Special Issue
Making blood safe
through accreditation
The Lead Surveyor for ISQua’s accreditation programmes, Dr B K Rana, Deputy Director, NABH, talks about the parameters of blood safety and the importance of the same.
he importance of blood safety cannot be underemphasised. While there is, today, general awareness about the need for safe blood, not many know what is safe blood (the word ‘blood’ being taken to include ‘blood and its products’) and even fewer probably know how one can ensure safe blood.

Talking of the basics about quality of blood, I think there is an urgent need to take initiatives in this direction. One can choose any method of improvement and can begin from anywhere; however, the accreditation mechanism provides a format using which any blood bank can easily start working towards improvement in the quality of blood.

One of the most important aspects of accreditation is to continue checking performance by way of participation in External Quality Assessment Schemes (EQAS)/Proficiency Testing. This mechanism provides an opportunity to any blood bank to compare its results with other blood banks. It ensures that the blood bank is not only selecting the right method but also following it properly.

We all know that such programmes are not easily available and, therefore, difficult for blood banks to participate. In trying to overcome this problem, the National Accreditation Board for Hospitals and Healthcare Providers (NABH) has started its own EQAS with the able support of a group of Pathologists, Immunohematologists and doctors involved or concerned with blood banking. The programme has the support of ISBTI and is run by a committee of eminent experts.

Many blood banks have enrolled in this programme and are making use of outcomes in correcting and improving their processes. The question that arises is: ‘What should be done to bring some culture in our blood banks that is good for everyone — the management, the staff, the patients, the regulators and other stakeholders?’ I think the most critical issue is related to ‘Information’. Creating awareness amongst the blood bankers, as well as the users, is highly desired. Users of the services are most important. I recall the saying of Dr Girdhar J Gyani, Secretary General, QCI, that the public is the most important driver behind all these voluntary systems. Once the public starts demanding quality, the concerned organisation has to offer that quality if it is to continue to survive in the market.

Donation Is A
Divine Mission.

— Dr A P J Abdul Kalam
Former President of India

To meet this challenge, NABH has conducted awareness programmes across the nation, and participated in various seminars organised by different organisations, including the annual conference of ISBTI. As we move ahead, we will continue creating and participating in more such activities.NABH, since its inception, is seeking recognition both

at national and international levels. In the year 2006, it became an institutional member of the International Society for Quality in Health Care (ISQua), which is the world’s apex body for granting recognition to the accreditation bodies. NABH became a member of Accreditation Council of ISQua, which is responsible for executing its International Accreditation Programme (IAP).
I have been elected as the Vice-Chair of this Council recently, and taking the responsibility in this new role from July 1, 2009. NABH is actively contributing to IAP through participation in the assessments/surveys organised by ISQua for organisations, assessor/ surveyor training programmes and standards. I am one of the Lead Surveyors for ISQua for all three programmes. This gives me an opportunity to study how other accreditation bodies around the world are operating their accreditation programmes, and how these can contribute to improving our own accreditation programme.

Being involved in designing the blood bank accreditation programme of NABH, I got an opportunity to be one of the ISQua assessors/ surveyors to conduct a survey of the American Association of Blood Banks (AABB), Bethesda, MD, USA in December 2008. It was a unique learning experience, as all of you probably know that AABB is one of the premier organisations in this specialised area in the world. The survey also provided an opportunity to visit some of the AABB accredited blood banks and to interact with their assessors/ experts. We exchanged ideas and experiences on making our systems more valuable and effective. Overall, the visit was very productive for both the surveyor as well as for the organisation being surveyed.

To give a brief insight into what safe blood is, it would be important, of course, to stress that blood free from transfusion transmitted infections (TTI) is safe. However, safe blood does not simply mean blood that is free from TTI; it may be even related to ensuring the right blood grouping. I would say ‘safe’ means quality, which comes through a comprehensive system encompassing every step, starting from donor selection to transfusion to the patient.
This system of ensuring quality blood or minimising the risk to the recipient is uniformly implemented in the blood banks/centres, and includes all steps followed for collection, processing, compatibility testing, storage and distribution and preparation of the components. One such system is accreditation. It ensures that the blood bank/centre has implemented an appropriate quality management system based on a pre-defined standard and is therefore providing quality blood.

Now the question is how many of us have actually succeeded in implementing such a system of accreditation. NABH introduced such a system to users in 2008 by launching its Blood Bank Accreditation Standards. This programme was unique as few countries in the world have such an accreditation programme. Details of the programme, including general information brochure, application form and other supporting documents, were posted on the website. Awareness programmes were conducted to involve the blood banks and make them aware about the standard and procedure of accreditation.

We are happy to report a positive response from the government, specifically the National AIDS Control Organisation (NACO) and State Blood Transfusion Councils. Some states, namely Gujarat, Maharashtra, Tamil Nadu, Andhra Pradesh, started organising workshops and seminars. The Indian Society of Blood Transfusion and Immunohaematology (ISBTI) is also playing a vital role in creating awareness amongst blood bankers and stakeholders.
It is important to motivate the community to donate blood, so that the shadow of death and suffering is removed.

— Sonia Gandhi
President, Indian
National Congress
Accreditation is not a magic but a strong tool enabling an organisation to work as per the correct documented policies and procedures, and has in-built checks to keep a control on a continuous basis. No one can prevent harm arising from deliberate mistakes. However, one can prevent mistakes that are not deliberate. The Standard Operating Procedures (SOP) guide blood bank staff to perform various activities. As per the SPO guide, each staff member is required to make records of his/her activities and these records are verified and the staff member concerned is informed if any deviation is observed. If the SOP fails to prevent the staff from committing mistakes, then they are given further training, their competency is verified and their work is supervised.

A staff member may argue that ‘I am competent enough to avoid mistakes but can’t help it as there are no proper equipments.’ That might well be true in some cases. However, the importance of safe blood is so paramount that we need to understand the requirements of the accreditation standard. The outline of the standard is given in the table below. In summary, it takes care of regulatory requirements, space and environment, staff, equipment, consumables, records, entire process control, identification
of deviations through internal audit, complaint handling and improvement plans.

It is evident from the outline of the standard that it takes care of most of the activities which can affect the quality of the blood. So if we know these are the control points, why not fix them? Our aim should be continuous improvement by adopting the relevant standards, which would eventually ensure accreditation of the organisation. In conclusion, I would like to quote: ‘Accreditation is a tool for the management to act for improvement.’