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'Education and understanding are so important in this field because blood transfusion is all about patient safety'

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We talk to Bev Ward, a nurse for 31 years, with experience as an Enrolled Nurse (Mental Illness), then as a Registered General Nurse, and now as a Transfusion Practitioner for Nottingham University Hospitals NHS Trust.

Why did you decide to do this role?

It was different and it looked interesting - and it is! I have had a varied career and haven’t stayed longer than 2-3 years in any post, but I think this one is different.

What qualifications did you need for your position?

To be a Registered Practitioner. I am a nurse - although my colleague, Hayley Bond, is a Registered Biomedical Scientist.

Transfusion Practitioners come from all walks of life. A background in haematology is useful - one of the few specialties in my career I haven’t covered, and it is a work in progress as I continue to learn on the job. There is always something new to learn - and it’s usually a fascinating snippet.

What jobs and experiences have led you to your present job?

I think I came to this job in a round-about way as opposed to a direct route. I have worked in several different areas and places, and done different things and this seemed to fit in with my way of working. I have worked in psychiatry on several different wards caring for people with different types of illnesses. As a general nurse I worked in 4 different hospitals on several different wards, and I also worked in Saudi Arabia and the United Arab Emirates for 3 years. So moving around and gaining different types of experiences is a familiar way of working for me. They have all stood me in good stead for what I have continued to do in my working life.

How could a student obtain the necessary experience?

This is difficult to say as the job is varied, interacting with many different health care professionals without being assigned to a particular clinical area - although there is a fair amount of associated documentation so there is a degree of office-based work. But if staff have been unsure about some of the products we use and what laboratory staff do then I have shown them around the lab and discussed what my colleagues do in different areas of Blood Bank. They can also see the differences between how blood and platelets are stored for example. A visit to one of the National Health Service Blood and Transplant (NHSBT) distribution centres could also be valuable for groups of students in order to gain an insight into how blood and blood products are collected and then processed into their individual components; it is fascinating to see.

In my experience when training I have found that students have many questions surrounding the collection of blood and the questions that are asked of prospective new donors. They do seem very interested and keen to become donors. And don’t forget that all donors are valued, but in the UK, only 5% of the eligible population who can donate, do so. New donors are always welcome.

Students could also come and collect blood from the blood bank initially with a trained colleague (all staff involved in any role in blood transfusion now have to be trained and assessed, including students) to see where blood is checked and collected and how this is achieved. It is a very important part of the process.

The Transfusion Practitioners are in close proximity to the Blood Bank at our Trust, so if they have any queries they can call and we can help.

After that they can attend lectures and follow the process to become trained and assessed in collecting blood products from Blood Bank. In order to do this at our Trust there is a lecture followed by a knowledge assessment test and then a practical assessment which currently occurs three-yearly. It probably sounds harder than it is!

What do you do in your day-to-day role?

To some extent, the role involves ensuring that our Trust complies with Blood Safety and Quality Regulations (2005). This is legislation which is applicable to all areas of the transfusion process to ensure the transfusion products available are safe - so tested, stored and handled in a standardised manner to ensure a quality service.

Some of what I do involves investigating incidents relating to transfusion. Staff are encouraged to report any incidents and part of my role is to investigate the cause, which may be due to a training issue or a gap in the transfusion process. Incident investigation is important because then the gaps identified in the system or in knowledge can then be addressed, thereby improving the safety of transfusion.

Certainly, since the introduction of the Transfusion Practitioner role, certain categories of incidents have decreased nationally.

I also answer numerous email and phone queries, book staff into training, and record each staff’s successful Competency Assessment on the electronic staff register.

Educating staff in Transfusion Safety is a significant part of my role, whether that’s ward-based, or lecture theatre-based, so I can be teaching 10-90 people depending on where I am.

Occasionally I visit other hospitals locally to deliver the Transfusion training.

I also create a newsletter with up-to-date transfusion information in it to go out to the Trust, using it as a method of communication, education, and explanation.

My other duties include traceability of products - where the process hasn’t been followed. For this, I can be seen on the wards, talking with staff to ascertain what has gone wrong and how to put it right.

As a trainer for mandatory role related training I attend Trust meetings regarding our Productive Training program so as to ensure our training fits with the Trust’s training updates.

Meetings are an important part of my role and I attend the Hospital Transfusion Team and Hospital Transfusion Committee meetings to ascertain problems that have occurred and to discuss how these can be addressed, rectified and prevented.

Audit is another aspect of my role; I have been involved in several audits, locally and nationally.

What are the skills that are most important for your job?

Three-dimensional thinking! That is, trying to ascertain who has done what and when in the process of prescribing, sampling, collecting or administering blood products and then setting out an action plan to address issues raised from problems presented.

Also, good interpersonal skills are a must; the ability to see situations from all points of view and try to find the best way forward to solve any issues which may arise is vital.

What is your favourite part of your job?

Learning and educating. The more I learn, the more I can inform and explain to others when there are aspects of the transfusion process that they don’t understand, as it can get very complicated.

This is why education and understanding are so important in this field because blood transfusion is all about patient safety - this is why it is so highly regulated. I enjoy putting the newsletter together and sitting in on lectures from the NHSBT because it so useful for me to get to be always learning.

And what is your least favourite part?

The Dreaded Quarantine Drawer! This drawer is located in one of the fridges in Blood Bank accessible only to laboratory staff. If there is something wrong with the unit of blood, then it is placed in the quarantine drawer until the problem can be resolved. Usually, units are placed in the drawer if required documentation isn’t completed, or further testing is required, but for me it is usually the start of an incident investigation. It is then my job to find out what exactly has happened to the unit - who took it from the fridge initially? Where did it go? Where has it been? How has it been stored? Have all the correct procedures been followed? Then the decision can be taken as to whether the unit can be used or must be disposed of. Then it is taken to the next level to decide what needs to be done to prevent it happening again. Is it a ‘one-off’ or is it happening often? Does it need auditing? Is it a training issue? Do we need to alter a process?

This can take some time because some of the staff I may need to talk to may have gone off-duty or on holiday and there may be no-one else to explain what happened to the blood until that person comes back. Blood has a finite lifespan in a bag, so there is often a time limit and an urgency to resolve the problem as the unit cannot be used until we have all the information. It is my least favourite part of my job because trying to sort out exactly what has happened can be complex and I am often against the clock, so the stress levels can be quite high.

What has been your greatest achievement?

Obtaining my second degree in nursing and Post Graduate Certificate in Education.

What advice would you give someone who wanted to do this role?

The RCN used to have a conference regarding transfusion, which I attended prior to applying for this role and found quite useful and informative. Also is an online learning package regarding transfusion which I found helpful. There is an opportunity to print off the subject matter for each module. It eventually becomes a 300 page document but it is full of useful information, and the program produces a certificate on completion.

Also, attendance at some of the NHSBT study days are very helpful too. There aren’t any actual Transfusion Practitioner courses nationally. It was being explored by one organisation but doesn’t appear to have developed beyond the pilot study, though NHSBT may potentially explore it in the future.

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