Major haemorrhage protocol: North NHS Highland (Guidelines)

Scope

Major Haemorrhage is a serious and life-threatening medical and surgical emergency, affecting patients in all clinical areas of the hospital across Medicine, Surgery, ED, Obstetrics and Paediatrics.  A coordinated, well-communicated and structured approach to case management is crucial to improving patient outcomes, as well as the experience for the hospital team.  This affects clinical teams as well as BTS and Blood Sciences labs, Portering Services and Communications / Switchboard.

The NHS Highland Major Haemorrhage Protocol (MHP) has been revised, with changes affecting Raigmore, Caithness General and Belford Hospitals.  The new policy incorporates updated national guidelines and major practice-changing evidence which has emerged since the last version of the MHP (2012), and acknowledges a recent interim statement from the Scottish Trauma Network regarding use of Andexanet Alpha.

The new policy aims to improve various aspects, with examples given below:

1. Switchboard will cascade alerts via talking bleeps to facilitate more effective and efficient activation of an event. The scenario will resemble the current ‘cardiac arrest’ arrangements, with timely attendance of members of several relevant teams and alert to the Duty Consultant Haematologist.
2. Porters will endeavour to remain at the case till stood down, with roles in blood collection and sample delivery.
3. Predetermined ‘packs’ of blood components.
4. Up-to-date recommendations as regards anticoagulation reversal.
5. Each site has ensured processes are optimised based on their individual requirements and resources. Tailored flowcharts have been prepared for Raigmore, Caithness and Belford sites.
6. There will be an emphasis on feedback and reflective practice, including a feedback form to be completed following each MHP activation.
7. The policy will be readily accessible on TAM and via Policies library, with printable paper / poster copies feasible from the resources provided.
8. Ongoing education, simulation, audit cycles and feedback loops are planned with regular review to ensure the policy is fit for purpose. An Education Faculty will be convened to plan and deliver this activity.
9. Ongoing improvements are planned including rollout to NTC, Broadford sites, and specific policies in development relating to Paediatrics, Obstetrics and Upper GI bleeds.

NHS Highland Hospital Transfusion Committee 

Audience

• North NHS Highland only
• Secondary Care only: 
  • Belford Hospital
  • Caithness General Hospital
  • Raigmore Hospital
• Adults, Children and Neonates