January 12, 2010
DEPARTMENT CIRCULAR
No. 2010 – 0013
OPERATIONAL
GUIDELINES FOR BLOOD SERVICES NETWORK IN SUPPORT TO THE IMPLEMENTATION OF
THE NATIONAL VOLUNTARY BLOOD SERVICES PROGRAM FOR BLOOD
SAFETY AND ADEQUACY, QUALITY CARE AND PATIENT SAFETY
I. RATIONALE
Pursuant
to Administrative Order No. 2005 – 0002 dated January 10, 2005 regarding
Rules and Regulation for the Establishment of the Philippine
National Blood Services amending Pertinent Provisions of Administrative Order
No. 9 series 1995 (Rules and Regulations implementing R.A. 7719,
otherwise known as the National Blood Services Act of 1994), the Blood
Services Network (BSN) shall be established to provide for the blood needs of
specific geographic areas in the Philippines through efficient distribution of
voluntarily donated blood and ensuring its availability to all patients,
maximizing utilization of available blood and avoid its wastage.
This
informal organization composed of all identified blood service facilities,
government and private hospitals and non–hospital based health facilities
performing transfusion, the National Reference Laboratory, LGUs and the
community–based volunteer donors shall endeavor to address blood adequacy and
safety while maintaining quality care for both volunteer donors and recipients.
Furthermore,
it supports the centralization of testing and processing of blood and its
components in the provision of adequate supply of safe blood. The high volume
of testing and processing of blood promotes efficiency and competency, thus
ensuring the quality of blood product. In addition, the limited blood resources
shall be maximized by the rational use of blood products.
This
Department Circular complements the following issuances: Rules and regulation
governing the Regulation of Blood Service Facilities; and Policies and
Guidelines for the Philippine National Blood Services (PNBS) and the Blood
Services Network (BSN) and the National Policy on Patient Safety (Administrative
Order No. 2008 – 0023).
II. OBJECTIVES
General
Objective:
To
provide a comprehensive policy that will govern the operation of the Blood
Services Network in all regions in the country.
Specific
Objectives:
To
set the guidelines that will:
1. Ensure an adequate supply of safe blood through
Voluntary Blood Donation;
2. Establish an equitable scheme of distribution of
blood;
3. Establish the highest standard of testing of donated
blood acceptable for the country;
4. Establish an efficient referral system among the Blood
Service Facilities in the Integrated Blood Bank Information System.
III. SCOPE
These
operational guidelines shall apply to all Blood Services Network supporting the
Philippine National Blood Services established under Administrative Order
No. 2005 – 0002 and shall supplement the Policies and Implementing
Guidelines for the Philippine National Blood Services (PNBS) and the Blood
Services Network (BSN).
IV. PURPOSE
These
Operational Guidelines for the Blood Services Network are promulgated pursuant
to the National Blood Services Act of 1994 (R.A. 7719) and its Revised
Implementing Rules and Regulation (A.O. 2005 – 0002). This Department
Circular supports the following Administrative Orders: Policies and Guidelines
for the Philippine National Blood Services (PNBS) and the Blood Services Network
(BSN); Policies and Guidelines for the Establishment and Operation of Local
Blood Councils in Support to the Implementation of the National Voluntary Blood
Services Program for Blood Safety and Adequacy, Quality Care and Patient
Safety; and, the National Policy on Patient Safety (A.O. 2008 – 0023).
V. DEFINITION
OF TERMS
A. BLOOD
CENTER (BC) – a non–hospital based
blood service facility, licensed by the DOH Bureau of Health Facilities and
Services (BHFS), whose main function is to process blood units into blood
components and testing of these units for the five (5) infectious disease
markers. Detailed service capabilities are enumerated in A.O. No. 2008 –
0008. The Blood Centers shall be classified into Regional, Sub–national and
National as assigned by the National Council for Blood Services (NCBS);
B. BLOOD
COLLECTION UNIT – a blood service
facility, duly authorize by the DOH – Center for Health Development (CHD),
whose main function is to collect blood from volunteer non – remunerated blood
donors. Detailed service capabilities are enumerated in A.O. No. 2008 – 0008;
C. BLOOD
STATION (BS) – a blood service
facility, duly authorized by the DOH – Center for Health Development (CHD),
whose main function is the storage, issuance, transport and distribution of
whole blood and packed red cells. Detailed service capabilities are enumerated
in A.O. No. 2008 – 0008.
D. BLOOD
SERVICES NETWORK (BSN) – an informal
organization established to provide for the blood needs of specific
geographical areas or catchment population. It is composed of the designated
blood center, hospital blood banks, blood collection units, blood stations and
end–user hospitals/non–hospital health facilities.
E. END–USER
HOSPITAL (EU) – a hospital with a
licensed clinical laboratory capable of red cell typing and cross–matching and
which does not have any blood service facility but which only receives blood
and blood components for blood transfusion as needed.
F. END–USER
NON–HOSPITAL HEALTH FACILITY – a
licensed/accredited non–hospital health facility without a licensed clinical
laboratory but which administers blood transfusion.
G. HOSPITAL
BLOOD BANK – a blood bank facility in
a hospital, duly licensed by the DOH – Center for Health Development (CHD)
whose service capabilities are enumerated in A.O. 2008 – 0008.
H. HOSPITAL
BLOOD TRANSFUSION COMMITTEE – a
hospital committee primarily responsible for the formulation of the blood bank
and blood transfusion policies and guidelines, monitoring and audit of the use
of blood and blood components within the facility in accordance with the Manual
of Standards for Blood Service Facilities issued by the DOH.
A
functional HBTC is a prerequisite for the licensing or authorization of a blood
service facility by the DOH and accreditation by the Philippine Health
Insurance Corporation (PhilHealth).
VI. GUIDELINES
FOR THE OPERATION OF THE BLOOD SERVICES NETWORK
A. Donor
Recruitment
1. The NCBS Committee on Public Education and Advocacy
shall formulate an operational plan for effective education and marketing
campaigns to promote voluntary blood donation. Implementation of such plan
shall be carried by the Donor Recruitment Officers/Teams identified from either
the Blood Collection Unit or Blood Center.
2. Donor recruitment program shall target volunteer blood
donors from the low risk population who meet defined selection criteria.
3. Strategies on donor recruitment relevant to targeted
low risk population shall be conducted to maintain efficiency and
sustainability of blood supply.
4. The local Blood Donor Program in each barangay, town,
city and province shall endeavor to recruit at least 2% of the total population
by authorized Donor Recruitment Officers/Team of LGUs, PNRC etc.
5. A continuing education program centered on social
marketing and research shall be undertaken for Donor Recruitment
Officers/Teams.
6. The establishment of association of Blood Donor
Recruitment Officers shall be encouraged.
B. Donor
screening, Counseling and Collection of Blood
1. Donor screening shall include medical interview,
pre–donation counseling and physical examination of donors following the
standards on Donor screening.
2. Blood shall be collected from healthy, voluntary non –
remunerated blood donors properly interviewed, examined and screened prior to
blood donation.
3. Collection of blood may be conducted in the premises of
the Blood Center/Blood Collection Unit or during a Mobile Blood Donation
activity.
4. Mobile Blood donations shall be conducted in
schools/universities, government or private agencies, shopping malls, business
establishments, factories, barangays, churches, communities, among others.
5. Mobile blood donations shall be regularly and properly
organized so that sufficient stocks of blood are sustained and periods of
oversupply/shortage are avoided.
6. Personnel who screen blood donors and collect blood
shall undergo sufficient training to assure the quality of blood collected.
C. Testing
Units of Blood
1. All blood units collected by authorized Blood
Collection Units (BCUs) and Mobile Blood Donation (MBD) Teams shall be tested
either at the Philippine Blood Center, Sub–national Blood Centers, selected
Regional Blood Centers (Government and Philippine National Red Cross/PNRC) under
the Philippine National Blood Services (PNBS) using the DOH–prescribed
methodology and reagents, and conforming to the minimum requirement set or
sensitivity and specificity by the Technical Committee of the National Council
for Blood Services (NCBS). The Technical Committee of the NCBS shall monitor
compliance by the testing Blood Centers to Quality Standards. The Blood Centers
shall likewise be required to participate and pass External Quality Assessment
Surveys either by the designated National Reference Laboratories (NRLs) or
international accrediting bodies such as WHO Collaborating Centers.
2. All blood units for transfusion must test negative for
the following: Hepatitis B, Syphilis, Malaria, HIV 1 & 2, and Hepatitis C.
In addition, blood typing (forward and reverse typing) must be done on each
unit. And when applicable, antibody screen should be done.
3. All units of blood issued by the Philippine Blood
Center, Sub–national Blood Centers, Regional Blood Centers (Government and
PNRC) under the Philippine National Blood Services (PNBS) network need not be
retested for Transfusion Transmissible Infections (TTIs) by hospitals and other
end user health facilities. The issuing Blood Center shall be responsible in
ensuring that all units of blood issued have been tested negative for the above
tests and have passed all the standards of quality set according to policies
and guidelines for total quality management. The legal liability for
transmission of TTIs therefore, shall be borne by the testing facility,
especially if the quality standards and requirements or technical operating
procedures have not been followed.
4. Every donated blood unit found initially reactive to
any of the five (5) TTIs shall be retested twice using the same test format. A
repeatedly reactive donated blood unit shall be sent to the National Reference
Laboratory (RITM) for confirmation using the prescribed NVBSP referral form.
5. When a donated blood unit is confirmed positive for
any of the Transfusion – Transmitted Infections (TTIs) by the National
Reference Laboratory (RITM), the donor shall be recalled for counseling and
referred to appropriate medical service for management.
6. HIV–positive cases shall be referred for confirmation,
counseling and management in accordance to the Flow Chart of accredited HIV
Testing Centers/National Reference Laboratory.
D. Storage
and Transport of Blood Components
1. Storage and transport of blood components shall be
maintained at optimal condition to prevent or delay physical, chemical or
mechanical changes detrimental to blood components; and to prevent or minimize
microbial contamination and proliferation.
2. Red cell components shall be stored at temperature +2
or +6oC in especially designed refrigerators. They shall never be
allowed to freeze as freezing causes hemolysis of red blood cells (RBCs). Its
shelf–life will depend on the preservative and anticoagulant used in the pack.
3. Blood bags containing red cells are kept in the
refrigerator in an upright position either standing or hanging for easy
inspection of signs of deterioration. During transportation, the temperature
shall be kept at a range between +2 and +6oC by using cold boxes
with ice packs and insulators (never let blood touch the ice packs.
4. Fresh frozen
plasma (FFP) and cryoprecipitate shall be stored in appropriate ultra low
freezers. It shall always be kept in frozen solid state and stored in lying position
to prevent cracking.
5. FFP and cryoprecipitate shall be transported in cold
boxes with ice packs or dry ice to maintain packs in solid, frozen state.
6. Pheresis–derived or random platelet concentrate (PC)
shall be stored between +20 and +24oC with continuous gentle
agitation (best in special platelet shaker incubator). Depending on the type of
pack used, its shelf–life is 3 to 5 days.
7. Prior to transport, the staff of the Blood Center
shall inspect the units of blood to ensure that the following are not present :
a. Over collection of whole blood
b. Excess volume for processed components (e.g. greater
than 250 ml for Packed Red Blood cells; greater than 70 ml for PC).
c. Defects in the blood bag such as:
(1)
Insufficient
sealing
(2)
Absence of red
cells in pilot tubing
(3)
Leakage/punctured
segment of bag
(4)
Air spaces in the
tubing or bag.
(5)
Improper
packaging of blood
(6)
Presence of red
cells in frozen components/reddish platelet concentrate;
8. In transporting the units of blood from the Blood
Centers to the Blood Stations (BS), blood banks and other end user health
facilities, the following temperatures shall be maintained, monitored and
documented:
COMPONENTS
|
TEMPERATURE ON TRANSPORT
|
Whole blood
|
+2 to +6oC
|
Packed red cells
|
+2 to +6oC
|
Washed red cells
|
+2 to +6oC
|
Platelets
|
+20 to +24oC
|
Platelet Pheresis
|
+20 to +24oC
|
Fresh Frozen Plasma
|
Maintain in frozen state
|
Cryoprecipitate
|
Maintain in frozen state
|
9. Upon arrival of the units of blood/blood products to
the hospital or end user health facility, the receiving trained staff shall
check the condition of the Cold Chain. The following conditions may indicate
improper storage during transport:
a. Direct contact of
blood bag with ice or ice water.
b. Complete melting
of ice due to temperature over +10oC.
c. Insufficient
number of cold packs/ice packs or not proportional to the number of units of
blood in cold box.
d. Plasma not in
frozen state.
10. The units of blood shall be inspected. If one or more
of the following is present, the component is not acceptable:
a. Pink or red
plasma as a result of hemolysis due to exposure to warm temperature during
transport;
b. Presence of blood
clots;
c. Any sign of
bacterial contamination; presence of pinkish discoloration at the red
cell/plasma interface, or purplish or dark discoloration at the red cell
compartment;
d. Any sign of
leakage in the bag;
e. Presence of
cracks or turbidity in FFP or cryoprecipitate;
f. Presence of unusual
turbidity of the thawed component which may indicate contamination;
g. Presence of
turbidity, greenish discoloration, or leakage in platelet concentrate.
11. If the units of blood are not acceptable, the issuing
Blood Center shall be notified to arrange for the return of the unit of blood.
Upon return, the component shall be quarantined, properly labeled and recorded
for the information of all concerned staff and proper disposal.
E. Rejection
and Return of Unit of Blood
1. Probable causes for rejection and return of unit of
blood by end user health facility are the following:
a.
Mislabeled blood
type
b.
Wrong component
issued
c.
Improper storage
of blood unit during transport
d.
Defects in the
blood bag
2. Incompatible cross match may also be a cause for
rejection and return of unit of blood provided that it is not due to clinically
significant antibody identified from the patient’s blood.
3. The end user health facility shall notify the
releasing Blood Center/Blood Station before the unit of the blood is shipped
back with accompanying documents stating the reasons for rejection.
4. The releasing Blood Center/Blood Station shall verify
for inconsistencies in all documents such as request form, issuance record of
the blood unit, among others, which could have resulted from a clerical error
such as mislabeling of blood. The releasing Blood Center/Blood Station shall
check/investigate for discrepancies and shall properly document the physical
condition of the returned blood unit.
5. The returned unit of blood shall be immediately
replaced with the same component requested without additional cost after the
releasing of Blood Center/Blood Station had properly validated and documented
the cause for rejection.
6. The releasing Blood Center/Blood Station shall
institute appropriate corrective and preventive measures relative to the
findings of the investigation.
F. Handling
of Blood Components
1. Maintain sterile
aseptic conditions during all steps of handling of blood and blood products;
2. At the time of
release of a unit of blood from the blood bank, identify the intended recipient
and the requested component using the prescribed NVBSP request form;
3. If the ward or
the operating room does not have a refrigerator specially designed for blood
storage, blood shall be kept in the blood bank and issued immediately prior to
transfusion. Ideally, one (1) unit is released at a time unless massive
transfusion is indicated;
4. Every blood unit
shall be inspected for signs of deterioration (e.g. clots, hemolysis, leakage,
or purplish/black discoloration):
a. Before it is issued from the blood bank
b. On arrival in the ward or operating room
c. Before transfusion (if it is not used immediately).
5. If any
discrepancies are found on identification, or the blood unit appears abnormal
in any way, the unit shall not be transfused and the blood bank shall be
informed immediately.
6. Discoloration or
signs or leakage may be the only warning that the blood contains bacterial
contamination and could cause a severe or fatal reaction when transfused.
G. Hospital
and Bedside Transfusion Practice
1. Hospital
transfusion practice shall follow the Standard Operating Procedures (SOPs)
based on the guidelines set by the Hospital Transfusion Committee or the
General Guidelines for Appropriate Blood Administration, part of the Manual of
Philippine Clinical Practice Guidelines for Rational Use of Blood and Blood
Products, launched June 15, 2009. The following may cover the Hospital
Transfusion Practice Guidelines :
a. Blood ordering
policy for elective and emergency situations;
b. Bedside
transfusion practice including storage, transportation, handling, dispensing,
administration of blood and blood components, use of appropriate transfusion
sets and monitoring of transfused patient;
c. Investigation and
reporting of adverse transfusion reactions and appropriate management;
d. Documentation of
all steps of collection, testing, processing and transfusion to permit
traceability of every blood unit from donor to recipient.
2. Clerical errors
at the bedside prior to or during blood transfusion have been found in studies
to be the major cause of morbidity and mortality associated with the
transfusion. Therefore a quality control system shall be implemented to ensure
the correct identity of the unit of blood and the intended recipient;
3. The safety of the
patient requiring transfusion depends on the utmost cooperation and effective
communication between clinical and blood bank staff.
H. Appropriate
Use of Blood and Blood Conservation
1. The Hospital Blood Transfusion Committee (HBTC) shall
be formed to implement the national blood policy and the guidelines on
appropriate use of blood and components and monitor blood usage and audit the
blood bank at the local level;
2. Blood shall be requested and transfuse only when
medically indicated and consistent with the Philippine Clinical Practice
Guidelines (CPGs) for the Rational Use of Blood and Blood Products (launched
June 15, 2009);
3. Alternative strategies to reduce the use of allogeneic
blood should be considered such as blood conservation technique in surgery;
autologous transfusion, i.e., the use of patient’s own blood that has been
collected in advance for planed surgery; or the use of pharmacological agents;
4. Modification of routine practices can minimize the
need for blood transfusion, such as checking and correcting anemia before
planned surgery, use of erythropoietin to improve hemoglobin and aprotinin to
reduce surgical bleeding;
5. The decision to transfuse varies from patient to
patient and should be based on sound clinical judgement. It is therefore
important to weigh the risks and benefits before one decides to do blood
transfusion;
6. There shall be periodic orientation of all staff in
policies and procedures for blood transfusion including the rational blood use.
I. Provision
of Blood In Case of Emergency
1. Patients needing blood in emergency are immediately
given type specific blood coming from the blood bank stock, and preferably
matched by immediate spin if time will still allow an abbreviated cross–match
to be performed by the blood bank personnel.
2. If type–specific blood is not available immediately,
other groups of blood may be given depending on the ABO group of the recipient
as seen in the table given below. The choice is packed red cells (preferable
washed or deglycerolized) of a group that are compatible by major cross–match.
3. Rh negative patients should ideally be transfused with
Rh negative red cells, especially female patients during childbearing period.
In other conditions or life – threatening situations, Rh positive units may be
given with some precautions including:
a. Documentation to
be available for us in future transfusion or pregnancy;
b. Anti–D Ig
injection to be considered within 72 hours of transfusion
4. If blood is needed immediately such that ABO grouping
cannot be done, use Group O (and possibly Rh negative) red cells, especially if
there is any risk of errors in patient identification. During an acute
emergency, this may be the safe way to avoid a serious mismatched transfusion.
5. Emergency cases needing blood urgently are the
following:
a. Patient in
hypovolemic shock due to severe acute blood loss.
b. Patients in the
Operating Room with continuous blood loss/when the volume of blood loss goes
beyond the estimated maximum expected loss.
c. Life–threatening
medical conditions which warrant immediate blood transfusion.
6. Emergency cases shall take precedence. Cases of non–emergency
transfusion are cases in which the transfusion is scheduled or may be safely
giver four (4) hours or more after request has been made.
7. The Attending Physician or Resident shall inform the
family of the patient for the urgent need for blood transfusion.
8. The Blood Bank shall coordinate with the Blood
Assistance Unit of the Blood Center or the staff on duty of the Blood Station
in case blood components needed are not available in the said blood bank.
9. To avoid transfusion of untested blood in Emergency
cases, each hospital shall maintain an adequate inventory of TTI negative units
of blood.
10. The Blood Services Network shall develop arrangement
to assist a Blood Bank which has to provide massive blood needs in an emergency
situation. For this purpose, the Blood Centers (Government or PNRC) shall have
updated information of available blood in the hospital blood banks and all
other Blood Service Facilities within its Network.
Selection
of Donor Blood According to ABO Group
Patient’s
Blood Type
|
Donor’s Blood
Type 1st Choice
|
Donor’s Blood
Type 2nd Choice
|
Donor’s Blood
Type 3rd Choice
|
A+
|
A+
|
A–
|
O+, O–
|
A–
|
A–
|
O–, O+, A+
|
None
|
O+
|
O+
|
O–
|
None
|
O–
|
O–
|
O+
|
None
|
B+
|
B+
|
B–
|
O+, O–
|
B–
|
B–
|
O–, O+, B+
|
None
|
AB+
|
AB+
|
AB–, A+2, B+2
A–2, B–2
|
O+, O–
|
AB–
|
AB–
|
A–2, B–2
|
O–, AB+, A+,
B+, O+
|
1
– when donor blood of recipient’s group is not available
2
– it does not matter which of these is chosen because they are similarly
Incompatible. They must be given
concurrently.
Type
B has the advantage of avoiding possible complications due to anti – A or anti
– H in the recipient serum
J. Reporting
and investigation of blood transfusion reaction
1. Each hospital and end–user health facility shall
formulate an SOP for the detection and reporting of suspected transfusion
reactions utilizing the appropriate NVBSP Form.
2. Every Hospital Blood Bank shall formulate a SOP for
the Investigation and report of results of transfusion reactions. Hospitals and
end–user health facilities without the capability of investigating transfusion
reactions shall refer such investigations to the nearest Blood Bank.
3. The adequate investigation and analysis of transfusion
reactions shall be the responsibility of the Hospital Blood Transfusion
Committee (HBTC). The HBTC shall recommend measures to minimize or prevent such
reactions.
The
HBTC is a DOH licensing requirement in all hospitals and a requirement for
accreditation of the hospital by PhilHealth.
4. A significant number of blood transfusion reactions
are caused by clerical error. Rarely, transfusion reactions are due to
incompatibilities of red cell blood groups which have not been detected by the
routine tests.
5. The occurrence of infections transmitted through
transfusion shall be monitored and investigated to prevent their recurrence.
6. All documented investigation of blood transfusion
reactions and near–miss events (NMEs) shall be included in the NVBSP
Hemovigilance or Post – Transfusion Surveillance Report.
K. Submission
of Reports
1. All blood service
facilities are required to submit to the concerned Center for Health
Development (CHD) their Annual Blood Safety Indicator (BSI) Report using the
latest prescribed NVBSP forms.
2. The BSI Reports
shall be consolidated and analyzed by the CHD Blood Program Coordinator into
the Regional BSI report.
3. The consolidated
Regional BSI Report shall be submitted to the Philippine Blood Center in
electronic and printed copies. The PBC shall be responsible to collate an
annual Country BSI Report for submission to the World Health Organization.
L. Health
Care Waste Management
1. Handling, Collection, Storage, Transport, Treatment
and Disposal of used needles, syringes, blood samples and rejected blood units
shall follow the guidelines as stated in the latest edition of the DOH Manual
of Health Care Waste Management.
2. Whenever possible, waste minimization strategies
should be incorporated into the operations and management of the blood service
facility.
VII. STRUCTURAL
ORGANIZATION
1. Blood
Services Network
The
Blood Services Network shall consist of:
a. The National Council for Blood Services and its
Committees;
b. The Philippine National Blood Services (composed of
National, Sub–national & Regional Blood Centers);
c. Authorized Blood Collection Units and Apheresis
Facilities: Government, the PNRC, or Non–Government Organizations;
d. Hospital Blood Banks and Blood Stations, both
government and private;
e. Non–hospital based blood stations: government, or the
PNRC;
f. End–User
Hospitals and Non–hospital based health facilities, both government and
private.
g. National Reference Laboratories for Immunology and
Immunohematology
2. National
Council for Blood Services (NCBS)
a. Composition
The
National Council for Blood Services shall be the governing body of the
Philippine National Blood Services which shall be composed of at least six (6)
members:
(1) The Secretary of
Health as Chairperson of the Board or his duly authorized representative;
(2) The Chairperson
of Philippine National Red Cross (PNRC) Board of Governors as Vice Chairperson
or his/her duly authorized representative;
(3) The President of
Philippine Society of Pathologist (PSP) or his/her duly authorized
representative;
(4) The President of
Philippine Society of Hematology and Blood Transfusion (PSHBT) or his/her duly
authorized representative;
(5) Director (or
Chief Executive Officer) of the Philippine Blood Center or his/her duly
authorized representative;
(6) Heads of other Offices
or Associations that may be added by the Council:
· Undersecretary of
Health for Policy and Standards Development Team for Service Delivery;
· Director IV,
National Center for Health Facilities Development (NCHFD);
· Designated DOH
Program Manager for National Voluntary Blood Services Program (NVBSP);
· DOH Consultant
for NVBSP;
· DOH Consultant
for Philippine Blood Center
(7) Each member of
the Board shall serve as an ex–officio member of the Council for the duration
of his/her incumbency as President or duly authorized representative.
b. Functions
(1) Approval of
policies governing the operation of the Philippine National Blood Services and
the utilization of blood products by hospitals and other health services;
(2) Approval of
Standards, Standard Operating Procedures and Guidelines for the Recruitment of
Donors, Collection, Transport, Testing and Processing of Blood, Issuance and
Administration of Blood Components and Monitoring of Blood Transfusion
Practices;
(3) Approval of
Directional/Strategic Plan of the National Voluntary Blood Services Program
(NVBSP) from time to time;
(4) Approval of
allocation of funds and monitoring of fund utilization;
(5) Development of
the capabilities of the Philippine National Blood Services and Blood Services
Network as the need arises;
(6) Creation of other
standing and special committees as appropriate;
(7) Approval of
certification of importation privileges.
c. Committees
(1) The
National Council for Blood Services shall establish the following Committees:
(a)
Executive
Committee
(b)
Technical
Committee
(c)
Committee on
Public Education and Advocacy
(d)
Committee on
Professional Education
(e)
Committee on
Curriculum Development
(f)
Committee on
Finance
(g)
Committee on
Information Technology
(h)
Other committees
that shall be created as necessary
The
Council shall appoint the Chairs and Members of the committees who will
exercise the duties and responsibilities delegated to them by the Council.
(2) Composition
and Function of the Executive Committee:
(a) Undersecretary
for Policy and Standards Development Team for Service Delivery – Chairperson of
his/her authorized representative;
(b) Vice Chairperson
or his/her authorized representative;
(c) The Director of
the Philippine Blood Center or his/her authorized representative;
(d) Other members of
the NCBS
(e) Chairs of
different Committees of the Council;
(f) Technical experts
that may be appointed by the Council.
The
Executive Committee shall exercise such powers as may be delegated to it by the
Council. The Executive Committee shall review and resolve matters to be
considered by the Council, to make recommendation to the Council and serve as
advisory body to the Council.
(3) Functions
of other Committees:
Technical Committee
(a) Provide policy
directions on the technical component of the National Voluntary Blood Services
Program implementation;
(b) Act as advisory
body to the National Council for Blood Services for Technical matters on Blood
Program;
(c) Recommend studies
for the formulation of policies and upgrading of standards, and;
(d) Create AdHoc
Committees for specific technical concerns.
Committee on Public Education and Advocacy
(a) Prepare a
coordinated five–year advocacy and promotion plan by all NVBSP implementers
based on the National Voluntary Blood Services Program five–year
directional/strategic plan, which shall be submitted to the National Council
for Blood Services for approval through the NCBS Executive Committee;
(b) Plan, coordinate,
monitor and evaluate the national advocacy and promotion programs;
(c) Facilitate the
establishment of Regional Advocacy and Promotion Committee as regional counterpart
who shall have the following responsibilities:
Ø
Formulate the
regional advocacy and promotion plan which shall be submitted to the Regional
Health Director for approval and endorsement to the National Council for Blood
Services;
Ø
Implement,
monitor and evaluate the regional advocacy and promotion activities
Committee on Professional Education
(a) Plan and arrange/conduct seminars, workshops and
training courses for the Personnel in Blood Service Facilities, i.e., Regional
and NCR Zonal Blood Banks/Centers, Blood Collection Units and Blood Stations;
(b) Prepare Training Syllabi for Blood Banks, Blood
Collecting Units and Blood Stations;
(c) Facilitate the conduct of seminars for continuing
education in Blood Banking and transfusion for clinicians, surgeons,
anesthesiologist, nurses, etc. on the rational use and proper administration of
blood and blood components;
(d) Conduct workshops for the establishment and operation
of Hospital Blood Transfusion Committee;
(e) Conduct workshops for the establishment of Local Blood
Councils;
(f) Ensure the inclusion in the continuing education
programs of health professional information on the National Blood Services Act
of 1994, its implementing Rules and Regulations, Manual of Standards for Blood
Banks, Blood Collecting Units and Blood Stations, and related administrative
regulatory issuance from DOH, DILG, etc.
(g) Prepare a 3–year Staff Development Plan for the Blood
Service Facilities of the Department of Health, local government health
facilities, PNRC and private hospitals.
Committee on Curriculum Development
(a) Develop, print
and distribute instructional materials and methods focused on the voluntary
blood donation for integration into the health subjects of all schools, public
or private, and at all levels of education, formal and non–formal;
(b) Orient and/or
train teachers on the utilization of such materials and methods;
(c) Monitor the use
and effectiveness of such materials and methods in terms of process and
products, and continuing revision of such as necessary;
(d) Prepare and
submit to the National Voluntary Blood Services Program Unit of the voluntary
blood services in the schools.
Committee on Finance
(a) Review the annual operation of the budget and propose
measures to increase the revenue and reduce the cost;
(b) Review the fiscal management of the Philippines
National Blood Services; and
(c) Make recommendations to improve the financial
operations of PNBS
Committee on Information Technology
(a) Promote the
nationwide implementation and effective utilization of the Integrated Blood
Bank Information System (IBBIS) in supporting the goals of the NVBSP;
(b) Formulate
standards, policies, guidelines relative to the development, implementation,
and sustainability of Information Communication Technology (ICT) programs and
projects of the Philippine National Blood Services and NVBSP;
(c) Provide
leadership in the development of strategic ICT plans and policies for the
NVBSP;
(d) Review and
approve the allocation of funds for procurement of ICT equipment, goods and
services;
(e) Develop and
implement ICT capability programs;
(f) Spearhead the
development and implementation of ICT activities.
VIII. ROLES AND
RESPONSIBILITIES
A. Philippine
Blood Coordinating Council
1. Consult and
coordinate with NCBS in the planning and implementation of various projects and
activities relative to the NVBSP especially on professional education;
2. Conduct
capability–building activities for:
a. Laboratory and
Blood Bank personnel on basic blood bank techniques and Quality Management
System (QMS), proper screening of donors, testing, collection and storage of
blood to assure the safety and quality of blood;
b. Health
Professionals and hospital personnel on voluntary blood donation, rational use
of blood and blood components, efficient operation of hospital blood programs
through the hospital blood transfusion committee and conduct of blood
transfusion audits;
c. Hospital
Administrators and Blood Bank head on Total Quality Management of BSF in
collaboration with PNRC, DOH and Health Professional Associations.
3. Provide resource
speakers through the formation and establishment of Speaker’s Bureau;
4. Assist in the development
and implementation of the Maximum Blood Ordering Schedule (MBOS) in hospitals;
5. Promote Blood
Stock Inventory Management principles;
6. Assist in the
formation or strengthening of Local Blood Councils at the regional, provincial,
and city levels;
7. Conduct research
studies in the areas of blood banking and transfusion medicine;
8. Develop and
produce IEC materials relevant to the training of health professionals in blood
banking and transfusion medicine.
B. Philippine
National Red Cross
1. Consult and
coordinate with NCBS in planning and implementation of various projects and
activities relative to the NVBSP especially on public education and advocacy on
voluntary blood donation;
2. Establish/maintain
and continually improve the PNRC blood service facilities nationwide as
licensed and authorized by the NCBS following the set standards and procedures;
3. Facilitate the
networking of PNRC blood service facilities in the regional blood services
network;
4. Promote voluntary
blood donation through public education campaign to the community to instill
public consciousness of the principle that voluntary blood donation is a
humanitarian act and a social responsibility;
5. Inform the public
of the need for voluntary blood donation to curb the hazards caused by the
commercial sale of blood;
6. Establish and
promote the collection of blood in various areas in the community, such as but
not limited to schools, business enterprises, barangays and military camps;
7. Educate and train
the personnel/volunteers for voluntary blood recruitment, retention and care to
secure commitments for regular blood donation in collaboration with PBCC;
8. Provide training
programs and technical assistance to enable the communities; youth, schools,
industrial and business sites, barangays, military camps and local government
units (LGUs) to implement their own voluntary blood donation programs;
9. Maintain and
update the rare blood type registry and provide date to those who need them.
C. Local
Blood Councils
1. Participate in
the formation of the Local Blood Donation Program that fulfills the needs for
blood transfusion in the community;
2. Plan and
implement public education, advocacy and donor recruitment activities to
promote voluntary blood donation;
3. Conduct an
organized and sustained public information campaign to promote voluntary blood
donation through:
a.
Flyers,
brochures, comics
b.
Posters,
billboards
c.
News, articles,
features, press releases
d.
Radio/TV spots,
talk shows
4. Assist in the
recruitment and retention of regular volunteer blood donors through:
a.
Community
meetings and seminars
b.
Door to door
campaigns
c.
Blood Donor Club
membership
d.
Blood donor
panels in barangays, schools, business firms, others
5. Organize Mobile
blood collection activities in coordination with the Blood Centers and
authorized Blood Collection Units; Government and Private Hospitals; and PNRC
Chapters in strategic sites:
a.
Barangays
b.
Shopping Malls
c.
Business offices
d.
Schools
e.
Churches
f.
Factories
g.
Military camps
h.
Others
6. Spearhead/Assist
in fund–sourcing/fund–raising from within the community and from external
governmental and non–governmental organizations, financial institutions or
agencies.
7. Strengthen the
linkages of local hospitals, BEmONC/CEmONC facilities and health services with
the Regional Blood Center;
8. Coordinate and
monitor the implementation of the Local Blood Donation Program
D. Hospital
Blood Transfusion Committee
1. The Hospital
Blood Transfusion Committee (HBTC) in all government or private hospitals shall
be composed of representatives of major Clinical Departments, the Blood Banks
or Clinical Laboratory, Nursing Service, relevant Administrative Departments,
the issuing blood center among others;
2. The Committee
shall be chaired by a medical specialist who is knowledgeable in Transfusion
Medicine or Blood Banking. The Chairpersonship may be rotated among the
Committee members;
3. The Hospital
Chief, in consultation with the Heads of Clinical Departments, shall determine
the term of office of the Chairperson and Members of the Committee;
4. The functions of
the Hospital Transfusion Committee are the following:
a. Review
transfusion practices in the hospital and recommend measures to improve them;
b. Organize
activities related to advocacy, education and promotion of Voluntary Blood
donation including HIV/AIDS prevention and healthy lifestyle;
c. Adopt and
implement criteria for appropriate use of blood and blood products;
d. Assess usage and
practices of blood component therapy;
e. Review and
analyze statistical reports of the blood bank;
f. Review clinical
and laboratory reports of adverse reactions to blood transfusion;
g. Make
recommendations and reports to the appropriate departments of the medical,
nursing and administrative services of the hospital;
h. Promote
continuing education on voluntary blood donation and appropriate transfusion to
all hospital personnel; and
i. Provide advice
and assistance in determining blood stocks inventory to assess and address the
need of the hospital especially in cases when emergency transfusion is
required.
E. Blood
Centers
1. Advocate,
disseminate information and promote voluntary blood donation including healthy
lifestyle in the community;
2. Social
mobilization activities
3. Recruit, retain
and care for qualified volunteers blood donors;
4. Conduct mobile
blood donation activities in partnership with the Local Blood Council, PNRC
BSF, LGU BCU and other institutional blood donor organizations;
5. Test blood units
for infectious agents, blood component processing and leuko –
reduction/depletion of units of blood;
6. Issue and
distribute safe, quality blood and blood products;
7. Regularly monitor
all BSF and hospital in its network;
8. Coordinate human
resource and logistics assistance to mobile blood donations within the Blood
Service Network;
9. Provide on–the–job
training for BSF staff;
10. Provide technical resource persons;
11. Conduct of research in the field of blood transfusion
and blood bank technology;
12. Collect apheresis–derived blood products from
qualified volunteer donors, if equipment is available.
F. National
Reference Laboratories (NRLs)
1. The NRL for
Immunology for the confirmatory testing of blood units shall be the Research
Institute for Tropical Medicine (RITM) while the NRL for Immunohematology shall
be the National Kidney and Transplant Institute (NKTI);
2. SACCL – SLH shall
conduct Proficiency Workshops in HIV and Hepatitis Testing and other
serological procedures for transfusion transmissible diseases for all Medical
Technologists;
3. SACCL – SLH shall
evaluate test kits and reagents for the purpose of registration in
collaboration with Bureau of Food and Drugs and the Bureau of Health Devices
and Technology, DOH;
4. The RITM HIV
Reference Laboratory shall conduct Externa Quality Assessment Surveys (EQAS) on
infectious markers for transfusion transmissible diseases as an output to
Quality Assurance of all BSFs performing donor blood testing.
5. The National
Kidney and Transplant Institute Reference Laboratory likewise shall conduct
External Quality Assessment Surveys (EQAS) on immunohematology as an input to
quality assurance of all BSFs.
G. DOH –
Center for Health Development
1. Promoting and
monitoring the following activities at regional, provincial and city levels:
a. Advocacy information dissemination and promotion of
voluntary blood donation including healthy lifestyle;
b. Social mobilization activities;
c. Recruitment, retention and care of volunteer non –
remunerated blood donors;
d. Blood donation activities in partnership with
government and private hospital blood banks, government and PNRC blood center
or blood collecting units, and Local Blood Council; and
e. Mobilization & utilization of resources of all
blood service facilities
2. Providing
logistics and technical assistance for capability building and other NVBSP
activities.
3. Facilitating
issuance of LTO/ATO of blood service facilities in the region.
H. Regional
Blood Program Coordinator
1. Implements the
NVBSP strategic plan in the region;
2. Conduct advocacy
visits to local chief executives and other major stakeholders for the promotion
of voluntary blood donation in their respective localities / service areas;
3. Designs and
organizes training program on Voluntary Blood Donation Program Management for
Provincial and Municipal Blood Program Coordinators; and on Effective Donor
Recruitment, Retention and Care for local blood donor recruitment officers;
4. Provides
technical assistance to LGUs and NGOs in the selection of local blood donor
recruiters;
5. Design IEC
materials for distribution to potential blood donors;
6. Assists
Provincial and Municipal Blood Program Coordinators in lobbying for fund
support from LGUs, donor agencies, business and the private sector to share in
financing the Local Blood Program;
7. Monitors the
implementation of the Blood Program in municipalities;
8. Collects,
collates and analyzes statistical data on the status of performance indicators
of Voluntary Blood Donation Program;
9. Organizes
training of concerned personnel on the SOPs in Blood Services (relative to all
the links in the transfusion chain);
10. Monitors the compliance of blood service facilities
and end – user hospitals to SOPs;
11. Prepares medium and long term Development Plan for the
Blood Service Facilities and the B/CEmONC Facilities with the Health Facilities
Development Unit and Maternal and Child Health Unit of the CHD and the LGUs;
12. Advocates for the centralization of blood unit testing
and processing;
13. Prepares information materials for blood end – users and
the general public on the importance of cost recovery in sustaining quality
blood services through collection of blood processing fees;
14. Organizes training on Quality Management for personnel
of various types of blood service facilities (including hospital blood banks);
15. Advocates to existing blood service facilities
(including hospital blood banks) subscription/participation in the nationwide
IBBIS;
16. Monitors the institutionalization of quality systems
in blood service facilities with trained personnel;
17. Promotes and monitors to hospitals the organization of
functional HBTC;
18. Collects, analyzes and provides feedback from the
blood utilization monitoring reports from hospitals.
I. Head of
Blood Service Facilities
1. Evaluates the
manpower needs and participates in the hiring, evaluation, promotion and
imposition of disciplinary actions on all laboratory personnel in accordance to
the human resource policies of the institution;
2. Establishes the
tests for TTIs and other technical procedures to be used in the BSF;
3. Regularly reviews
technical procedures for appropriateness, efficiency and timeliness;
4. Regularly reviews
adherence to administrative and technical procedures;
5. Leads in the
evaluation of equipment and consumables that will be purchased for, and
utilized by the BSF;
6. Sets the
guidelines for the implementation of a quality assurance program including
quality control activities;
7. Implements a
performance evaluation scheme for the personnel in the BSF;
8. Implements a
continuing education program of the technical staff in skills pertinent to the
personnel’s function in the BSF;
9. Provides
consultative services in transfusion to attending physicians which is accessible
and timely;
10. Participates in the cost analysis of blood/blood
components as the need arises;
11. Addresses administrative and technical concerns of the
facility that are appropriately referred in a timely and accessible manner;
12. Helps in the construction of an organizational chart
that defines all aspects of operations of the BSF;
13. Represents the BSF in the planning, development,
promotion and policy making activities of the Blood Program.
IX. REPEALING
CLAUSE
All
the existing issuances/provisions inconsistent with this Department Circular
are hereby repealed.
X. EFFECTIVITY
This
Department Circular shall take effect immediately
FRANCISCO T. DUQUE III,
MD, MSc
Secretary of Health
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