Transfusion and Apheresis Science 48 (2013) 307–309

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Transfusion and Apheresis Science

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Certification of donor apheresis nurses: Keys to develop aneffective training program

1473-0502/$ - see front matter � 2013 Elsevier Ltd. All rights reserved.http://dx.doi.org/10.1016/j.transci.2013.04.004

⇑ Corresponding author. Address: Sanquin Blood Supply, Plesmanlaan125, 1066 CX Amsterdam, The Netherlands.

E-mail address: h.vrielink@sanquin.nl (H. Vrielink).

H. Vrielink ⇑, P.J.M. van den Burg, C. van Antwerpen, R. van Dongen, M. Durant, A. de Fijter,A. van de Griendt, R. Kivit, A. Lubberdink, W.L.A.M. de KortSanquin Blood Supply Foundation, Amsterdam, The Netherlands

a r t i c l e i n f o

Article history:

a b s t r a c t

Within Sanquin Blood Supply, a training program to train apheresis nurses was developed.The parts of the work for which qualification should be necessary was analysed. Based onthis analysis, a modular program with theoretical and practical information and knowledgewas developed. The modular program consists of two sections: a theoretical and technical /practical. The theoretical section consists of by the project group identified themes includ-ing basic hematology (e.g. the characteristics, kinetics, physiology and function of bloodcells), basic apheresis physiology, indications for apheresis procedures, criteria for donorsapheresis, difficulties and risks of procedures as well as the actions to be taken in case ofside effects, and introduction to the apheresis machine available, including the mechanismof the machine. The program for the technical / practical section consists of machine andprocedure knowledge (in theory and practise) and troubleshooting. To conclude each indi-vidual module, tests in theory and capability to perform procedures are taken. Each traineeneeds to demonstrate to have sufficient insight and skill to master all the relevant criticalfeatures of the work. Also a text-book for the trainee was written. This educational pro-gram provides an approach to educate and test apheresis donor nurses. The combinationof theoretical and practical components and monitoring of the progression are an impor-tant basis.

� 2013 Elsevier Ltd. All rights reserved.

1. Background

In the Netherlands, the Blood Supply Act (‘‘Wet inzakeBloedvoorziening’’) came into force in 1998, and sincethere is only one organisation for the blood supply in theNetherlands: Sanquin Blood Supply Foundation (Sanquin).This act regulates the frames for an effective and efficientblood supply. Starting points are to strive for nationalself-sufficiency of the blood supply with blood componentsthat are donated voluntarily and non-remunerated. Toachieve self-sufficiency, there are roughly 125 donor cen-ters in the Netherlands for whole blood donations, and in46 of them also apheresis procedures (mainly plasmaphe-

resis) are performed by approximately 800 donor nursesperforming apheresis and/or whole blood donations.

In the Netherlands, the Act on Professions in IndividualHealth Care (BIG Act; ‘‘Beroepen Individuele Gezondheids-zorg’’) of December 1993, is one of the Dutch laws whichspecifies in what way persons can be active in the field ofindividual health care. Amongst others, the aim of thislaw is to monitor the quality of the performance of health-care, and to guard care recipients against careless handlingby care givers. The professions that are regulated in the BIGAct, including amongst others physicians and nurses, havea mandatory registration with periodic re-registration, andthe professional title is protected. The paramedical profes-sions have no mandatory registration, but have a formalqualification. By law, the responsibility for quality assur-ance for practicing paramedic professions needs to be or-ganized by the professional groups themselves.

Module 1: Apheresis basics

Module 4: Other Cytapheresis

Module 3: Plateletapheresis

Module 2: Plasmapheresis

Module 6: Plasmaph. Equipment B

Module 7: Cytapheresis Equipment A

Module 8: Cytapheresis Equipment B

Module 9: Cytapheresis Equipment C

Module 10 Cytapheresis Equipment D

Module 5: Plasmaph. Equipment A

Fig. 1. Modular course for the training of a donor apheresis nurse.

308 H. Vrielink et al. / Transfusion and Apheresis Science 48 (2013) 307–309

Based on this law also, a number of professional actsand operations are only to be performed if the professionalhas the required title or qualification, or should be ap-pointed to qualified paramedics. Necessary instructions,e.g. by protocols must be present, and it is assumed thatthe practitioner or paramedic is qualified and competentto perform the action properly.

According to various laws and good manufacturingpractice (GMP), acts on donor centers to collect blood orblood components need to be performed by trained, qual-ified and competent persons. For this reason Sanquin builta training programme to guarantee uniformity, quality andefficiency for their personnel to collect whole blood fromthe blood donor. This programme was implemented someyears ago. To continue in their professional career, andwhen they have sufficient knowledge and skills, the train-ing programme for donor apheresis nurse can be attended.A special programme to train apheresis nurses in theoret-ical and technical knowledge and skills was developed.

Theoretical lessons

Machine knowledge

Theoretical lessons

Training on the job

Theoretical lessons

Machine knowledge

Theoretical lessons

Training on the job

Fig. 2. Composition of the cour

2. Methods/results

A project group of experts in donor apheresis (physi-cians and nurses) and in education techniques was com-posed. In this group, the components of the work forwhich qualification as donor apheresis nurse should benecessary, was recognised and thereafter analysed. Basedon this analysis, a modular programme (see Fig. 1) wasdeveloped consisting of

1. a basic module for all apheresis knowledge appointedfor the donor apheresis nurse with subjects such asanatomy, backgrounds of apheresis, basic apheresisknowledge, basic hematology (e.g. the characteristics,kinetics, physiology and function of blood cells), basicapheresis physiology, and side effects of apheresis;

2. a module for plasmapheresis, containing issues such as‘what is plasma’, aim of plasmapheresis in the Nether-lands, basics of a plasmapheresis procedure, standardsfor plasmapheresis in donors;

Examination

Knowledge test / Sign off

Trouble shooting

Cert i f i cat ion

Examination

Knowledge test / Sign off

Trouble shooting

Cert i f i cat ion

se donor apheresis nurse.

H. Vrielink et al. / Transfusion and Apheresis Science 48 (2013) 307–309 309

3. a module for plateletapheresis, containing subjects suchas ‘what are platelets and what is their function’, aim ofplateletapheresis in the Netherlands, basics of a platele-tapheresis procedure;

4. a module for cytapheresis procedures other than pla-teletapheresis, containing subjects such as ‘what areleukocytes and erythrocytes and what is their function’,aim of cytapheresis in the Netherlands, basics of a leu-kocyte collection procedure, basics of an erythrocytecollection procedure;

5. various modules for apheresis equipment, with partshow is the machine working, how to operate a specificmachine, etc.

The training program consists of two sections: theoret-ical and technical/practical (see Fig. 2). The theoretical sec-tion consists of by the project group identified themesincluding basic hematology, basic apheresis physiology,indications for apheresis procedures, criteria for donorsapheresis, difficulties and risks of procedures as well asthe actions to be taken in case of side effects, and introduc-tion to the apheresis machine available, including themechanism of the machine. This theoretical part will belectured by experts in the typical apheresis areas.

The programme for the technical/practical section con-sists of machine and procedure knowledge (in theory andpractice) and troubleshooting. Machine experts and repre-sentatives of the manufacturing industry will give thesetrainings. The trainee will be trained in practice by inapheresis techniques experienced supervisor. A specifiednumber of procedures need to be performed and logged.

To complete each individual module, tests in theoreticalknowledge and capability to perform procedures (to bejudged by the in apheresis techniques experienced super-visor) are taken. Each trainee needs to demonstrate to have

sufficient knowledge, insights and skills to master all therelevant critical features of the work.

The modular layout gives the donor apheresis nurse theopportunity to be trained to perform donor apheresis pro-cedures with apheresis machines from different manufac-turers. Additional modules can be followed in case ofnew brands of machines or in case new procedures areintroduced in the work of the specific nurse.

Based on by the project group identified knowledgeneeded for this profession, facts, critical steps and skillsthat should be known by donor apheresis nurses, numer-ous learning objectives were identified, and a text-bookfor the trainee was written. The basic structure of identifi-cation of learning objectives was essential in composingthis text-book and making questions for module exit tests.

In the practical training, the trainee is supervised byexperienced trainers. Progression of the trainee during amodule can be followed by using check-lists during thevarious modules. Evaluation/feedback forms on interestand knowledge needs completed by the trainee on comple-tion of the module can provide information to improve thetraining.

3. Conclusion

This modular educational program provides an ap-proach to educate and test trainees in apheresis. The com-bination of theoretical and practical sections andmonitoring of the progression is an important basis. Ade-quate preparation and planning of the various componentsof the training programme can lead to demonstrable pres-ence of sufficient knowledge and skills necessary neededfor a person who is qualified and capable doing his/herjob. This can also be of help in GMP/ISO inspections andaudits.