The London Regional Transfusion Committee

Confirmed Minutes of the London Regional Transfusion Committee London Blood Transfusion Forum (RTC Business Meeting) held on 19 October 2018 Peter Samuel Hall, Royal Free Hospital, London

Present: Dr Phil Kelly (Chair) King’s College Hospital Lasitha Abeysundara Royal Free Hospital Mohanad Abid Harefield Hospital Abdul Adamu Whittington Hospital Naim Akhtar NHSBT Colindale Saynab Ali Barking, Havering & Redbridge NHS Trust Sandra Amajor Lewisham Hospital Vivienne Andrews TDL / Chelsfield Park Hospital Maria Anievas Royal Brompton Hospital Mfon Anwana Hillingdon Hospital Kat Ayscough Parkside Hospital Susan Bland Queen’s Hospital Catherine Booth Whipps Cross Hospital Alison Brownell Queen’s Hospital Sandeepa Chandarana Milton Keynes Hospital Vashira Chiroma Hammersmith Hospital Yahya Clathworthy-Williams Royal London Hospital Ben Clevenger Royal National Orthopaedic Hospital Adeline Cloete RCI, NHSBT Sue Cole Princess Royal University Hospital Helena Day Royal Brompton & Harefield NHS Trust Sonia Dhillon London Northwest Healthcare Trust John Dick University College Hospital Joceylyn Faruk BUPA Cromwell Hospital Evodian Fonyonga Homerton Hospital Michaela Gaspar Royal Brompton Hospital Philip Gold Princess Royal University Hospital Jan Gordon Chelsea & Westminster Hospital Scott Gregory Queen’s Hospital Khadra Gulaid RCI, NHSBT Sara Hammond St. Bartholomew’s Hospital Amelia Harris Kingston Hospital Catherine Hawkins Princess Royal Hospital Many Hobson Barnet & Chase Farm Hospitals Thirumagal Iynkaran Kingston Hospital Jipsa Jacob Royal Free Hospital Dharshana Jeyapalan Guy’s & St. Thomas’ NHS Trust Julie Jordan Princess Royal Hospital Philomena Joseph BUPA Cromwell Hospital Amanda Joseph Kingston Hospital Dorothy Kasibante HCA Healthcare UK

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Tosin Kelani Queen Elizabeth Hospital Elizabeth Kelsey Royal Free Hospital Anita Kinga Royal National Orthopaedic Hospital Doris Lam NHSBT Tooting Sarah Lennox Royal National Orthopaedic Hospital Joanna Lewandowska London Independent Hospital Anna Li Royal Free Hospital Sharon Lindo University College Hospital Cathy Lynch Queen’s Hospital Paul Malgwi Kings College Hospital Michelle Martin Barking, Havering & Redbridge NHS Trust Oscar Martin-Simon BUPA Cromwell Hospital Denise McKeown Imperial NHS Trust Wendy McSporran Royal Marsden Hospital Anne Minogue Queen’s Hospital Abdi Wahab Mohamed West Middlesex Hospital Muna Mohamed King George Hospital Rachel Moss Great Ormond Street Hospital Nathalie Muller Whittington Hospital Joe Nanuck Queen Elizabeth Hospital Woolwich Lloyd Noble Charing Cross Hospital Kelly Nwankiti Kings College Hospital Lisa Oumade-Singh BUPA Cromwell Hospital Florence Parkinson Croydon Hospital Rebecca Patel London Northwest Healthcare NHS Trust Sajal Patel University College Hospital Diana Rabasquinho BUPA Cromwell Hospital Haridassan Ramachandran Frimley Park Hospital Gill Rattenbury Chelsea & Westminster Hospital Sally Sharp Harefield Hospital Julia Stanger London Northwest Healthcare NHS Trust Taku Sugai Hillingdon Hospital Zsofia Takats Hillingdon Hospital Hannah Turner Royal Free Hospital David Veniard Princess Royal Hospital Pascal Winter Barts Health NHS Trust Ursula Wood Great Ormond Street Hospital Julie Wright Queen’s Hospital Sasha Wilson PBMP, NHSBT Gemma Fawke PBMP, NHSBT Richard Whitmore CSM, NHSBT Deepa Takhar CSM, NHSBT Angela Pumfrey RTC Administrator, NHSBT

09/18 Welcomes and Introductions PK welcomed everyone to the meeting and informed them of the housekeeping arrangements.

Minutes of Last Meeting (17th May 2018)

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The minutes were accepted as a true record. AP to arrange for the minutes to be uploaded to JPAC website.

10/18 NBTC & RTC Chairs Meeting Feedback Presentation by Dr Phil Kelly, RTC Chair

RTC Chair & NBTC Update.pdf

RTC Chairs Update Staffing issues is a national problem: Difficulty in recruitment and retention of staff Increased workload and senior staff leaving/retiring is affecting staff morale Staff are finding it difficult to get away for meetings both in and out of their respective Trusts. TLMs’ are regularly having to work on the bench • Support from NBTC for a national TP group • National problem with meeting QMS standards from MHRA and UKAS • Cell salvage – less opportunity for small hospitals to do it - how do staff keep up their skills.. • Website – issues ongoing. It is the only platform available to us. Money is the main obstacle to improving it.

NBTC Update • Laboratory Modernisation Pathology Networks was discussed. Richard Whitmore informed the meeting that everyone needs to be aware of Essential Services Laboratories (ESL) and urged the attendees to read the literature, especially if you have been asked to set up an ESL. RW can circulate it through the RTC Administrator to the HTC Chairs, but you should be able to search for it. • HLA matched platelets – proposal to change on-call service from 24 hour to 0600 - 2300 • Foreign sourced plasma – still on hold • NBTC Symposium 2024 Strategy – to be held in March 2019 in place of the NBTC meeting. Will re-establish ToR and draft 5-year plan for NHSBT. Invited guests from a variety of stakeholder organisations will be in attendance. • SHOT – New Chair. Their two main recommendations are circle of safety around the patient re. name bands. and labels, and improving consent for TACO.

Blood Stocks Management Scheme Presentation This was part of the meeting The BSMS team are doing roadshows around the country and are also offering to carry out targeted stock holding reviews if requested by individual hospitals.

London RTC Update • BMS Empowerment Group – ManNisha Patel is the new Chair Shared Care Group – Sasha will try to get the group restarted. • A neg platelets – was also discussed in national meeting. It should be the universal platelet of choice, but this is not the case in practice. • Twitter – currently at 754 followers, but figure is rising constantly. It is the most effective way of sharing articles and papers.

11/18 NHSBT Update Presentation by Richard Whitmore and Deepa Takhar, NHSBT Customer Service Managers Confirmed Minutes of London RTC Meeting – 19 October 2018 3

NHSBT Update.pdf

• Shortage of O D neg blood: Letter sent out last week about this. Anything that hospitals can do to reduce demand for this can help us. Please accept substitutions when offered. • O neg K Pos Trial: Ongoing • Import of Welsh red blood cells: You need to make sure your LIMS system is updated with the codes. • New indicator labels for irradiated blood: Will be in use from next week. These labels will not have the date of irradiation on them. • Recalls: Please follow the three steps and check the number. • OBOS Reconciliation: Will commence in London on 21/01/19. • RCI Sample Inconsistencies: Be aware the sample will be rejected if there is major inconsistency between the sample and request form. Question: If no sufficient stock in NHSBT what happens. Will borrow from Wales, and may be even from Scotland if we need to.

Question: Awareness about AB Platelets - People are not aware about AB platelets being available and it is important that they do know. RW said because there is no demand for AB platelets we reduced our AB donors. If there was a bigger demand for AB platelets, then we would have to do something. He suggested that the RTC Chair writes to NHSBT highlighting this. He also urged people to think about why they are requesting these platelets.

12/18 Current Donor Risk Presentation by Dr Gavin Cho, NHSBT Donor Medicine Consultant

Current Donor Risk.pdf

Question: Do NHSBT check iron levels in donors? Haemoglobin levels are checked, but not iron levels. If it is too low, donors are turned away, usually menstruating women.

13/18 London Platelet Audit Presentation by Kelly Nwankiti, Patient Blood Manager, Kings College

LoPAG Platelet Audit.pdf

14/18 Developing an IV Iron Clinic Business Case Presentation by Dr Ravi Raobaikady, Consultant Anaesthetist, Royal Marsden

Developing an IV Iron Clinic.pdf

Help needed from RTC members: 1) Question why there is a need for big tubes 2) Are so many tests really needed?

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3) Sit with your coding team and see how they code management of anaemia. There are many different codes they can use, all with varying tariffs ranging from £267 - £3842 per episode. Question: Why a haemoglobin level of 130? Patients respond better after surgery. Question: Can you postpone surgery? You can question whether to postpone surgery unless life-threatening condition Question: How do you set up an anaemia clinic Obtain all your evidence to show it would be cost saving. Nominate a lead person, preferably clinician or anaesthetist to be the driving force. Devise a form that can be used by your clinical coders and enter on the form the correct diagnosis so your coders can capture the correct tariff.

15/18 Ask the Audience 1. Relaunch of Shared Care – ideas how to deal with it and communication between different hospitals • Shared care is not working the way it was meant to. • Clinicians need to inform the labs – they do not realise why it is important. • Some clinicians do not understand why patients have that requirement – they need to be educated. • Information about patients needs to be accessible by all departments not just the lab. • Nowadays patients do not always attend their closest hospital. • Suggestion to give information to special requirement patients and their relatives and rely on them to present it to the hospital. • St. Thomas’ Hospital has a card that says “I need special blood”. Most doctors do not even ask patients if they have had a blood transfusion before or have special requirements. • Sp-ice report will have a card that says “This patient has XX antibody”. Can NHSBT print a card when they send the card. It does not come with the unit – do we have to download it off Sp-ice.

2. Patients Needing Cross Matching – could we have card with the unit of blood? No, the card is on the Sp-ice report.

3. Patients Going to Multiple Hospitals – how to handle them There is an information sheet on the website.

4. Could NHSBT produce a card for special requirements saying “this patient has special requirements”? Can give to the patient and they can take to any hospital NHSBT does not know which patients have special requirements. You could ask if they can design a card. This can be feedback to the Sharedpecial Care working group.

16/18 Any Other Business a) National Comparative Audit 2019 Please give suggestions to Sasha or Gemma on what topic you would like the NCA to be about. It can be a new audit or a previous one that you would like re-audited.

Meeting Ended

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