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By Dr Rana Nabulsi, PhD, Msc, CPHQ, SSGB, EFQM, Senior Clinical Quality Specialist, Head of Quality Assurance Unit, Development & Follow-up Section, Pathology & Genetics Department, Dubai Health Authority, UAE
The primary goal of transfusion medicine is to ensure a safe transfusion of blood and blood products to patients. To achieve quality service in transfusion medicine, laboratory professionals ought to follow international guidelines set forth by AABB (formerly known as the American Association of Blood Banks), FDA (US Food and Drug Administration), CAP (College of American Pathologists), GMP (Good Manufacturing Practices) and JCI (Joint Commission International).
Blood transfusion services are commonly divided into two areas: donors at Blood Banks and recipients at hospitals.
The quality journey starts with the donation process, followed by the immediate storage of blood units, components preparation within six hours after collection and accurate labeling for ABO and Rh grouping. Facility design should include separate areas for donor selection, blood collection, blood processing, storage, and laboratory facilities.
Essentials of quality at blood banks shall cover quality control procedure for reagents, blood units, blood products, equipment management, calibration of temperature storage devices, continuous temperature monitoring system and alarms. External quality assurance programme is important to monitor accuracy of laboratory testing. Avoiding mis-identification risk before and during transfusion is considered the most important safe practice to minimise transfusion reactions.
Compliance with international standards is not adequate to show excellence in Transfusion Medicine Services. Most blood banks need to think outside the box and start implementing quality improvement models such as Six Sigma and Lean tools.
Implementing Six Sigma in Transfusion Medicine will help laboratory professionals reduce variation in processes and start counting their errors, defects and deviations. Calculating the Sigma metric will help laboratory professionals monitor their improvement in accuracy and increase process capability in order to reduce variation. Converting all errors in Transfusion Medicine Services yearly into defects per million opportunities, (DPMO) will help blood bank professionals monitor the level of Sigma Metric that the blood bank has. Implementing Six Sigma Model of DMIAC (Define, Measure, Improve, Analyse and Control) will improve the services in transfusion services.
Implementing Lean is important to accelerate the process flow between different processes and reduce the wasted resources in process time, inventory, and defects. Implementing Lean helps blood banks in streamlining their processes, eliminating the “no value-added activities” and accelerating the workflow. Lean provides a platform for sustainable and continuous process improvement. Poor layouts of blood bank processes and working stations can cause increased congestion, stress for staff, increased turn-around time, error potential as well as decreased capacity and efficiency. Reduction in RBC and plasma product wastage had been reported by hospitals that implemented the Lean Six Sigma improvement model.
The Kanban Model is one tool of Lean Management system that triggers a notification system. Once the notification system is activated, it will trigger a response to start another process. A good example is an inventory notification card for low supply of certain blood products or low supply of certain reagents.
The Kanban model can be used to turn the working environment into a visual instructive by using visual cues. Visual cues are used to reduce the amount of wasted time that is spent on searching, looking, waiting and asking for things such as reagents, patient records, blood products or consumables. Using coloured labels, coloured test tube racks, TV monitors, signage and white boards are good examples of Kanban model.
5S Model, which is another model of Lean Management System, can help transfusion service facilities to organise the workspace by the tool sort, set in order, shine, standardise and sustain. Mistake-Proofing (Poka-Yoke) tool is a third type of Lean Management system. It can be utilised to reduce human errors inside blood banks. The use of Bar Coding to match a patient with the blood unit is a good example of Poka-Yoke. In addition, Mistake-Proofing is best utilised by blocking the laboratory analyser from testing patient samples after any failure in calibration or quality control runs.
To summarise, implementing quality improvement models in Transfusion Services such as Lean and six Sigma models can increase Blood Bank efficiency and capacity, enhance process effectiveness, reduce overall costs, better utilise blood products, eliminate error potential and improve patient outcomes.
References available on request.