• Contents
• Letter of transmittal
• User guide
• part 1: overview of the nba and the blood sector
• part 2: highlights of 2011–12
• NBA's Performance
  (PARTS 3,4, AND 5)
• part 3: performance: securing the supply of blood and blood products
• part 4: performance: improving the sector and its management of risk
• part 5: performance: supporting appropriate and safe use of blood and blood products
  • Introduction
  • National Guidelines and Criteria for Use
  • Standards, Accreditation and Stewardship
  • Education
  • Clinical Governance and Data Systems
  • Networks and Communications
  • Quality Improvement Initiatives
• part 6: Corporate management
• part 7: financial management and accountability
• part 8: appendices

Part 5: Performance: Supporting Appropriate and Safe Use of Bloof and Blood Products

QUALITY IMPROVEMENT INITIATIVES

Priorities for action identified at WHO's Global forum for blood safety: PBM was held in March 2011 and included adopting a patient-centric focus to diagnosis and treatment at the hospital level. The forum also encouraged governments to develop national guidelines and a multidisciplinary approach to PBM. The implementation of PBM in the hospital environment is an effective mechanism to implement most of the initiatives described in this report.

Patient blood management

Internationally, hospitals that have introduced PBM practices have reported significant health care savings and improved patient outcomes. In Western Australia, where initial steps have been made to introduce PBM practices, a reduced demand for red cells has been found in the pilot institution.

In 2009 a national patient blood management steering committee, now the Patient Blood Management Committee (PBMC), was established to assist governments in setting priorities and monitor the ways in which PBM initiatives could be implemented.

During 2011-12 we worked on various projects:

• at a workshop held in May 2011 the JBC had supported a nationally coordinated approach to PBM and considered ways in which this could be achieved. At the beginning of 2011-12 jurisdictions commenced a gap analysis on the extent and nature of PBM activities. Later in the year an independent consultant was engaged to synthesise the various analyses and formulate recommendations. JBC will consider these during 2012-13; ensuring sustainability will be a particular issue
• work commenced on a PBM toolkit. The first elements of the toolkit will be a ??How to guide', patient consent materials, and an exemplar transfusion ordering and consent form. The WA Health Department is developing the first of these, which will include a wide range of materials and guidance information to assist in implementing PBM at the local level. Feedback has been sought from the PBMC and the PBM Perioperative Module Clinical Reference Group to assist in developing the material
• the Anaemia Management Working Group organised a workshop on intravenous iron which was held in March 2012. Testing patients' haemoglobin levels and if necessary treating them with iron prior to surgery (particularly surgery where blood loss is anticipated) can help to reduce the need for blood transfusions during and after surgery. Treating low haemoglobin levels with iron is considered by many to be a safer option than red blood cell transfusion. The objectives of the workshop were to:
  • identify best practice use of intravenous iron and strategies to increase awareness of best practice
  • consider what intravenous iron products are available in Australia, and identify other potential intravenous iron products currently available internationally
  • identify the gaps in access to intravenous iron in Australia
  • review the limitations and barriers to using intravenous iron products in clinical practice.

The workshop was well attended by clinicians, pharmacists, nurses and government representatives with an interest in intravenous iron. We are preparing a discussion paper containing the outcomes of the workshop, for consideration by governments.