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Last Modified: July 16 2014 
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The Transfusion Transmitted Injuries Section, of the Public Health Agency of Canada (PHAC), coordinates two ongoing national surveillance systems for monitoring transfusion related events –the transfusion associated adverse events reporting system (TTISS) and the transfusion error surveillance system (TESS). Together, these surveillance systems are aimed at improving transfusion processes and maximizing patient safety in Canada. Additional information can be found at http://www.phac-aspc.gc.ca/surveillance-eng.php

Transfusion Reaction Toolkit

Transfusion Reaction Toolkit contains:

A guide for clinical staff to manage early patient care once a transfusion reaction is identified.
Provides information to clinical staff for what signs/symptoms/conditions require:
  • an immediate call to the TMS/Lab 
  • samples and product to be sent to the TMS/Lab
  • Transfusion Reaction Report Form:
    Provincial model document that records the details of the reaction.
    This information is used by the laboratory during the investigation
    and by the pathologist in reaching a conclusion.
Two versions of the form were developed to reflect differences in phlebotomy practices:
Version TTI 0002F has no phlebotomy section.
Version TTI 0003F contains a section to record phlebotomy information.
Job Aid: Transfusion Reaction Reporting to External Agencies
This process was reviewed and revised to reflect pathologist decisions about provincial best practices for the laboratory investigation of transfusion reactions.

Existing training and competence documents were reviewed and revised to reflect the changes made to the Transfusion Reaction Investigation Process. Case studies were also developed.

In addition to these documents, the TM-Medical Policy Manual was revised as Transfusion Reactions were moved from Section 4.0 (Daily Operations) to a new Section 11.0 (Transfusion Reactions) . This document records recommendations for all pathologists involved in a transfusion reaction.

Transfusion Transmitted Injuries and Surveillance System (TTISS)

TTISS evolved from a pilot project in 1999-2002 involving four participating provinces – British Columbia, Québec, Prince Edward Island, Nova Scotia – and has now become the national surveillance system for capturing moderate and serious adverse transfusion events reported in Canada. The proportion of hospital sites reporting nationally currently represents 70% of red cell transfusion occurring in Canada per year. In addition to its surveillance properties, the TTISS program allows for assessment of new transfusion risks, including emerging pathogens and the monitoring of trends to determine increases in known risks.

TTISS is supported by input from front line health care workers, the National TTISS Working Group and the National Working Party for Data Review for improvement of surveillance activities. TTISS collaborates with Canadian Blood Services (CBS), Héma-Québec (HQ), and Canada Vigilance (Health Canada) for reconciliation of all data collected in order to ensure complete and accurate reporting. TTISS strives to produce quality data and strictly adheres to the definitions for the classification of reactions. Data are disseminated regularly to stakeholders through TTISS Program Reports.

TTISS continues to evolve, change and improve nationally. Future initiatives include upgrading the TTISS database to a web-based system which will incorporate a module for more in-depth reporting of transfusion-related errors. Also, the Public Health Agency of Canada (PHAC), in collaboration with stakeholders, has developed a standardized Guideline for investigation of suspected transfusion transmitted bacterial contamination which was released in January 2008 on the Canada Communicable Disease Report (CCDR) website.

British Columbia, through the BC Provincial Blood Coordinating Office (PBCO), was one of the four original provinces participating in the 2000 national pilot. In 2010, BC hospital participation in TTISS accounts for more than 90% of all red cell units transfused in BC.
In 2009-2010, BC reviewed and revised its processes related to transfusion reactions. The work of cross-professional teams (nurse, TM-MD and technologist) resulted in the release of provincial model documents that merge TTISS reporting elements with standardized provincial best practice with respect to bedside recognition and reporting of the reaction, laboratory investigation process, and TM-MD interactions. These documents are collectively called the Transfusion Reaction Toolkit.

Transfusion Error Surveillance System (TESS)

In early 2005 TESS was initiated as a pilot project in four provinces in Canada. The TESS Pilot Project was designed to capture errors in the transfusion chain for the administration of blood, blood components and plasma derivatives. TESS is a non-punitive, anonymous, web-based error reporting system that captures actual events that have the potential to cause harm if not detected.

Managed by the Public Health Agency of Canada (PHAC), the TESS Pilot Project provides participating institutions and their respective provincial/territorial blood coordinating offices with benchmarking data for process improvement. PHAC disseminates the results of analysis to its stakeholders through regular reports, conferences and stakeholder meetings.

An objective of the TESS Pilot Project is to lay the groundwork for a national transfusion error reporting system that can be integrated with the Transfusion Transmitted Injuries Surveillance System (TTISS). The two systems will help improve blood transfusion-related patient safety. The pilot is expected to end in 2008/09 and participation of additional institutions is anticipated. Plans for the future expansion of TESS are still under development.