Guidelines For Education, Training and Competency In Apheresis

June 2001 1st Edition

Copyright by the Australian and New Zealand Apheresis Association Inc

Apart from any fair dealing for the use of private study, research, criticism, or review as permitted under the Copyright Act, no part of this book may be transmitted or reproduced in any form, electronic or mechanical, or by any information storage and retrieval system, without the written permission of the Publishers.

Publishing Australia by: Australian and New Zealand Apheresis Association Inc 145 Macquarie Street Sydney NSW 2000 AUSTRALIA

ISBN 0-9586251-1-5

June 2001 1st Edition

GUIDELINES

FOR

EDUCATION, TRAINING AND COMPETENCY

IN

APHERESIS
1ST EDITION, JUNE 2001

Prepared by The Guidelines for Education, Training and Competency Working Party Of Australian and New Zealand Apheresis Association Inc.

Secretariat: 145 Macquarie Street SYDNEY NSW 2000

June 2001 1st Edition

ANZAA Guidelines for Education, Training and Competency Working Party Members 1999

Co-Ordinator: Ms. Rosemary McKenna Members: Ms. Mary Brettell Ms. Margaret Armstrong Mr. Peter Chase Ms. Lindy Steele Ms. Dawn Thorp Ms. Sue Burtt

Queensland Victoria New South Wales Western Australia Victoria South Australia Victoria

Introduction

Apheresis is a well established, but comparatively new, specialty discipline. To date guidelines for education and training to prepare apheresis personnel have not been articulated. Australian and New Zealand Apheresis Association (ANZAA) is committed to promoting and achieving professional accountability and excellence in apheresis practice. These guidelines for education, training and practice are presented by ANZAA to assist and guide health care facilities in establishing their in house training programs for apheresis specialist personnel. The content of the training program should be a means of enhancing the intellectual development of the apheresis professional. Staff undertaking the training and education program should be encouraged to maintain and extend their professional development. To this end, extensive resource materials and some suggestions are listed in Appendix 1, page 11. Rosemary McKenna Co-Ordinator Guidelines Working Party May 2001

1. EDUCATION 1.1 The apheresis professional will have a sound knowledge of basic anatomy and physiology particularly of blood and circulation and basic immunology and pathophysiology of diseases treated by apheresis. 1.1.1 The apheresis professional should be able to : List the components of blood and know their normal ranges, life span and site of genesis. Explain the function of blood in relation to transport of oxygen, carbon dioxide, waste products, hormones and enzymes. Explain the role of blood in regulation of body temperature, pH and water content of cells. Understand the clinical process of the immune system and the application of this process in Apheresis. 1.1.2. The apheresis professional should have sound knowledge of the principles of centrifugal separation and be aware of the specific gravity of blood and its components.

1.1.3 The apheresis professional should have sound knowledge of the principles of apheresis. The principles of apheresis shall include, but not be limited to, knowledge of available technology e.g. continuous flow centrifugal devices, discontinuous flow centrifugal devices and membrane technology The apheresis professional should be able to: Describe the concepts behind said devices. Describe diseases treated by apheresis and the clinical indications for therapeutic apheresis in those diseases. List other modalities that may be included in an apheresis program e.g. selective plasma component removal, photopheresis and column adsorption. 1.1.4 The apheresis professional should have a sound knowledge of medications employed during apheresis procedures. Assess and describe patients current prescribed medications and their potential interactions and loss of effectiveness during apheresis procedures. e.g. TPE cardiac drug interactions, antibiotic and oral contraceptive blood levels. Have sound knowledge and awareness of the clinical implications of medications employed during apheresis procedures e.g. sodium citrate, dextran, heparin and calcium gluconate, steroids etc.

1.2 Education is a broad concept and includes all aspects of knowledge, skills and attitudes relevant to the apheresis professional. 1.2.1 The content should be a means of enhancing the intellectual development of the apheresis professional not an end in itself e.g. the apheresis professional should be able to use critical thinking to utilize the information acquired such as solve problems, create new information or gain self knowledge. 1.2.2. The content should also promote discussion regarding moral and ethical considerations and outline attitudes and behaviour appropriate to the professional role. 1.2.3. The content should provide the opportunity to advance clinical skills as well as broaden and deepen knowledge in clinical assessment. 1.3 ANZAA acknowledges that education is never static, but rather learning is an on-going process. Therefore continuing education opportunities should be made available and accessible. 1.3.1 It is recommended that apheresis professionals should : Hold membership of the ANZAA organization as a pre-requisite to creditialling. Attend an international meeting e.g. WAA or ASFA no less often than every 3 years. A national meeting annually. Local branch meetings twice a year. 1.3.2. Continuing Education Units (CEUs) will be awarded yearly at the national meeting and it is recommended all staff currently undertaking apheresis procedures achieve 30 points over a 3 year period.

2.0 CLINICAL 2.1 The apheresis professional should be able to successfully screen donors for suitability to donate. 2.1.1 The clinical component should ensure exposure to, and experience and identification of, screening requirements which include but are not limited to: Knowledge of current legal blood donation medical questionnaire and HIV declaration forms. Being able to answer questions regarding HIV associated risk behaviour and the donation process. Being familiar with the correct procedure for identifying donors. Being familiar with correct component labeling as per Apheresis Guideline 9.1.3. Identifying that the donor has read and accurately completed the blood donation medical questionnaire and HIV declaration forms. Identifying that the donor has had sufficient, appropriate fluid and food intake prior to donating. Knowing the correct procedures for correcting an incomplete or inaccurate donor written response. Scanning donor history to ensure all areas are completed, initialized and that signatures are present. Identifying how the donor feels during and post donation, being knowledgeable of potential side effects and taking correct action. Examining the donor for suitable venous access. Knowing the pulse, temperature and blood pressure parameters for safe donation practice. Knowing the recommended product volume for safe donation practice according to donor weight. 2.1.2 The apheresis professional should be competent at venepuncture and cannulating, demonstrating correct technique and cleansing of site according to the facilitys SOPs and infection control guidelines.

2.2 The apheresis professional is expected to be able to identify the range of patients and disease entities treated by therapeutic apheresis (TA) and be able to manage same. 2.2.1 The clinical component should provide experience that enables the development to competence in, but not be limited to: Recognition of the different haematological variations from the normal. Ability to review patients medical history and chart for appropriate TA request form, laboratory values, allergies, medications and haemodynamic stability. Management of potential side effects from the procedure and the patients underlying condition. Recognition of conditions requiring medical officer attention and the appropriate line of reporting. Management of the patients education of the procedure being undertaken, their physical comfort and post procedure instruction. Managing and accessing the variety of devices required for TA such as subclavian and jugular central venous catheters, arterio-venous fistulae and implanted vascular prosthetics. Venepuncture techniques for patients with less than optimal venous access.

2.3 The apheresis professional will have training in the practices, policies and procedures of the institution. 2.3.1. The clinical component will have training in : CPR proficiency skills competency to be assessed and training updated annually. Emergency drugs, their dosages and routes of administration. Fire and evacuation procedures Actions to be taken in the event of possible or actual harm occurring to the patient/donor. Action to be taken in the event of electrical shutdown or other emergency. 2.3.2. The clinical component will require the annual review of manuals containing standards of practice, clinical protocols for apheresis and the institutions policies and procedures. 2.3.3 The apheresis professional will demonstrate effective communication skills. 2.3.4. The apheresis professional will provide and maintain a safe environment according to OH&S guidelines.

2.4

It is recommended the apheresis professional undergo a competency evaluation that demonstrates relevant current safe practice, evolving national standards and standards expected of the experienced nurse at an advanced level of professional practice at 3 yearly intervals. 2.4.1. Competency tools are developed by the apheresis instrument companies and are available following training programs, computer and software updates or following purchase of a new machine. 2.4.2. Local competency tools are often available within a facilitys SOPs, or training program and can be evaluated by peers, apheresis consultants during annual appraisal, or company representatives in line with machine company validation.

3. TRAINING 3.1 The apheresis professional should obtain the knowledge and ability to safely and competently operate the apheresis device by successfully completing a training program and competency assessment tool. Such specific training programs and assessment tools are available for each procedure on each device by the instrument company e.g. COBE BCT, Baxter Healthcare Pty.Ltd. and Haemonetics. 3.1.1 The familiarization program will result in the ability to: Identify and name the machine and kit components Identify the safety features of the instrument. Describe and understand the mechanism of the instruments separation device. Describe and understand the vein monitoring system and flow rate control. Identify the tubing links and pathways and their significance. Know the structure of the Unit and the line of reporting. Describe and understand the procedure of record keeping. Describe universal precautions as safeguard to patients, staff and donors. Successfully screen donors. Demonstrate correct cleaning methods and routine maintenance required for specific instrumentation. 3.1.2 The clinical skills program will result in obtaining the knowledge for and the ability to : Skillfully perform venepuncture and cannulation. Install and prime a variety of procedure kits. Perform programming for different procedures. Discuss with and describe to patient/donors when their co-operation is required to aid the procedure such as during venepuncture. Understand the Control Panel and access and modify procedural information. Discuss and understand the use of drugs during a run. Discuss and understand the choice of appropriate replacement fluid. Calculate blood and plasma volumes exchanged.. Troubleshoot successfully potential problems arising from the instrument. Manage appropriately patient reactions and complications. Perform successfully and independently a variety of procedures such as Therapeutic Plasma Exchange, Leukocyte reductions, Peripheral Blood Stem Cell collections and Platelet collections.

3.2

Training shall also incorporate the knowledge: To debate and critically analyse ethical issues and considerations surrounding apheresis such as informed consent and patient autonomy in treatment decisions, evidenced based treatments, and directed donors who do not meet guidelines. Of the procedure for contacting technicians and servicemen in the event of machine breakdown or for routine maintenance. To understand cost effectiveness in relation to component production, maintenance contracts, maintenance and expiry of stores and supplies. To build into the budget software updates and machine replacement according to current market best practice. To discuss and present research or study projects related to apheresis.

APPENDIX 1

The anatomy and pathophysiology material required for apheresis has been collated well by the American Society of Apheresis (ASFA), in their Principles of Apheresis Technology and Baxter in the CS3000 Training Manual. Procedure training booklets and competencies are provided with training sessions by COBE BCT and Haemonetics have Clinical Education Series booklets.

American Society for Apheresis Standards and Education Committee. 1998. Validation of training and competency of apheresis specialists: organizational guidelines for therapeutic apheresis facilities Journal of Clinical Apheresis 13:174-189.

International Council of Nurses 1992. Guidelines on specialisation in nursing Geneva:ICN. Printed by the Australian Nursing Federation with permission of ICN. Kevy, S., Kim, H., Sink, B., Smith, J., Vamvakas, E. & Weinstein, R. (eds.) 1998. Principles of Apheresis Technology, 2nd edition. Tuscon:American Society of Apheresis.

McLeod, B. (ed.) 1997. Apheresis: Principles and Practice Maryland:AABB Press. Therapeutic Goods Administration (TGA) 1992. Australian Code of Good Manufacturing Practice for Therapeutic Goods: Blood and Blood Products Canberra:Australian Government Publishing Service. Therapeutic Goods Administration (TGA) 1992. Australian Code of Good Manufacturing Practice for Therapeutic Goods Blood and Blood Products, Annexes 1-7 Canberra:Australian Government Publishing Service.

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