Survivorship and Patients Perspective
Jane Gibson, Sarah Wells, Sharon Jackson, Philip Higham, Deborah Seal, Kim Linton
The Christie NHS Foundation Trust, Manchester, UK
Background: A clinical audit was undertaken in 2016 following an increase in the number of near misses (21 in 2015, 33 in 2016) involving lymphoma patients where the blood transfusion laboratory had not been alerted that the patient required irradiated blood products. At that time there was no robust communication system in place between clinicians, laboratory and patients. The audit showed poor compliance with Trust and national guidelines. Recommendations were implemented and a re-audit carried out demonstrated significant improvement in compliance.
Methodology: 51 lymphoma patients meeting the requirements for irradiated blood products were identified. Retrospective casenote review undertaken of lymphoma patients who attended outpatient clinics between September and November 2016. Data sources included patient interview, data collection proforma and blood transfusion laboratory data. Re-audit in July 2017 used the same sample size and methodology.
Results: The 2016 audit found 39% (20/51) of patients had received an irradiated blood product written information and alert card; this increased to 82% (42/51) in 2017. In 2016 the blood transfusion laboratory had been informed of 65% (17/26) of patients with Hodgkin lymphoma; in 2017 this was 100% (27/27). In 2016 the blood transfusion laboratory had been informed about relevant chemotherapy (Fludarabine, Bendamustine) in 88% (22/25) of cases; 100% (24/24) in 2017. In both audit samples all patients who had been transfused (n = 15 in 2016, n = 6 in 2017) received irradiated blood products. The number of reported near misses fell to 2 in the first six months of 2017; 6 in total in 2017.
Conclusions: Improvements in practice followed implementation of recommendations in the light of the original audit findings. These included improvements in communication between the clinical team and blood transfusion laboratory as well as provision of written information to patients. Other recommendations included planned introduction of Trust electronic patient record system as well as ongoing education of ward medical and nursing teams.