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Radiographer-led blood product prescribing

22 May, 2018

Author: Lucy Davidson, Specialist Radiographer, Christie NHS Foundation Trust

Lucy Davidson
Lucy Davidson

Almost 60% of patients with solid tumours undergoing anti-cancer treatment become anaemic, with a haemoglobin (Hb) <110g/l during their treatment (Joint United Kingdom (UK) Blood Transfusion and Tissue Transplantation Services Professional Advisory Committee [JPAC], 2016).

Besides the direct physiologic consequences of anaemia such as fatigue, shortness of breath and tachycardia, anaemia itself can result in an inferior treatment outcome to radiotherapy by causing tumour hypoxia and radio-resistance (Hoff, 2011).

How did it come about?
Following an internal audit, reviewing all SCC anal cancer patients who received concurrent chemo-radiotherapy treatment over a 12 month period, it was identified that 21.7% of these patients required a blood transfusion during their radiotherapy treatment.

Working autonomously as an advanced practitioner within radiotherapy, I review and support patients during their treatment as a practitioner. Not authorised to request either a cross-match or blood product prescription, this was completed by a medic. However, it was identified that there was a risk to patient safety because the medic may not have reviewed the patient prior to completing the relevant documentation.

The move forward
My clinical supervisor and I identified that these risks would be significantly reduced if I was able to undertake blood product prescribing. Local policy, though, identified that apart from medics, only advanced nurse practitioners with relevant training were able to do this procedure.

We contacted the trust transfusion practitioner and non-medical prescribing lead to discuss our concerns and gain their expertise and thoughts. Initially, there was some hesitation because the blood transfusion team had not worked with a specialist radiographer before but there was excellent support from the transfusion practitioner, who contacted a wide variety of people: the Northwest Transfusion Practitioners, the consultant haematologist, the National Clinical Director for Patient Blood Management and secretary of the National Blood Transfusion Committee, as well as the clinical lead for transfusion in Central Manchester Hospitals, and the Society and College of Radiographers.

It was noted that there was no nationally recognised radiographer carrying out blood product prescribing, but there was support for role development. We could create a template to be used nationally for other radiographers and to gain confidence for this role
extension within other professional groups.

What did we do?
A risk report was submitted to the hospital transfusion and patient safety committees. A minimum set of academic and clinical competencies required were proposed, which matched the competencies required by an advanced nurse.

The following processes were also undertaken:

  1. Local blood transfusion policy was updated to reflect changes in competency framework.
  2. The blood transfusion competency booklet was adapted.
  3. A risk assessment was completed and added to the risk register.

Training
Although a blood product is defined as a medical product rather than a medicine, the requirement of working as a non-medical prescriber and the use of a ‘prescription’ is for a safety and governance reason, rather than a legal one. Therefore, both locally and nationally, it is highly recommended that healthcare professionals who undertake blood product prescribing are independent non-medical prescribers.

Following the national approval for therapeutic radiographers to become independent prescribers, I have completed my conversion course from supplementary prescribing to independent. I took the three day training course with the NHS blood and transplant team. It gave me further understating of the blood transfusion process from donor to recipient and the potential risks.

Where we are now
I am currently completing my competency and hope to be prescribing blood products shortly. The true impact of multidisciplinary team working and the good working relationship I have developed with the blood transfusion practitioner have been positive experiences.

The recognition locally and nationally of radiographer-led blood product prescribing is an essential area of role extension to improve the patient pathway and reduce risks, whilst also being a significant and important step forwards for the profession.

Acknowledgement
My thanks to Sharon Jackson, transfusion practitioner, for her help and support.

 

 

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