Blood Matters COVID-19 newsletter issue 5



COVID-19 – Newsletter 5 April 29 2020Dear All (Transfusion Nurses/Trainers /Safety Officers/Scientists/SCIg coordinators and others that you forward this to)This week we continue to share ideas, strategies and issues raised by health/pathology services. Please let the Blood Matters team know if there are issues/areas where we can provide additional support/resources. We would love to hear about initiatives that are being implemented to assist any aspect of dealing with COVID-19 to bloodmatters@.au We encourage consultation and collaboration when looking at any change/s in your practice/s to understand the impact these may have on other services. Also included is a Lifeblood AHP Coronavirus update from 8/4/20. How I check blood for a patient in isolationBedside check for blood transfusion in isolation Checking blood for patients in isolation can be a challenge. Many health services will have well established processes, where these are not in place some examples are included below for consideration and consultation with infection control team.Blood Matters do not endorse any particular method and health services need to ensure the checks are completed appropriately regardless of circumstances, to reduce the risk of incorrect blood component transfusion events occurring.Example 1 (no documents enter the patient room)If able, transfusion could be timed for when two nurses are needed to be in the isolation room at the same time. Two authorised staff check the blood outside the room of the COVID positive patient against the paperwork (prescription and/or compatibility report) ensuring all aspects match i.e. right product, right blood group, right time, right patient (as against prescription).The staff perform hand hygiene and don PPE and take the blood product into the room of the COVID positive patient.Perform positive patient identification (PPID)ask patient to state name and date of birth, check this matches patient ID band; check details match patient information on blood bag. If all match the primary nurse commences the transfusion and stays in the patient zone for the first 15 minutes.On leaving the room the nurses remove PPE and perform hand hygiene. Complete documentation outside the room.Example 2 – checking blood products in the operating theatre (OT) for COVID-19 patientsStaff inside the OT are part of the “operating team”. They are unable to exit the environment easily to collect or check blood.No documentation enters the OT, this includes the anaesthetic chart. The system is managed as a two team process – “clean team” outside the theatre and “operating (dirty) team” inside the theatre. The anaesthetic team use the telephone to communicate all treatment and observations to be documented outside the room by the clean anaesthetic team. Blood checkingThe “clean team” (2 staff outside the OT of the COVID positive patient) check the blood product against the paperwork (prescription/compatibility report) ensuring all aspects match i.e. right product, right blood group, right time, right patient (as against prescription).If all are correct and match the blood product, it is passed to the “operating (dirty) team” wearing PPE inside the OT.The “operating team” compare the blood product with the patient ID band.If patient ID matches they commence the blood transfusion.The documentation remains outside the OT.The “clean team” sign the documents initially.Following the operation, after removal of PPE the “operating team” sign the documentation.Blood checking with electronic medical record (EMR)For health services with an EMR, the prescription may be in the form of an electronic request. In order to perform blood product checks the computer (in the form of computer on wheels, workstation on wheels, etc) may need to be taken into the room for checks to be completed.Where this is the case, consider:These workstations are designed for infection control cleaning, and if removed from the room must be cleaned with the appropriate detergent/antiseptic as per health service guidelines.Consider if able, leaving one workstation in each room of COVID-19 patients to reduce the risk of cross contamination.Follow health service policy for the use of these workstations.BloodNet discard episodesWhen discarding blood products in BloodNet due to potential respiratory droplet contamination please discard with the applicable discard code, for example:356870032385please enter notes relating to COVID-19 in the comments field.00please enter notes relating to COVID-19 in the comments field.318706519050Clinical – ordered for patient, not required or Storage – out of controlled storage or Other BloodNet team have been contacted regarding the feasibility of adding a COVID-19 specific discard code. In the interim, please use comments to note where blood component discards are attributed to COVID-19.Has a blood component/product been at risk of COVID-19 contamination?Scenarios in which blood components and products must be discarded in relation to COVID-19 should be discussed with your infection control team. The risk of contamination must be taken into account and not every product that leaves the transfusion laboratory will be at risk. Some sites have implemented a process where a signed statement is included with each blood component/product returned to the laboratory, stating if there has not been a risk of contamination from COVID-19. An example can be found in Newsletter 3 (09/04/2020).A reminder to work with your infection control team to ensure procedures are correct to meet local guidelines.A reminder to be PREPARED and only collect product for immediate transfusion.A recent ANZSBT newsletter links to COVID-19 related information. It can be found at Subcutaneous Immunoglobulin (SCIg)The COVID-19 pandemic has seen much change in practice to protect vulnerable patients and staff. The significant increase in uptake of SCIg nationally and in Victoria is evidence of clinicians taking extra measures to protect at risk patients. This has been supported by SCIg nurses in Victoria adapting practice to limit patient exposure to the hospital setting, the additional work required for this is acknowledged. Examples include:Telephone review of patients Allowing relatives to pick up product & consumablesCoordination of ‘drive through SCIg’ collectionArranging home delivery of product and consumablesCoordinating the training and clinical support of patients transitioning to SCIg.We are liaising with key professional bodies to ensure the supply of product and consumables are able to meet the increase in demand. Please contact Nadine Gilby for any concerns at nagilby@.au .Look after yourselves, and look after each other.Blood Matters teamAuthorised and published by the Victorian Government, 1 Treasury Place, Melbourne.?State of Victoria, 29 April, 2020.ISBN 978-1-76069-428-9 ?(pdf/online/MS word) ................
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