10

Implementation and audit

10.1

Local implementation

Implementation of national clinical guidelines is the responsibility of each NHS Trust and is an essential part of clinical governance. It is acknowledged that every Trust cannot implement every guideline immediately on publication, but mechanisms should be in place to ensure that the care provided is reviewed against the guideline recommendations and the reasons for any differences assessed and, where appropriate, addressed. These discussions should involve both clinical staff and management. Local arrangements may then be made to implement the national guideline in individual hospitals, units and practices, and to monitor compliance. This may be done by a variety of means including patient-specific reminders, continuing education and training, and clinical audit.

Implementation of the guideline and compliance with the Scottish Office MEL (1999)⁹ "Better Blood Transfusion" depends not only on the commitment of clinicians but also the support of Trust and hospital managements to provide organisational resource to enable:

• Preadmission assessments 3-6 weeks before operation
• Patients to be given fixed admission dates if predonation or preoperative erythropoietin therapy has been agreed
• Availability of erythropoietin for the limited number of patients in whom it is clearly indicated
• Availability of blood salvage equipment where caseload is shown to justify its use
• Availability of suitable anaesthetic support if ANH is being used
• Adequate audit of transfusion practice locally through the hospital Blood Transfusion Committee
• Adequate audit of transfusion practice nationally
• Training of all staff involved in the transfusion process