NHS Blood and Transport (NHSBT) is the sole supplier of blood to the NHS in England yet, despite being part of the NHS, many nurses know little about it, how it functions, the challenges it faces and the nursing roles within it. But there is much that colleagues in the wider NHS could do on a daily basis to help NHSBT meet some of the challenges to ensure we have a safe, continued supply of blood and blood components.
Supply and demand
Each year, NHSBT needs to recruit 135 000 new donors to replace those who are no longer able or do no wish to donate for a range of reasons. Every day we need up to 5000 people to donate blood to fulfil hospitals' demands to meet patients' needs. We must collect the right mix of blood groups and components in order to supply hospitals with their requirements for red cells, platelets and plasma.
Blood donors are healthy volunteers who donate blood altruistically. They do not have to donate, so it is vital that they receive an excellent donor experience. Nurses working in blood donor teams have a crucial role in leading their colleagues to minimise waiting times and ensure everyone is delivering great customer service. Nurses must be professional, friendly and ensure the donor is as comfortable as possible throughout the process and cared for in a way that maintains their dignity and makes them feel valued. At the same time, they must ensure that the supply of blood at the point of donation is managed with safety, quality and care.
NHSBT has implemented a range of clinical metrics and key performance indicators (KPI) with targets and tolerances, which are reviewed and updated monthly for each collection team and donor centre. These KPIs include donor satisfaction scores, waiting-time satisfaction, the number of complaints and their management, and donor adverse events such as fainting and bruising.
Demand for blood components is closely monitored. NHSBT employs a customer service team that works closely with hospitals and can discuss specific changes in their requirements. Hospitals are encouraged to review their stock levels regularly to ensure that blood components are available for the right patient at the right time.
Despite this, there are occasions when NHSBT has to inform hospitals that stocks of certain components are low, and to ask hospitals to conserve these whenever possible. Platelets are particularly vulnerable due to their short shelf life, which is 7 days.
Group O RhD-negative red blood cells are a priority. These cells are known as the ‘universal’ donor because they can safely be given to any patient regardless of their blood group. Group O RhD negative red cells are therefore often used in emergency settings. Only 8% of the UK population has O RhD negative blood, but demand from hospitals often exceeds 13%. A major challenge for NHSBT is recruiting more donors with this blood group.
Fortunately, stock shortages are generally short lived, due to the efforts of both NHSBT in increasing donations and hospitals conserving supplies.
Black, Asian and minority ethnic patients
Some blood groups such as O RhD positive and B RhD positive are more prevalent among black, Asian and minority ethnic (BAME) communities, and some rare blood groups and subtypes are found only within BAME communities. For example, black people are 10 times more likely than white people to have the vitally important ‘Ro’ blood subtype. This subtype is crucial for treating sickle-cell disease because many patients with the disease who require transfusion over the long term have the Ro subtype, and any mismatch could result in a blood transfusion reaction.
However, there are not enough black donors so some black patients do not always get the best-matched blood. Sickle-cell disease is the most common inherited genetic disorder in the UK. It is usually found in people of African heritage, although it is also found in people of Caribbean, Middle Eastern and Mediterranean backgrounds. In the UK, 15 000 people have the disease and more than 300 babies are born with the condition each year.
While people from all communities and backgrounds give blood, fewer than 6% of blood donors in the past year were from BAME communities.
There is a strong focus on recruiting more Ro donors. The NHSBT blood marketing team delivers targeted messages through a range of media and works closely with local influencers, faith and community groups.
A wide range of promotional materials is available from the NHSBT website (www.nhsbt.nhs.uk).
Challenges
The process of blood donation faces many operational challenges, and nurses play a vital role in overcoming these. They include issues related to donor attendance, staff availability, venue accessibility and suitability, transport and communication.
Blood donation mobile sessions are held in various community venues, such as sports halls, religious worship venues, village and town halls, schools, hotels, colleges and community centres. Although sessions are generally planned at least 16 weeks ahead, problems can occur, so sessions can sometimes be moved, rearranged or even cancelled. Transport problems can affect not only blood component deliveries, but also availability of blood donation equipment and members of blood donation teams.
These challenges require problem-solving, management and leadership skills, with multiprofessional teamworking and communication.
NHSBT is a national organisation with geographically dispersed teams, which means that communication across teams can be challenging. Information technology plays an important part in NHSBT's communication strategy. Nurses working in the service routinely use a variety of devices to communicate, such as tablets and smartphones.
NHSBT is in the process of implementing a new IT-based innovation known as ‘session solutions’ that will see a more streamlined donation process. Blood donation teams will use handheld devices to map the donor's journey through the session, which will automatically communicate with other parts of the organisation to ensure a safer and more streamlined process of donation.
Information for, and communication with, donors are provided via the www.blood.co.uk website and the NHS Give Blood blood donor app, which is available for Apple and Android devices. Potential donors are encouraged to look on the website for information about blood donation and check if they are suitable to become a donor.
To book an appointment donors can contact the national contact centre, or make an appointment via the website, www.blood.co.uk, or using the app. Donors can set up, and then sign into, their online account, and then search for donation sessions and manage their appointments, which provides great flexibility and enhances their donation experience.
Conclusion
It is vital that we have a sufficient supply of safe blood components to meet the needs of patients requiring blood transfusions. Every year, NHSBT collects 1.4 million whole-blood donations. However, we face challenges relating to supply and demand. It is important that hospitals help conserve blood stocks for those who really need it, ensuring that the right component is available for the right patient at the right time.
Nurses working in the blood donation service play a vital role, applying their extensive professional knowledge and highly developed management and leadership skills to ensure blood donation sessions run smoothly and efficiently, and provide donors with excellent care and satisfaction.
However, we face challenges with the supply of blood and blood components, especially for rare blood groups and subtypes that are found only within BAME communities. We can all help promote blood donation, both at work and outside work with our friends and families.
Blood donation is an amazing gift. Please give blood and encourage others to do so.