CBPR Cumulative Blood Product Record Blood Management Service

Update to Form Required Last update was done in 2010 Currently not being used provincially This form was not standardized within the province A working group was formed to make this form standardized so that each region had documentation that was consistent and compliant with AABB and Accreditation Canada guidelines Shared Health Service has taken ownership of this form Blood product list changes New transfusion reaction algorithm

Side 1 Will be formatted by print shop at HSC

Side 2

Guidelines and Appendix will be updated Appendix 6 is the completion guide for the CBPR with an example filled in All other guidelines within the MTBPRM that are affected by these changes have been amended. These changes are now on the Best Blood Manitoba Website.

Education Timeline April 10th form will be available from print shop there is a global SAP number Education will be via a pre recorded presentation available on BBM This power point is also available for those who wish to print this There will be a point form 8 x 11 printable poster of changes Will also have a side 2 similar to Version 1 Still discussion on how to include transfusion reaction identification on form.

Roll Out Process This form will be available as of April 10th. As units run out of the old versions of this form the new one will be supplied when ordered there is a Global SAP number which is #29178 In the other Regional Health Authorities this document has been provided to the CNO’s for distribution It is expected that this form will be completely implemented as the standard documentation for blood and blood products for the province in 1 year- April 10 2020.

Updates Include; Individual Regions will no longer be required on the form.

A check mark will be required once verification of consent and the 2 authorized providers have verified that the correct product has been issued to the intended patient. It is expected that the transfusionist has ensured a patent IV has been established, a pre transfusion assessment is complete, vital signs and education has been complete prior to this form being initiated. Lines removed; Patient/family education (includes type of product, reason for administration, signs and symptoms of a reaction) Physician order for a product Intravenous site checked and patent Pre transfusion vital signs

Transfusion Reaction Assessment- this is included Transfusion Reaction Assessment- this is included. It aligns with the Transfusion Reaction Algorithm. Prior document had assessment parameters, with no associated actions for these. Used to say, “ If symptomatic document in assessment section and provide details in intervention section.” There are more symptoms of a transfusion reaction than were listed and these symptoms needed to occur after the transfusion had been started. Charted will now be N for no or Y for yes with details to follow in the intervention section or patients progress notes.

Blood product list has been updated with the most common products Blood product list has been updated with the most common products. If a product is not listed please refer to BBM product monograph section. https://bestbloodmanitoba.ca/product-monographs/ If there is a monograph for the product you are giving this needs to be charted on this document. i.e. only products issued from the blood bank.

Date and time unchanged Check box for consent/verification of product Blood group and Product Few changes required to algorithm Revised list of Major symptoms - they are now in order of the most common reaction which is TACO- the number one mortality issue related to blood transfusions Removed the directions to contact the transfusion MD on call to be indepenent on bottom of algorithm Changed the wording to relfect the processing of blood bags that go to blood bank Needed to establish more interventions and definitions of the symptoms We have added interventions/ symptoms onto back of algorithm Still in early phase Blood Day will have an afternoon talking all about transfusion reactions Roll out will include tags added to the blood products to reflect the algorithm change, and then will develop into a series of educational attachments on the different transfusion reactions and how to identify these.

This is where the sticker that is on the back of the product or attached to product is removed and attached here Derivatives have a larger sticker that will take up 4 spaces For derivatives can write the Lot and Sequence number legibly to save space

Space to write complete set of vital signs

A column added to check of when the ROT has been returned to the blood bank

Interventions if they are lengthy should direct reader to the IPN or patients progress notes This area is where the total volume of product has been infused is listed. The amount is to be listed after the product has infused. This should also be listed on the patients fluid balance record

The initial column is where the 2 authorized practitioners sign the 2 person product to patient verification. Charts should include a signature page where your full signature is charted.

Product notification- check when this has been provided to the patient on discharge from the facility This column has been added. The old form had a small box on the bottom of the sheet. The Cumulative blood product record can be used multiple times on different admissions. As per accreditation Canada a patient must be notified that they have received a blood product on discharge from hospital.

Form #NS01164- within the WRHA Will also be available on BBM Within the WRHA there Form #NS01164- within the WRHA Will also be available on BBM

The SAP number is unchanged for the WRHA BBM is referenced on the bottom of the sheet.

Side 2 Will have to reinforce during education that the sheet can be flipped over for further charting.

Questions? If there are questions please call Blood Management Service at 204-926-8006 Or email BMSclinical@wrha.mb.ca