Objective 3. Promote the safe and efficient use of blood and blood products

NBA placed a high priority on delivering outcomes in relation to the promotion of the safe and efficient use of blood and blood products in 2012-13. In particular, the NBA continued the delivery of key reference material and accelerated supporting implementation activities in relation to reducing wastage and improved fresh blood use based on the NBA developed Patient Blood Management Guidelines. The National Blood Research and Development Strategic Priorities 2013-16 published by the NBA provides guidance to the research sector about where evidence would support improvements in safety and appropriate use of blood and blood products.

Reference Development

By working with stakeholders and other experts, reference materials to support clinical practice, product use guidelines and quality improvement initiatives were developed by the NBA in 2012-13. As outlined in this section progress was made on the PBM Guidelines, IVIg Criteria and work on replacing existing clotting factor guidelines.

PBM Guidelines

Over 100,000 copies of the PBM modules have been either issued in hard copy or downloaded in over 60 countries. They provide evidence based guidance on optimisation of the patient’s own blood, non-transfusion strategies to minimise blood loss and bleeding and strategies to manage anaemia. In 2012-13 the NBA published two further modules of the PBM Guidelines: Module 3 Medical and Module 4 Critical Care. The development of these modules took approximately two years and involved input from 15 Clinical/Consumer Reference Group members including representation from 11 clinical colleges and societies. These two modules complement Module 1 Critical Bleeding/Massive Transfusion and Module 2 Perioperative.

Haemophilia guidelines (previously clotting factors guidelines)

The NBA has worked closely with the AHCDO over the past year to scope and develop a strategy to replace the existing Clinical Practice Guidelines for the Use of Recombinant and Plasma- Derived Factor VIII and Factor IX products published in 2006. The revised guidelines will provide more comprehensive, patient-focused guidance to support the management of patients with haemophilia. The revised guidelines are expected to be developed during the 2013-14 financial year.

IVIg Criteria

The Criteria for the Clinical Use of Intravenous Immunoglobulin in Australia identifies the indications for which IVIg is funded under the national blood arrangements. Patients must meet a set of criteria in order to receive IVIg. The second edition of the criteria was released on 10 August 2012 after an extensive period of review and consultation. The revised criteria removed some indications for which new evidence demonstrated little efficacy or potential harm, added a small number of new indications and revised the qualifying and review criteria for other indications to ensure that only patients who are likely to derive a genuine health benefit receive this product.

Implementation

A core element of ensuring reference material influences the safe and efficient use of blood and blood products are activities that support their implementation. In 2012-13, NBA focused on implementation of measures to reduce wastage of blood and improve appropriate use through PBM. The strategies address a significant proportion of requirements identified in the 2010 Australian health ministers’ statement on national stewardship expectations on the supply of blood and blood products. Although the strategies differ in terms of specific outcomes, the strategies share key common elements including the development of:

• best practice tools
• promotional and communication activities
• supporting education and training
• data to support implementation of improvement.

Best practice tools

In 2012-13 the NBA undertook extensive consultation through its PBM Clinical/Consumer Reference Groups and Steering Committee to identify a range of tools to support the implementation of PBM practices. This consultation was complemented by a comprehensive review of publically available tools and materials in Australia and overseas. As an outcome of these reviews, the National Patient Blood Management Guidelines Implementation Strategy was developed and approved by JBC in May 2013. The strategy identifies several focused subsets of tools that will be developed with oversight from the NBA. This is to assist in addressing the issue that many of the existing tools are not available publicly and may need some refinement to ensure national applicability. The NBA has been actively collaborating with a number of experts and organisations across the sector to ensure public access to high quality tools. Some of the high priority areas of focus for tools are:

• intraoperative cell salvage
• patient consent
• single unit transfusion policy
• case studies to support best practice.

Case studies showcasing better inventory and wastage reduction strategies at Hunter Area Pathology Service and SAN Pathology in NSW and the BloodMove Project in South Australia were initiated in 2012-13. To view the case studies visit www.blood.gov.au/case-studies.

Promotion and communication

With the release of another two modules of the PBM Guidelines, and the increased focus on appropriate use of fresh blood products, opportunities to publicise the guidelines and NBA’s key messages at conferences and sector events were leveraged in 2012-13. Through trade stands, presentations or conference advertising, NBA initiatives were promoted at the following key events:

• Joint Scientific Meeting of HSANZ/ANZSBT/ASTH and APSTH (HAA)
• Australian Private Hospitals Association 32nd National Congress
• Australian and New Zealand College of Anaesthetists 2013 Annual Scientific Meeting
• Royal Australasian College of Surgeons 2013 Annual Scientific Congress
• Clinical Excellence Commission Workshop - Towards Patient Blood Management: Future Directions for NSW
• 2013 Transfusion Update
• Immune Deficiencies Foundation of Australia 2013 National Conference
• 32nd International Congress of the International Society for Blood Transfusion 2012
• National Immunohaematology Continuing Education

In 2012-13 members of the NBA Clinical/Consumer Reference Group presented on the PBM Guidelines at numerous international, national and local meetings.

On 21 May 2013 NBA hosted a private sector forum to engage key private health organisations in relation to implementation of PBM and improved inventory wastage. Private sector engagement has been supplemented with bilateral discussions with significant private sector entities at a CEO level.

In 2012-13, NBA engaged the ACSQHC to co-brand the National Blood Symposiums in 2013-14. Planning and promotion of the three one day events scheduled to be held in September 2013 in Sydney, Melbourne and Adelaide was initiated to ensure a range of attendees from various health providers registered. The agenda of the symposiums will be focused on supporting implementation of Standard 7 Blood and Blood Products of the NSQHS Standards (see National Safety and Quality Health Service Standards on p.48).

As a general awareness measure, the NBA negotiated with the Blood Service to include a cost indicator on all fresh blood product labels from 13 May 2013. The NBA worked closely with the Blood Service and the jurisdictions to communicate this change to health providers.

Education and Training

National Blood Sector Education and Training Strategy

With the publication of the PBM Guidelines and the implementation of Standard 7 Blood and Blood Products - the demand for supportive education, training and information resources has risen. In 2012-13 NBA consulted with key stakeholders to draft the National Blood Sector Education and Training Strategy 2013-16. This strategy will outline a plan to work with current education and training providers to address the growing demand for high quality, well-tailored education, training and health promotion materials to support the implementation of evidence-based practice and attainment of health service accreditation under the new standards. The NBA will consult further in 2013-14 on this strategy before seeking endorsement from the JBC.

BloodSafe eLearning Australia

BloodSafe eLearning Australia is funded by all Australian governments. The online site offers a range of courses relating to clinical transfusion practice including PBM, blood specimen collection and product handling. The suite of courses have proved to be very popular with 187,017 registered users with 55,699 new registrations in 2012-13. On average the site attracts about 5,000 new registrations and 8,000 course completions per month.

There were 28 per cent repeat registered users during 2012-13 demonstrating that existing users continue to return to the site to participate in new educational offerings.

The following enhancements were made to BloodSafe eLearning Australia during 2012-13:

• release of a new module on critical bleeding based on the NBA’s critical bleeding/massive transfusion module of the PBM Guidelines
• release of an app for iphone and android to accompany the Iron Deficiency Anaemia course (www.bloodsafelearning.org.au)
• update of the Clinical Transfusion Practice course to reflect the new PBM Guidelines and the second edition of the Australian and New Zealand Society of Blood Transfusion and the Royal College of Nursing Australia, Guidelines for the Administration of Blood Products
• commencement on the development of a new module based on Module 2 Perioperative of the PBM Guidelines.

National Safety and Quality Health Service Standards

As part of the National Health Reforms, the ACSQHC has developed the NSQHS Standards. These standards are intended to drive improvement in safety and quality for patients through their use. They also provide a clear statement of the level of care consumers can expect from health services. Accreditation against the standards commenced in January 2013. The NBA is committed to supporting health service organisations meeting the requirements under Standard 7 Blood and Blood Products by identifying and/or developing resources. During 2012-13 the NBA worked with the Commission and other stakeholders to develop the:

• Standard 7 Safety and Quality Improvement Guide, Frequently Asked Questions and Factsheet
• Hospital Accreditation Workbook

At the request of the Commission, the NBA also led a series of webinars in May 2013 in response to queries from health service organisations about the implementation of the Standards. The webinars were aimed at both public and private hospitals, dental and day procedure surgeries with one aimed at rural and regional hospitals. The purpose of the webinars was to provide an overview of Standard 7 and allow participants to ask questions of an expert about implementation of the Standard at their health service organisation.

The NBA also presented on Standard 7 at the Blood Service hosted Transfusion Update held in June.

Research and Development

National Blood Sector Research and Development Priorities

Under the National Blood Agreement the NBA is charged ‘…to facilitate and fund appropriate research, policy development or other action in relation to new developments by relevant government or non-government persons or bodies.’ To support this, in 2012-13 NBA worked with stakeholders to release the National Blood Research and Development Strategic Priorities 2013-16. The purpose of the publication is to provide a useful resource to guide priority setting for research. It may be used by researchers to support funding requests, by identifying that their research aligns with priorities communicated by governments.

In 2013-14 NBA will continue to develop a framework to identify the activities the NBA will undertake to facilitate research to meet the strategic priorities. Activities in the framework will need to be considered and approved by all governments prior to implementation.

Blood Service research and development framework

The NBA and the Blood Service have agreed a research and development framework for commencement in 2013-14 as part of the Deed of Agreement variation. This framework outlines strategies to ensure appropriate incorporation of government priorities and expectations in the development and implementation of the Blood Service research program. It also describes reporting requirements that will improve the transparency to governments of activities and expenditure of the research and development program.

Through a grant specified in the Deed of Agreement, the Blood Service received grant funding of approximately $8.1 million for its research and development program. The Blood Service has four research programs:

• donor and community
• applied and developmental
• transfusion science
• clinical.

Transfusion Outcomes Research Collaborative

In 2012-13 NBA confirmed its participation as a partner in the Transfusion Outcomes Research Collaborative (TORC) NHMRC Partnership Grant application on Improving outcomes for patients with critical haemorrhage requiring massive transfusion. TORC is a collaborative lead by the Monash University’s Department of Epidemiology and Preventive Medicine. The proposed scope of work of this project closely aligns with governments’ approved statement of blood research and development strategic priorities. In particular, the work will address significant gaps in the areas of appropriate use of blood and implementation of the NHMRC approved PBM Guidelines. This will in turn directly contribute to improving patient outcomes.