C lick to edit Master text styles Test Transfusion Associated - PowerPoint PPT Presentation

C lick to edit Master text styles Test Transfusion Associated Circulatory Overload C lick to edit Master subtitle style Anna Bartholomew – Specialist Transfusion Practitioner Northumbria Healthcare NHS Foundation Trust Test Wansbeck General Hospital 07/10/15 1

C lick to edit Master text styles Test TAC O occurs when a patient's circulatory system is unable to handle an increase in circulatory volume Leads to pulmonary oedema R isk factors: C ardiac failure C lick to edit Master subtitle style R enal Impairment Hypoalbuminaemia or fluid overload Aged more than 70 years Test Low body weight 07/10/15 2

C lick to edit Master text styles Test International S ociety of Blood Transfusion (IS BT) definition states that TAC O includes any 4 of the following that occur within 6 hours of transfusion Acute respiratory distress Tachycardia C lick to edit Master subtitle style Increased blood pressure Acute or worsening pulmonary oedema Test E vidence of positive fluid balance 2014 S HOT R eport informs us definitions of TAC O are being reviewed 07/10/15 3

C lick to edit Master text styles Test C lick to edit Master subtitle style Test 07/10/15 4

C lick to edit Master text styles Masters Level Degree Test Project to manage TAC O always been of interest C ollaboration with Denise Prompt for NC A C lick to edit Master subtitle style Decided on an audit R ecognition of transfusion associated circulatory Test overload in patients aged over 70 years R etrospective audit over a 3 month period in 2012 07/10/15 5

C lick to edit Master text styles Test To determine: Incidence of TAC O within the Trust Is under-reporting indicated? Observable links to TAC O in patients aged over 70 C lick to edit Master subtitle style years If an framework would assist with the prescribing Test of blood components for this vulnerable group of patients 07/10/15 6

C lick to edit Master text styles Test Availability and accessibility of patient s notes Layout of notes and information Multiple volumes of notes C lick to edit Master subtitle style Large number of patients Lack of relevant documentation Test 07/10/15 7

C lick to edit Master text styles Test Age of patient Male / F emale Weight of patient Location of patient at time of transfusion C lick to edit Master subtitle style If a diuretic was prescribed in advance of the transfusion R ecorded on fluid balance chart Test Any evidence of TAC O if so, was it reported within Trust / S HOT 07/10/15 8

C lick to edit Master text styles Test 247 patients, accounting for 526 blood 29 components 170/247 (69% ) were 70 - 74 years 48 C lick to edit Master subtitle style 75- 79 years aged over 80yrs over 80 years 170 107 Males Test 140 F emales 07/10/15 9

C lick to edit Master text styles Test 183/247 had a weight Patient's weight recorded (74% ) 120 110/183 (60% ) weighed 100 Num ber of patients 80 less than 70kg C lick to edit Master subtitle style 60 Number of patients Lowest weight recorded 40 was 34kg! 20 Test 0 <70 kg 71 - 80kg >80 kg Weight in kgs 07/10/15 10

Location of patient C lick to edit Master text styles Orthopaedics Test Elderly care Theatre / recovery General surgery Medical admissions unit Emergency Care (A&E) Community ward Oncology day unit Haematology Palliative Care Unit C lick to edit Master subtitle style Intensive Care / HDU Cardiology Stroke unit Ambulatory care Surgical assessment unit Test Community day case Gynaecology Respiratory medicine Medicine 0 5 10 15 20 25 30 35 Number of episodes 07/10/15 11

C lick to edit Master text styles Test 28/247 (11% ) were Prescription rate of units prescribed a diuretic in 292 advance of the 300 250 transfusion 200 100 97 C lick to edit Master subtitle style Number of units 150 20 100 A further 9 patients (4% ) 50 0 < 60 mins 90 mins 120 mins 180 mins required a diuretic as a Prescription rate Test result of the transfusion 07/10/15 12

C lick to edit Master text styles Test Only 56/247 episodes, accounting for 92 units were recorded Not all units in the episode were recorded, e.g. one C lick to edit Master subtitle style but not the other Many incomplete charts Test No charts used 07/10/15 13

C lick to edit Master text styles Test 8 cases of possible TAC O Not identified at the time, so not reported to S HOT 5/8 weighed less than 70kg; 2/8 had no weight recorded 8/8 aged over 80 years 6 F emales; 2 Males C lick to edit Master subtitle style S uggestion of high incidence of under reporting Test 07/10/15 14

C lick to edit Master text styles Test Units Diuretic in History of History of renal Patient ID transfused advance Full observations cardiac failure impairment 2 x x 1 3 x 2 2 x x 3 C lick to edit Master subtitle style 2 x x 4 2 x x x 5 Test 3 x x 6 2 x x x 7 2 x x 8 07/10/15 15

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C lick to edit Master text styles Male patient aged 87 Test Admitted to MAU through A&E Patient weighed 69.8kgs Hb 62 g/ L 2 units RBC’s prescribed Pt developed acute respiratory distress C lick to edit Master subtitle style Increased blood pressure Acute/ worsening pulmonary oedema all within 6 hours Test NO fluid balance chart present History of AF and Hypoalbuminaemia 07/10/15 17

C lick to edit Master text styles Test Review was requested of ward medical staff after the transfusion had completed IV Furosemide 80mgs given to patient Hb checked and a further unit was given the next day with 2 x Furosemide 40mgs given to C lick to edit Master subtitle style the patient before and after No reference to TACO or fluid overload Test documented following this episode No Datix/ SHOT report 07/10/15 18

C lick to edit Master text styles Test F emale patient aged 86 weight 53.9Kgs on Gynae Prescribed 2 units of blood for Hb of 75g/L actively bleeding Acute respiratory distress Tachycardia C lick to edit Master subtitle style Acute/worsening pulmonary oedema E vidence of positive fluid balance Within 6 hours of Transfusion Test History of C ardiac Failure and F luid Overload 07/10/15 19

C lick to edit Master text styles Test Units recorded on fluid balance chart Pt reviewed by ward Medics and commenced on 35% O2 Furosemide after 1 st unit and at 3am and required 40mgs However not documented in patient s notes C lick to edit Master subtitle style No Datix and not reported Not reported to Lab/S TP/TTT/HTC to S HOT Test 07/10/15 20

C lick to edit Master text styles Male pt aged 80+ weight not recorded Test Haematology Patient admitted with active UGI Bleed Hb 76g/L Pt developed AR D Acute/worsening pulmonary oedema C lick to edit Master subtitle style E vidence of positive fluid balance Within 6 hours of transfusion Test Patient had history of cardiac failure and fluid overload 07/10/15 21

C lick to edit Master text styles Test Pt reviewed by ward medical staff Transfusion stopped part way through 2 nd unit Oxygen commenced unable to determine % given Diuretic administered C lick to edit Master subtitle style Documented in the patients notes Test Not reported to Lab/S TP/TTT/HTC No Datix and not reported to S HOT 07/10/15 22

C lick to edit Master text styles F emale pt aged 85 weighed 70 Kgs Test Hb 79g/L Orthopaedic pt Given 2 units of R BC 's Pt developed increased S OB Increased BP C lick to edit Master subtitle style Acute or worsening pulmonary oedema Had evidence of positive fluid balance Test not within 6 hours but 2 days later E arlier in 2012 evidence of heart failure on previous admission for pulmonary oedema 07/10/15 23

Daily dose of 20mgs furosemide C lick to edit Master text styles Test Pt developed post transfusion crackles on auscultation of the chest with a ?pulmonary oedema diagnosis Patient had only 1 kidney 2LO2 commenced via nasal cannulae No additional furosemide to daily dose administered C lick to edit Master subtitle style Patient had received 2 x 1L N S aline over 12 hours but this had not been recorded on the fluid balance chart Test and blood was not recorded either Not reported to Lab/S TP/TTT 07/10/15 24

C lick to edit Master text styles Test E nsure staff: R ecord the patients weight C omplete a fluid balance chart C onsider diuretic cover Monitor for TAC O at all times Present findings at appropriate meetings C lick to edit Master subtitle style S uggest a NC A Develop an algorithm Test Advocate use of single unit transfusions where appropriate P BM R esources S ize Matters Don t give 2 07/10/15 25

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C lick to edit Master text styles Test Poster presentation at BBTS in 2014 in C linical Transfusion and Hospital Laboratory Practice and Patient Blood Management category Develop algorithm for use C lick to edit Master subtitle style P ublish findings NC A to take place in autumn 2016 Test 07/10/15 28