From definition to identification to prevention,the Sankalp Patrika, in the last 3 months has carried some extremely important articles describing aspects related to adverse donor reactions. Although all our efforts must be focussed on providing the right ambience for blood donation, there are situations when one or more adverse events do occur.
Management of the adverse reaction is a critical aspect. A poorly managed case will not only put the donor under question in a spot of bother, it will affect the overall morale of the drive. Other donors, typically first timers will become extremely sensitive and may end up themselves being the subject of an adverse reaction.
After extensive research on this topic and consultation from several experts, Sankalp India Foundation has been able to compile effective steps for the management of these reactions
5 Step Preparation for Management of Adverse Events
A. Preparation To Handle Events Of Any Magnitude
In a blood donation drive, we must be prepared to handle an adverse event of any magnitude. In case the magnitude of seriousness is beyond what can be handled in the donation area, sufficient measures need to be adopted to give necessary medical attention to the donor at a nearby hospital.
For this, it is necessary to identify
- Preferred service providers in various parts of the geographical area where the drives are organised
- Chain of command and individuals/roles with the authority to make necessary decisions
- Mechanisms for transportation and organising for necessary finances.
B. Preparation of Staff
Ensure that the roles of medical officer, drive incharge, technicians, nurse, supporting staff and counsellor are well defined and understood. In principle,
- The Medical Officer and the camp in-charge from the blood bank must be thorough with the protocol.
- At-least a few staff members in each drive should have received adequate training at complication management.
- At least one lady must be part of the blood bank staff team for each drive. Sometimes the lady donor facing complications need to speak help which is best given by ladies. Moreover, the complication might happen in areas the access to which is prohibited for the male members of the team
C. Define A Protocol For Documentation
Documentation of adverse reactions shall be covered in detail in the next edition of the Patrika. However, the team must have in place a ready reference of all documents that are handy in taking care of donors. In general it will be very good to identify,
- Who is responsible for overseeing the adverse reaction prevention and management program
- How reactions should be reported and documented
- Clear guidelines on follow-up with donor - including calling donor and making further care available in a time bond and responsive manner.
- In case the donor requires medical intervention, how will it be organised for.
D. Have Emergency Medical Equipments At The Drive
Carrying emergency medicines and equipment must be a part of the regular routine for blood banks. These items must be time and again audited and kept in good working condition/ within the date of expiry if they are drugs. Here is a common list of the most handy items. Oxygen cylinder with mask, gauge and pressure regulator.
- 5 percent Glucose or Normal Saline.
- Disposable sterile syringes and needles of various sizes.
- Disposable sterile I.V.infusion sets.
- Ampoules of Adrenaline, Noradrenaline, Mephentin, Betamethasone or Dexamethasone, Metoclorpropamide injections
- Aspirin
- Bandages
- Thrombophobe
- Ice packs/ cold compress
- Spinal Board/ Stretcher in case the donor needs to be shifted to a hospital
E. Essential Training Needs
The following trainings must be made available for the staff of the blood bank to keep the, prepared for management of adverse events:
| Training | Required For | Remarks |
|---|---|---|
| General training on management of complications | All | To be refreshed annually. |
| Cardiopulmonary Resuscitation, Artificial Respiration and Emergency Oxygen | Doctors, Staff Nurses, Technicians | |
| Advising, reassuring and counselling donors | Doctors, Camp in-charge and counsellor. |
What To Do In Case Of An Adverse Reaction?
1. Immediate Steps:
In case there is an adverse reaction, the following things have to be done immediately
- The first person to observe the reaction much judge whether they are in a competent position to assist the donor. If the person is aware of what needs to be done, they should first take the necessary steps. If the person is not, the first person who is competent must be approached.
- After the first 30 seconds of attention have been given the person must make attempts to communicate with the person who is responsible for the management.
- Once the donor is all set to recover, keep a watchful eye for any further complications which may arise
2. Handling Conflict Of Interest:
There could be a conflict of priorities in the event of a complication. Blood donation drives usually have just enough staff members for smooth running of the drive. In such scenario, a complication can cause confusion on what needs to be attended to first. Use the following guideline to make decision on the same
- Attending to the donor facing the complication is most important
- One complication is known to act like a trigger for several more complications. Therefore, attention must be given to prevent any more complications.
- The collection of blood from more donors should resume only after the complication is being managed well and that all needed steps to prevent more complications have been taken.
3. Only Competent Staff Handling Issues
While attending to complications is necessary, only the competent and necessary members of the staff must involve in attending to the complication. All staff members should do what is required of them to be done for the management and try and return to their normal work as soon as possible. Crowding, expression off anxiety, panic, loud talking and hyper-vigilance leads to more donors feeling uneasy and causes more events/ reactions.
4. Free Cost For Resting:
Keep at least 1 bed free at all times to make space for donor who might experience complications.
5. Reassure & Comfort The Donor:
Please keep in mind that while it is necessary to speak to the donor to reassure and to find the possible contributing factors, it is important to be sympathetic and warm. A common mistake that is made is attempts to trivialise the situation. Another improper communication is an attempt to highlight the donor's food preference, lifestyle or other personal choices as contributing factors. Be sensitive to the donor and keep the conversation private.
6. Follow Up With Donor
Ensuring that donors who had adverse reactions are doing good and have overcome the problem is very important. Apart from helping in donor retention in subsequent drives, it will be reassuring and comforting to the donor if he/she is spoken to again. Here is what is to be done:
- Ensuring safety and well being of all donors who faced an adverse reaction during the drive(through phone call).
- Giving some more basic advice on self care in case the donor is experiencing a minor effect of the adverse reaction.
- In case the donor is in a state of panic or there is any major discomfort, necessary treatment/care shall be administered to the donor with the following guidelines:
- The blood bank involved in bleeding the donor should meet/ counsel the donor and give necessary medical advice and reassurance.
- The details of actions taken up by the blood bank to deal with the donor must be well recorded.
The next issue shall carry details on documentation of adverse reactions.
Through the Patrika an appeal is made to all Blood Bankers to put in practice the methods and tools as mentioned in the protocol. This protocol is a sincere effort from Sankalp India Foundation to make blood donation drives a pleasurable and awesome experience for blood donors.
Readers are encouraged to bring forth queries, suggestions and ambiguities by writing to sankalp.admin@gmail.com Lets walk together to make voluntary blood donation in India safer.