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

In 2016-17, the NBA continued its intensive program to promote the safe and efficient use of blood and blood products. This includes the delivery of a range of key reference material and accelerated supporting implementation activities in relation to reducing wastage and improving fresh blood use based on the NBA-developed Patient Management Guidelines (PBM Guidelines).

Reference Development

In 2016-17, the NBA commenced a project to identify and implement a more sustainable methodology for reviewing and updating the PBM Guidelines. The NBA also commenced an update of the 2003 Guidelines on the Prophylactic Use of Rh D Immunoglobulin (Anti-D) in Obstetrics to ensure they continue to reflect current evidence and best clinical practice.

National Patient Blood Management Implementation Strategy 2017-2021

The National Patient Blood Management Implementation Strategy 2017-2021 takes a patient-centred approach intended to optimise clinical outcomes and improve patient safety.

Since the launch of the PBM Guidelines and accompanying implementation strategy, Australia has seen a significant reduction in the use of red blood cells. This reduction in use would not have occurred without the concerted effort of jurisdictional programs, clinical PBM champions and a willingness by healthcare professionals to adopt a patient focus rather than a product focus and using blood and blood products more appropriately and safely. The NBA estimates there remains significant scope for consolidation of gains already made and further penetration of PBM in clinical practice.

The core element of the strategy is to collaboratively facilitate activities and development of materials at a national level that support implementation at a health service organisation level. The four main elements covered in the 2013-17 strategy have been updated to six and now include:

  • Guidelines
  • Tools and resources
  • Education and training
  • Promotion and communication
  • Data
  • Research and development

The PBM activities to be undertaken are categorised to reflect these new elements in line with the revised goals and objectives. The content has been reviewed to align with the revised National Safety and Quality Health Service Standards, Blood and Blood Products Standard. The strategy also includes further information on partnerships, reviewing and updating PBM initiatives currently being implemented, and evaluation processes.

cover of the National Patient Blood Management Strategy

covers of selected NBA publications

PBM Guidelines

Over 140,000 hard copies of the PBM modules 1 to 6 have been issued. They have also been 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 2016-17, the NBA turned its attention to maintaining the currency of the PBM Guidelines and commenced a review of the current development process. The review aims to identify and implement a model that allows updated clinical guidance to be published and disseminated as the evidence base and clinical practice evolves.

cover of Module 1 Critical Bleeding/Massive Transfusion cover of Module 2 Perioperative cover of Module 3 Medical covers of sixPBM Guidelines publications covers of sixPBM Guidelines publications covers of sixPBM Guidelines publications

PBM Guidelines publication covers

National Anti-D Guidelines

The NBA commenced a review of the 2003 Guidelines on the Prophylactic Use of Rh D Immunoglobulin (Anti-D) in Obstetrics in 2016-17 to ensure they continue to reflect current evidence and best clinical practice. A multi-disciplinary Expert Reference Group has been established to oversee the development of the new Guideline.

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 2016-17, the NBA continued its focus on activities to support implementation of measures to reduce wastage of blood and improve appropriate use through PBM as defined in the JBC approved National Blood and Blood Product Wastage Reduction Strategy 2013-2017 and the National Patient Blood Management Guidelines Implementation Strategy 2013-2017. The strategies address a significant proportion of requirements identified in the 2010 Australian health ministers' Statement on national stewardship expectations for 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.

Patient Blood Management Guidelines Review

The NBA completed the suite of the National Health and Medical Research Council (NHMRC)-approved Patient Blood Management Guidelines in 2016, comprising Critical Bleeding/Massive Transfusion (2011), Perioperative (2012), Medical (2012), Critical Care (2013), Obstetrics and Maternity (2015) and Neonatal and Paediatrics (2016).

The Patient Blood Management Guidelines provide evidence-based clinical guidance on optimisation of the patients' own blood, non-transfusion strategies to minimise blood loss and bleeding and strategies to manage anaemia.

Upon completion of the suite of the Patient Blood Management Guidelines, the NBA turned its attention to maintaining their currency and commenced a review and update process.

The review is considering a broader scope across the entire suite of modules rather than updating each module in isolation and aims to identify and implement a guideline model that allows updated clinical guidance to be published and disseminated as the evidence base and clinical practice evolves.

While the review is underway, the original modules remain available to guide practice. Copies of the Patient Blood Management Guidelines and their accompanying Quick Reference Guides can be downloaded or ordered free of charge at
www.blood.gov.au/pbm-guidelines.

Red blood cell wastage and supply chain efficiencies

The National Blood Authority's Wastage Reduction Strategy 2013-17 has been very effective in helping to reduce unnecessary wastage of blood and blood products through two streams of work:

  1. supply chain efficiencies from the point of collection to the point of issue of blood and blood products to health providers from suppliers and distributors
  2. improving health provider inventory management from the point of receipt of blood and blood products to the transfusion of these units to patients.

Various projects, resources and direct health provider engagement have contributed to significant reductions in issues and wastage rates for red blood cells:

  • National Blood and Blood Product Wastage Reduction Strategy 2013-17
  • the National Patient Blood Management Guidelines (6 modules)
  • manufacturing cost included on blood component labels
  • national blood symposia highlighting strategies required to reduce wastage
  • promoting strategies at key conferences and collaborative meetings
  • National Safety and Quality Health Care Service National Safety and Quality Health Service (NSQHS)
  • Standard 7 - Blood and Blood Products
  • Managing blood and blood product inventory
  • The National Inventory Management Framework project (NIMF)

red cells issues and discards chart

A variety of free resources and 'Stop the Waste' promotional products are available to help health providers promote the wastage strategy including the below promotional items.

stop the waste promotional products

Promotion and communication

In 2016-17 the NBA continued its promotion and communication campaign to increase awareness of the need to improve clinical practice and inventory management in relation to blood products. This included representation and promotional and educational activities at a range of clinical and health sector conferences and events, including the following:

  • 27th Annual Conference of the Australasian Society of Clinical Immunology and Allergy (ASCIA), September 2016
  • Haematology Society of Australia and New Zealand, Australian & New Zealand Society of Blood Transfusion and the Australasian Society of Thrombosis and Haemostasis (HAA), 2016, November 2016
  • Inaugural Patient Blood Management Conference RBWH, Royal Brisbane Women's Hospital, February 2017
  • Royal College of Pathologists - Pathology Update 2017, February 2017
  • Transfusion Update Conference 2017, April 2017
  • 3rd Intraoperative Management of Blood (IMOB) Australian and New Zealand College of Perfusionists (ANZCP), May 2017
  • Australia & New Zealand College of Anaesthetists Annual Scientific Meeting (ANZCA), May 2017.

The NBA promotes improved inventory management and appropriate clinical use of blood and blood products at a range of relevant national forums.

BloodMove Platelets Project significantly reduces platelet wastage for South Australia

Aim:

The aim of the BloodMove Platelets project was to minimise platelet wastage due to expiry.
The data confirms a significant reduction in South Australia when compared with the national wastage figure over the past four years.

Implementation:

The BloodMove Platelets project was implemented in a staged manner following initial planning, preparation, consultation and education. Initial planning included auditing inventory levels, platelet usage and wastage patterns across all metropolitan public hospitals.

The BloodMove Platelets project aimed to minimise platelet wastage through a number of different strategies including:

  • transfer of near expiry platelets to large metropolitan hospital laboratories
  • establishing a common shared Day 5 Platelet Listing for use by all Adelaide metropolitan hospital and private laboratories (in preference to the use of available Day 3 or 4 platelets or by placing a BloodNet order)
  • reducing platelet inventories deemed excessive.

Summary:

The BloodMove Platelets project has demonstrated a reduction in platelet wastage. High platelet wastage rates that were previously seen as unavoidable are now deemed unacceptable in the current climate of healthcare cost containment.

The BloodMove Platelets project involves a collaborative platelet inventory concept that moves Day 4 platelet blood stocks from low usage sites to high usage sites and then sharing a common multi-site near expiry Day 5 platelet inventory. Additionally, minor inventory level changes and dispatch practices were implemented.

Transfusion service laboratories across the SA Pathology network, together with the large private pathology transfusion service laboratories, have significantly reduced platelet wastage to levels previously thought as unachievable. This reduction was sustained for 36 months and currently appears to have stabilised. The flow-on substantial cost savings to jurisdictional governments will enable funding to potentially be redirected to other important areas.

Importantly, BloodMove practices have reduced the risk of a valuable resource, that is freely provided by blood donors, being wasted.

These initiatives have shown that with good planning, collaboration and education, significant reduction in platelet component wastage due to expiry is attainable.

platelet discard rate chart

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 continues to rise.

In 2016-17, the NBA progressed the National Blood Sector Education and Training Strategy 2013-2016. The strategy outlines 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.

BloodSafe eLearning Australia

BloodSafe eLearning Australia (BEA) provides online education and training resources for health professionals in Australia. The program aims to improve knowledge of patient blood management and clinical transfusion practice in order to improve patient outcomes.

The first course, Clinical Transfusion Practice, was released in late 2007. The course catalogue has since expanded to 17 courses and one mobile device application ('app'), with further courses in development. All courses are based on published guidelines, best practice and expert opinion.

At the end of June 2017 there were more than 425,000 learners registered with the program who had completed more than 850,000 courses.

For the 2016-17 reporting period the BEA program:

  • received 58,510 new user registrations
  • had 155,792 courses completed by users, with more than 12,983 courses completed on average each month
  • was used by more than 1,500 Australian health care organisations (hospitals, pathology laboratories, staffing agencies etc) to improve staff knowledge and assist them to meet their accreditation requirements
  • promoted the available courses in professional journals, at scientific, medical and nursing conferences, and provided resources for organisations to undertake their own promotions
  • finalised new course content based on PBM Guideline Module 5 - Obstetrics and Maternity
  • finalised and released a major review of the Clinical Transfusion Practice Collecting Blood Specimens and transporting blood courses
  • commenced the development of courses to support the PBM Guidelines Module 6 - Neonatal and Paediatrics
  • commenced major upgrades and new developments to the learning management system.

National Safety and Quality Health Service Standards

As part of the national health reforms, the ACSQHC (Commission) has developed the NSQHS Standards. These standards were intended to drive improvement in safety and quality for patients. They also provide a clear statement of the level of care consumers can expect from health services. The NBA is committed to supporting health service organisations to meet the requirements under Standard 7 Blood and Blood Products. During 2016-17 the NBA continued to work with the Commission and other stakeholders in the process to review Standard 7 in support of the development of the next edition of the Standards, scheduled for release in November 2017.

Thank you

thumb up

The National Blood Authority (NBA) would like to acknowledge the extraordinary help and support of the clinical, scientific and consumer community. The NBA could not fulfil its role in the blood sector without the considerable contribution of all stakeholders but we wanted to draw readers' attention to the numerous groups that provide their valuable time and resources to a large number of initiatives and business as usual tasks. All external stakeholders in the blood sector provide the NBA with advice that allows us to produce quality outputs and meet the objectives of the national blood arrangements.

Thank you to our clinical, scientific, and consumer advisors.

These include the members of the:

  • Jurisdictional Blood Committee Working Group for the review and update of the Patient Blood Management Guidelines
  • The Patient Blood Management Guidelines Clinical/Consumer Reference Group for the update of the Critical Bleeding/Massive Transfusion module
  • National Immunoglobulin Governance Advisory Committee including the Specialist working groups for Immunology, Haematology, Neurology and Transplantation medicine
  • Australian Bleeding Disorders Registry Steering Committee
  • Australian Bleeding Disorders Registry User Reference Group
  • Australian Haemophilia Centre Directors' Organisation (external)
  • National Patient Blood Management Steering Committee
  • National Blood Sector Education and Training Committee
  • Haemovigilance Advisory Committee
  • BloodNet User Reference Group
  • MyABDR User Reference Group

The NBA would also like to acknowledge the support it receives from the many colleges, societies and individuals, who contribute to our publications, resources and tools.

There are too many to list here but if readers want to know who we are thanking they can go onto our website for further information.

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'. The National Blood Research and Development Strategic Priorities 2013-16 is currently under review. 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, including from the National Health and Medical Research Council, by identifying that their research aligns with priorities communicated by governments.

National Blood Sector Research and Development Pilot

In September 2015 the NBA received approval from funding governments to implement a Pilot to fund research and development activities in the blood sector.

The Pilot was established to fund a limited number of projects or activities assessed as likely to produce valuable research outcomes in identified key priority areas. In addition, information gathered from the Pilot will be used to inform consideration by governments of the viability and potential value of further blood sector specific research and development funding.

The Pilot targeted the following topics, where the priority for research had been identified by pre-existing strategic programs of the NBA and governments in the blood sector:

  • patient blood management evidence gaps, as identified in each module of the PBM Guidelines
  • efficient and effective use of immunoglobulin products, as highlighted through the Ig Governance Program.

The overarching objectives are to identify and support strategic priority areas appropriate for targeted blood sector research funding that will:

  • enhance the sustainability and affordability of the national supply of blood products, including through increased efficiency and reduced blood product usage and wastage
  • identify appropriate use and reduce inappropriate use of blood products
  • maintain or enhance clinical outcomes for patients by providing evidence or new knowledge to:
    • understand the biological action of blood products
    • identify optimum treatment, dosing or indications for use for blood products
    • compare the use of blood products with alternative strategies and treatments.

In 2016-17, the NBA commenced funding of nine successful research grant applications from Round 1 of the Pilot. Applications for the second round under the Pilot were invited in early 2017. Round 2 attracted 23 high quality applications of which seven were deemed suitable for funding. Grants for these projects will commence in early 2017-18.

The NBA received input from clinical academic, research and government experts who participated in the review process and assisted the NBA in determining the mix of projects to be funded within the Pilot's limited budget. The NBA is confident that the funded research will provide significant inroads towards achievement of the blood sector's research outcomes. The outcomes of each grant funding round are reported on the NBA's website.

National Blood Sector Research and Development Pilot

After the successful Round 1 of the Research and Development Pilot the NBA commenced and awarded grants for Round 2.

The NBA was impressed with the number and quality of submissions for Round 2. The NBA was grateful to have received high quality input from clinical, research and government experts who participated in the review process and assisted the NBA in determining the mix of projects to be funded within the limited pilot budget. The NBA is confident that the funded research will provide significant inroads towards achievement of the blood sector's research outcomes.

Through this pilot, the NBA will test and evaluate its capacity to meet the objectives of the NBA's Research and Development Framework objectives and its ability to administer a grants program.

The NBA sourced a group of peer reviewers from its clinical groups who had expertise in not only peer review but also in the topics of patient blood management and immunoglobulin therapy. The process was facilitated by an individual with significant expertise and experience in the management of scientific peer review processes. The process ensured that each application was evaluated in a fair, unbiased and equitable manner.

The topics funded for research in this Round 2 will address important knowledge gaps in both patient blood management and immunoglobulin therapy. Grants were offered as scholarships, seed grants or project grants. Research will inform clinical practice, practice improvement and policy.

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