Introduction to PBMT Certification
No profession in medicine is better positioned to address the rapidly expanding field of blood management than perfusion.The comprehensive curriculum on perfusion education identifies no less than seven pages of techniques for blood conservation (management) in the Accreditation Committee –Perfusion Education (AC-PE) Comprehensive Curriculum for Perfusion Education[1]. The Commission on Accreditation of Allied Health Education Programs lists ‘Autotransfusion’ in only two of the 20 profession’s Standards and Guidelines for the Accreditation of Health Specialties[2]: Perfusionist and Surgical Assistants. The Surgical Assistants only refer to it in regards to the operative field and not the use of the cell collection and processing devices. The fact that these educational standards are developed by the combined efforts of numerous health specialties, including physician organizations, is testament to the importance in which the perfusion profession plays in the safe and competent administration of this task.
The term extracorporeal takes on many meanings and is open to interpretation of the reader as well as the context to which it is applied. An on-line definition states that it is “an extracorporeal medical procedure is a medical procedure which is carried outside the body.”[3] When perfusionists or cardiac surgeons speak or use the term ‘extracorporeal’ it is most often referred to as a descriptor of circulation, and hence, the use of the heart-lung machine. However, almost all hospitals where perfusionists practice use ‘extracorporeal’ to include multiple areas of blood management. These include autotransfusion, cell salvage, intraoperative platelet pheresis, acute normovolemic hemodilution and intraoperative hemofiltration.
Two of the major organizations that have promoted the safe utilization of standards for perioperative blood management have been the AABB (formerly the American Association of Blood Banks) and the Society for the Advancement of Blood Management (SABM). In 2006 these organizations jointly published a monograph entitled Perioperative Blood Management: A Physician’s Handbook (AABB, ISBN 1-56395-235-1), edited by Jon Waters, MD. This well written and concise overview identifies the complexity of techniques of blood management and the need for protecting patients by providing safe and competent applications. The editors have correctly identified a major deficiency in the field of blood recovery and reflect: “Primary to these standards is the requirement for personnel who have been given adequate time and training to operate the equipment effectively and safely.”[4] Furthermore, almost all of the state licensure bills that have passed to date have generic language that includes autotransfusion and techniques of blood conservation. There are numerous individuals currently providing blood management services and with the absence of a formal certifying agency, are providing this service without the oversight of a formal entity. Clearly the void of such a certifying agency for blood management technicians is not in the best interest of patients exposed to these techniques.
To address this shortcoming, and improve the safety and care that blood management clinicians provide to their patients, AmSECT is working closely with the AABB to coordinate this rapidly developing field. During the past two years the Perioperative Blood Management Taskforce, consisting of over 70 members from diverse clinical specialties, has worked diligently to create a process for formal recognition of individuals involved in blood management. One of the first steps was the creation of the International Board of Blood Management that has as its mission “to promote education and sound scientific principles to advance the safe and competent practice of perioperative blood management, which will lead to recognition of this specialization through examination and certification.
The IBBM has created a new specialization termed the Perioperative Blood Management Technologist (PBMT) for individuals primarily responsible for providing autotransfusion during operations where blood loss is to be expected. An examination has been developed using the American Board of Clinical Autotransfusion examination as a template. The examination review process has involved Taskforce members who have been working diligently to assure that all aspects of the broad field of blood management are included. Criteria are being established to determine eligibility for taking the PBMT examination have been developed and are listed below. Once successful completion of all criteria for certification has been passed, the individual will be awarded the credential of PBMT. The first examination will be given on site at the Hilton Walt Disney World Resort immediately preceding the AmSECT 46th Annual International Conference in Orlando, FL on April 8, 2007. To maintain this PBMT designation there will be a yearly recertification requirement that will have both a continuing education requirement along with a clinical activity segment, again established by the IBBM. Although both the AABB and AmSECT organizations provide continuing education venues for blood management, other formal mechanisms for continuing education will be accepted as determined by the IBBM. Upon evaluation of the breadth and diversity of blood management techniques, it became evident that a second specialty would need to be created to address these additional areas. The taskforce has recommended that the second designation provided by the IBBM should be that of Perioperative Blood Management Specialist (PBMS). This is directed at individuals who in addition to providing perioperative autotransfusion, would also be utilizing techniques of platelet pheresis for the production of platelet gel and other developing technologies. The criteria for the PBMS have yet to be developed with the anticipation of certification beginning in 2009.
During the past year AmSECT has made a concerted effort to inform its members, and concerned individuals, about these developments. We encourage anyone who has questions or comments concerning this development to contact any of the Directors of the IBBM, whose contact information can be found at IntBBM.org.
INTERNATIONAL BOARD OF BLOOD MANAGEMENT
Structure
The IBBM is comprised of no less than six members and no more than twelve, all dedicated individuals who maintain membership in AmSECT. Board members serve four-year terms.
The primary purpose of the IBBM is protection of the public through the establishment of standards in blood management professionals. The IBBM has established requirements and qualifications for examination and for the process of recertification. These requirements will be reviewed on a regular basis and when alterations in criteria are deemed necessary, changes will be made.
Certification in blood management does not imply competency. Instead it is a means of peer recognition of the individual’s qualifications for the conduct of blood management procedures that require the expertise of an adequately prepared clinician to achieve these goals. The certification process is voluntary and is not intended to exclude individuals from such practice. Instead, it will provide peer recognition to those individuals who have met all criteria for performing blood management procedures in a clinical environment.
The IBBM will be determine who has met all criteria for certification; maintain a list of all certified individuals; and monitor the recertification process assuring that all certified individuals complete the yearly requirements.
[1] http://www.ac-pe.org/documents/pdf/AC-PECurriculum.pdf as of 12/9/07
[2] http://www.caahep.org/documents/ForProgramDirectors/PERF_SG_Standards.pdf as of 12/9/07
[3] http://en.wikipedia.org/wiki/Extracorporeal as of 12/9/07
[4] Perioperative Blood management: A Physician’s handbook, AABB, Page 59.