNBTS will inform the Transfusion Laboratory that stocks have risen to a level where hospitals can move to AMBER or GREEN status.
  • Local EBMGs will inform the pan Glasgow EBMG when stocks have returned to normal and they will inform the Chief Executive and Medical Director.
  • The SNBTS will adopt a phased return to normal issue levels.
  • The Hospitals will adopt a phased return to normal activity levels; in particular, elective surgery backlogs should not be compressed into the immediate post recovery period.
  • The EBMG will convene to review the effect of the blood shortage and amend the Emergency Blood Management Arrangements as necessary.
Appendix 1: Cascade of information on activation of Emergency Blood Management Arrangements

Appendix 2: Emergency Blood Management Group members and deputies

Emergency Blood Management Group Members and Deputies

WIG/GGH

Title

Name

Contact Details

Deputy

Contact Details

Chair   

Dr.L.Anderson

07808477729 *

Dr.R.Soutar

07818426744 *

Consultant Haematologist

Dr.R.Soutar

07818426744 *

Dr.E.Fitzsimmons

07860421694 *

Consultant Surgeon and A/E Consultant

Mr.M.Clancy

Dr.S.Perry

07801277336 *

Mr.E.Murio

Dr.P.Grant

07877131094 *

07801364867 *

Consultant Acute Medicine

Dr.C.Geddes

07870734496 *

Dr.M.Walters

07970343961 *

Director of Nursing

Mr.R. Farrelly

0141-201-1311

Mr. J Stuart

07900678367 *

Hospital Transfusion Laboratory Managers

Mr. G. Cameron (WIG)

Mrs.M.McQuade

(GGH)

EXT: 52406

 

EXT: 53359

Mr.D.Taylor (WIG)

Mr. A Robertson

(GGH)

 

Transfusion Practitioner

Mrs.C.Collins

07899931302 *

Mrs.L.Sinclair

07557950549 *

Bed Management Lead Co-ordinator

Anne Campbell

EXT: 52669

Page: 4394

Duty Bed Manager

Page: 4394

 

*Mobile numbers only to be used for EBMA

 

GRI

Title

Name

Contact Details

Deputy

Contact Details

Chair   

Dr.Alan Mathers

0141-211-5218

Page: 2252

Dr.Campbell Tait

0141-211-4669

Page: 3293

Consultant Haematologist

Dr.Campbell Tait

0141-211-4669

Page: 3293

Dr.Louisa McIlwaine

0141-211-4492

Page: 3362 or  5849

Consultant Surgeon and A/E Consultant

Mr. Mathew Forshaw

Dr.Neil Dignon

07775604936

0141-211-5166

Page:3056

None provided

Dr. Donogh Maguire

 

0141-211-4002 Page: via switchboard

Consultant Acute Medicine

Prof Miles Fisher

Dr Ravi Jamda

0141-211-4182

0141-211-5372

Page: 2277

Dr.Gerry McKay

Dr Allan Cameron

0141-211-4971

Page: 3783

0141-211-9205 Page: via switchboard

Director of Nursing

Mr. Rory Farrelly

 0141-201-1311

Mr .John Stuart   

07900678367 

Hospital Transfusion Laboratory Managers

Mr. Graham Cameron  

0141-301-7727

0141-211-4667

Ms Alison Whitelaw

Ms Christine Addie

Ms Joanne Kenney

0141-211-5047

Transfusion Practitioner

Ms Lorna Sinclair

07557950549

Mrs Cathy Collins

0789931302

Bed Management Lead Co-ordinator

Ms Kim Fitzpatrick

0141-211-4813

No deputy

 

 

 

 

Yorkhill

Title

Name

Contact Details

Deputy

Contact Details

Chair   

Dr. Jim Beattie

0141-201-0605

(ext: 80605)

None provided

 

Consultant Haematologist

Prof  Brenda Gibson

0141-201-9307 page8033

None provided

 

Consultant Surgeon and A/E Consultant

Dr. Nicola Brindley

Page 8700

 

 

Consultant Intensivist

Dr. Chris Kidson

0141 201 0083

 

 

Director of Nursing

Mr. Rory Farrelly 

0141 201-1311

Mr. John Stuart

07900678367

Hospital Transfusion Laboratory Managers

Mr. Hugh McLelland

0141-354-9093

None provided

 

Transfusion Practitioner

Mrs. Elaine Harrison

0141 201 0440

0141 354-9119

None provided

 

Bed Management Lead Co-ordinator

Ms Anne Douglas

0141-201-0778

None provided

 

HTC Chair

Dr. Phil Bolton

0141 201 0821

Page 8035

 

 

 

VIC/ SGH

Title

Name

Contact Details

Deputy

Contact Details

Chair   

Dr. R. O’Connor

0141-201- 1658

Dr. J. Crawford

0141-201 - 1658

Consultant Haematologist

Dr. A. Morrison 

0141-354 - 9084 

Dr. I. MacDonald

0141-354 - 9082 

Consultant Surgeon and A/E Consultant

Dr. J. Long

0141-201 - 1475

Dr. N. Littlewood

0141-201 - 1455

Consultant Acute Medicine

Dr. J. Morris 

0141-211 - 4470

No deputy

 

Director of Nursing

Mr  R. Farrelly

0141-201-1311

Mr. J. Stuart

079006678367

Hospital Transfusion Laboratory Managers

Mr. Tom Moffat (SGH/Vic)

0141-354 - 9095 

Mr. Hugh McLelland

(SGH/Vic)

0141-354 - 9093  

Transfusion Practitioner

Ms. Margaret McGarvey

(SGH/Vic)

0141-354 -9119 0141-201- 5942

 

Ms. Elaine Harrison (SGH)

 0141-354- 9119

 

Bed Management Lead Co-ordinator

None provided

 

 

 

 

 

Clyde

Title

Name

Contact Details

Deputy

Contact Details

Chair   

Dr.Andrew Thompson

Consultant Gynaecologist

Via RAH switchboard  0141-887-9111

Dr.Morton Hair

Consultant

Gynaecologist

Via RAH switchboard 0141-887-9111

Consultant Haematologist

Dr. Audrey Todd

Via RAH switchboard 0141-887-9111

Dr. Carol Stirling

Via RAH switchboard 0141-887-9111

Consultant Surgeon and A/E Consultant

Mr. Rashid Abu-Rajab

Via RAH switchboard 0141-887-9111

Dr Alan Exton

Via RAH switchboard 0141-887-9111

Consultant Acute Medicine

Dr.Rizwana Hamid

Via RAH switchboard 0141-887-9111

Dr. Ian Keith

Via RAH switchboard 0141-887-9111

Director of Nursing

Mr. Farrelly

0141-201-1311

Mr. J Stuart

07900678367 

Hospital Transfusion Laboratory Managers

Ms. Margaret Jane

Cartwright

0141 314 6162

 

Mr. Martin Wight

 

0141 314 6162

Transfusion Practitioner

Ms. Tina Watson

Via RAH switchboard 0141-887-9111

Not applicable

 

Bed Management Lead Co-ordinator

All bed managers carry pages opposite

RAH: page56005

IRH: page 51040

VOL: page53108

Not applicable

 

 

Appendix 3: 'All-User Email'

To all staff in GG&C :

National blood stocks have fallen to very low levels and unfortunately it has become necessary to implement the National Emergency Blood Management Arrangements (EBMA) with immediate effect.

These detail restrictions in blood use that are required and will be co-ordinated by the hospital’s Emergency Blood Management Group (EBMG) which will oversee implementation of the arrangements. Further information will follow but each individual must play their role in carrying out the plan and ensuring that blood supplies are maintained for the most essential transfusions.

Staff will be kept up to date with the situation and will be informed when the shortage is over.

Yours sincerely

 

On behalf of the Emergency Blood Management Group.

Editorial Information

Last reviewed: 14 May 2014

Next review: 26 February 2016

Author(s): Greater Glasgow and Clyde OTC

Approved By: Clinical Effectiveness