Training activity information
Details
Select and issue appropriate blood components in accordance with current guidelines and clinical details
Type
Entrustable training activity (ETA)
Evidence requirements
Evidence the activity has been undertaken by the trainee repeatedly, consistently, and effectively over time, in a range of situations. This may include occasions where the trainee has not successfully achieved the outcome of the activity themselves. For example, because it was not appropriate to undertake the task in the circumstances or the trainees recognised their own limitations and sought help or advice to ensure the activity reached an appropriate conclusion.
Reflection at multiple timepoints on the trainee learning journey for this activity.
Considerations
- Component type
- Specialist requirements of components for a diverse range of patient characteristics
- Individualised transfusion management plans
- Transfusion indication codes
- Major haemorrhage protocols
- Cold-chain for blood components
Reflective practice guidance
The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.
Before action
What does success look like?
- Identify what is expected of you in relation to selecting and issuing appropriate blood components.
- Consider how the learning outcomes apply, specifically learning outcomes which relate to guidelines, limitations, acceptance testing, and identifying transfusion requirements/management plans.
- What criteria define the appropriateness of a blood component for a given patient’s clinical condition and serological findings?
- What are the essential pieces of information required from a clinical request to select the correct component e.g., component type, quantity, modifications like irradiation, patient history, diagnosis, clinical urgency?
- Discuss with your training officer to clarify the range of components you should be familiar with and the expected decision-making process for selection, especially in non-routine situations.
What is your prior experience of this activity?
- Think about what you already know about the different types of blood components available and their indications for use. What do you know about the requirements for providing compatible blood based on ABO/Rh type and identified antibodies?
- Consider possible challenges you might face e.g., patients with multiple antibodies, limited stock of rare components, urgent requests, interpreting complex clinical details. And think about how you might handle these.
- Recognise the scope of your own practice for this activity. When would you need to seek advice regarding component selection for complex patients or during critical stock shortages?
- Acknowledge how you feel about being responsible for selecting and issuing blood, knowing the direct impact on patient care and safety.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop in applying guidelines and patient-specific information to select appropriate components.
- Identify specific insights you hope to gain into the clinical decision-making process for transfusion and the logistical challenges of blood stock management.
What additional considerations do you need to make?
- Have you consulted any actions identified from previous experiences with crossmatching, antibody identification, or stock management that are relevant here?
- Identify important information you need to consider before embarking on the activity, such as current national and local transfusion guidelines, the status of blood stock, specific patient requirements e.g., CMV negative, irradiated, or the procedures for emergency issue.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst selecting and issuing blood components?
- Are you encountering situations such as:
- Limited stock of rare components or components with multiple special requirements e.g., irradiated and CMV negative
- An urgent request conflicting with the time required to perform necessary compatibility checks for a complex patient
- Incomplete clinical information or conflicting requirements that make component selection ambiguous
How are you reacting to the unexpected development?
- How is this impacting your actions? Did you adapt or change your selection and issuing process in the moment?
- Consider the steps you are taking in the moment, such as:
- Immediately applying current guidelines based on the available clinical details to select the most appropriate component
- Adapting the issuing process to manage limited stock or urgent timelines
- Seeking immediate guidance on component selection for complex patients e.g., neonate, sickle cell patient or during critical stock shortages
- How are you feeling in that moment? For instance, are you finding it difficult to apply guidelines correctly under urgency? Is it affecting your confidence in authorising the issue of blood?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully identifying transfusion requirements and creating management plans, or needing support to resolve complex stock or special requirement conflicts?
- What are you learning as a result of the unexpected development? For example, are you gaining crucial insight into the logistical challenges of blood stock management or the specific requirements for providing compatible blood components for complex patients?
On action
What happened?
- Begin by summarising the process you followed to select and issue appropriate blood components for a patient. What were the current guidelines and clinical details you considered? What components did you select and issue?
- Consider specific patients or scenarios that presented challenges e.g., patients with antibodies, special requirements like irradiated or CMV-negative blood, or emergency issue. How did you feel making decisions in these situations?
- Include any ‘reflect-in-action’ moments where unexpected clinical information or laboratory results prompted you to immediately adjust your component selection or issue process.
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding matching blood components to patient needs, considering antibodies, special requirements, and clinical urgency. What strengths did you demonstrate, such as skills in applying guidelines and identifying transfusion requirements? Were there knowledge gaps regarding specific components, special requirements, or national guidelines?
- Compare this experience against previous experiences. Has your ability to select appropriate components improved? Are you more confident in applying guidelines to specific patient scenarios?
- Identify any challenges you faced e.g., incomplete clinical information, limited blood stock, urgent requests and how you handled them.
- Did you need to seek advice or discuss the patient’s requirements or component selection with a senior colleague or transfusion practitioner? Did you ensure you were working within your scope of practice when authorising the issue of blood components?
- Acknowledge any changes in your own feelings now you are looking back on the experience regarding your confidence in selecting and issuing appropriate blood components.
What will you take from the experience moving forward?
- Identify the actions or ‘next steps’ you will now take, such as specific components, patient conditions e.g., massive transfusion protocols, transfusion in specific patient populations, or guidelines you need to study further. Do you need to review national or local transfusion guidelines?
- How will your approach to selecting and issuing components change based on this experience?
- Do you need more practice in interpreting clinical details to inform component selection or in using the blood tracking/issue system?
Beyond action
Have you revisited the experiences?
- Reviewing your past experiences selecting and issuing blood components, have you reflected on your previous learning points?
- What specific aspects did you aim to improve, such as understanding component modifications, selecting for patients with specific conditions (e.g., haemoglobinopathy, transplant), or applying current guidelines?
- Have you successfully applied these improvements in subsequent component selections? Are you now more proficient in selecting the correct product for diverse patient needs?
- Have you engaged in professional storytelling or discussed cases requiring complex component selection or issuing procedures with peers, supervisors, or clinicians?
- Did these discussions provide new insights into the clinical context, specific patient requirements, or challenges related to stock management or guideline interpretation?
How have these experiences impacted upon current practice?
- How does the cumulative learning from selecting and issuing blood components, and your reflections, contribute to your overall preparation for assessments that may involve selecting appropriate blood for crossmatch (DOPS) or discussing transfusion requirements with a clinician (OCE)?
- How has your ability to select and issue appropriate blood components based on guidelines and clinical details evolved over time?
- Are you more skilled at considering all relevant factors and applying the correct procedures?
- How confident are you now in recognising when a component request is unusual or complex and requires senior review or discussion with the clinical team, ensuring you work within your scope?
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 1 |
Outcome
Select suitable and valid techniques for transfusion pre-compatibility testing. |
| # 3 |
Outcome
Describe the limitations of methods used in pre-compatibility testing including sources of error and sample issues. |
| # 4 |
Outcome
Practice in accordance with guidelines and procedures relevant to pre-transfusion testing. |
| # 5 |
Outcome
Perform acceptance testing of samples requiring pre-transfusion testing and ensure samples follow appropriate testing streams relating to clinical condition. |
| # 9 |
Outcome
Identify transfusion requirements and create management plans for patients following completion of all pre-compatibility investigations. |