In Focus
The role of the transfusion practitioner in haemovigilance
Supporting and enhancing transfusion and patient safety
The term Transfusion Practitioner (TP) is an overarching term that originated in the United Kingdom (UK) and is used internationally to describe a specific role and the many and varied activities undertaken by an array of health care professionals in the areas of transfusion and patient blood management (PBM).
Common titles that are used by countries to describe this role are Transfusion Nurse, Transfusion Safety/Quality Officer, Haemovigilance Officer/Nurse, Transfusion Clinical Nurse Consultant and PBM Coordinator/Practitioner1.
The TP role emerged in the UK and Canada in the 1990’s and evolved across Australia, Europe and the United States in the early 2000’s. Uptake of the role continues across the world. Today, TPs are recognised internationally as experts in safe, appropriate transfusion practice2.
TPs come from different healthcare backgrounds, commonly nursing, scientific, and in some countries medical, which provides diverse skillsets seen across the role. The activities undertaken by the TP are as varied as their backgrounds and largely driven by a combination of the TPs skills and the requirements/strategic direction of the organization in which they work. The majority of TPs work within hospitals and focus on the recipient side of the transfusion chain. However, all TPs contribute to haemovigilance in some capacity1,3.
Haemovigilance is defined as a set of surveillance procedures covering the entire transfusion process from vein to vein. It incorporates the donation and blood collection process, product processing, laboratory procedures and transport of the product, right through to follow up of the patient receiving the product4,5.
Across the globe, there are varying levels of maturity of implementation of national haemovigilance systems. The International Haemovigilance Network (IHN) vision is for health services around the world to have effective haemovigilance systems in place4,5,6,7,8.
Haemovigilance aims to collect, monitor and assess information on unexpected events and adverse reactions associated with transfusion, to prevent occurrence or recurrence, support organisations to benchmark both locally and nationally, and provide opportunities for shared learning4,5.
TP involvement in haemovigilance includes the investigation and reporting of transfusion reactions internally, and externally to national haemovigilance schemes and includes conducting a detailed process review and communicating directly with clinical and laboratory staff or patients involved. This enables the TP to provide additional details to the investigation process, providing a more complete or wholistic picture of the event. The provision of extra information can assist with the conclusion of the transfusion reaction investigation as well as inform recommendations for future transfusion plans for the patient3.
Likewise, the TP is also involved in transfusion associated adverse event and near miss reporting. They often carry out root-cause analysis and collaborate with others, working to achieve corrective and preventative measures. Surveillance is often supported through audits which assist with identification of gaps in staff knowledge, topics for future education and contribute to the development of quality improvement projects3.
TPs combine their expert knowledge with their haemovigilance skills to support quality improvement in transfusion policies, procedures, digital systems and develop reference guides and educational resources3.
TPs also provide or support the development and delivery of staff education. Hot topics often focus on recognised high-risk points in the transfusion chain such as pre-transfusion sample collection, product collection, blood administration, and transfusion reaction monitoring and responding.
Recognition of the risk points and prioritisation of education topics may be informed through haemovigilance processes or data. Education provided by a TP to clinical and laboratory staff may be structured in the form of lectures or via informal staff discussions about a specific case or when staff seek advice and ask questions3.
An essential part of the TP role is acting as a liaison between the clinical and laboratory settings. Therefore, it is important for TPs to maintain a visible presence in the clinical setting and have good communication and collaboration skills3.
TPs not only contribute to haemovigilance by supporting hospital transfusion committees. They may also, collaborate nationally or internationally, to elevate the role, share learnings and raise awareness of adverse events and trends in practice changes.
In some countries there are new and emerging aspects to the role of TPs and haemovigilance with the implementation of electronic medical records (EMR). EMRs, can offer many safety nets and opportunities to support haemovigilance. For example, implementation of IT assisted scanning of patient identification bands and blood bags can improve compliance with checking procedures and assist with traceability of blood components/products. However, introduction of EMRs may also provide associated unintended consequences to workflows and potentially introduce errors associated with systems failure, the transition between written or manual processes and the EMR, and failure of interactions between the system and users. This can lead to the development of unsafe clinician developed workarounds which may offset potential benefits. TPs need to work with IT specialists and clinicians to support safe practice and workflow integration with the introduction of any proposed hardware and software solutions to promote risk reduction strategies and ensure haemovigilance reporting pathways remain sound9,10.
The TP role is not yet established in all countries and the role of TPs in haemovigilance continues to evolve with the fast-paced changing healthcare systems they work within. This article demonstrates the important role TPs play in supporting and enhancing transfusion and patient safety through haemovigilance.
References
- International Society of Blood Transfusion (ISBT). Transfusion Practitioners | The International Society of Blood Transfusion
- K. Miller, C. Akers, A. Davis, E. Wood, C. Hennessy, L Bielby. The evolving Role of the Transfusion Practitioner. Transfusion Medicine Rev (2015)
- C. O’Reilly, R Deelen. The role of the Transfusion Practitioner in Haemovigilance. Transfusion Today. 2017:113:10
- International Haemovigilance Network (IHN). Haemovigilance - International Haemovigilance Network
- World Health Organisation (WHO). A guide to establishing a national Haemovigilance system. Health products policy and standards
- National Blood Authority (NBA). Australian Haemovigilance Report. Haemovigilance Report 2021-22.pdf
- National Advisory Committee on Blood and Blood Products. 2026. Overview of Adverse Transfusion Reaction Reporting for Hospitals in Canada: a NAC and Québec Hemovigilance System Collaborative Initiative | National Advisory Committee on Blood and Blood Products (NAC)
- Serious Hazards of Transfusion (SHOT). About us - Serious Hazards of Transfusion
- Australian and New Zealand Society of Blood Transfusion (ANZSBT). Guidelines for the implementation and use of electronic medical records for transfusion - ANZSBT
- International Society of Blood Transfusion (ISBT). ISBT-TP-JobDescriptionFinal1 (1).pdf
