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

In 2018-19 the NBA continued its program to promote the safe and efficient use of blood and blood products through the identification and synthesis of new clinical evidence, development of draft clinical guidance in collaboration with clinical stakeholders, and research and analysis of methodologies capable of retaining the currency of clinical practice guidelines. This includes the delivery of a range of tools and resources to support implementation activities in relation to reducing wastage and improving fresh blood use based on the NBA-developed Patient Blood Management Guidelines (PBM Guidelines).

PBM Guidelines

Almost 160,000 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 2018-19 the research protocol, literature searches and screening of literature for the update of the critical bleeding/massive transfusion module (Module 1) were completed. The synthesis of evidence is currently underway.

In 2018-19, the research protocol, literature searches and screening of literature were completed to underpin the update of the perioperative (Module 2), medical (Module 3), critical care (Module 4), obstetrics and maternity (Module 5) and neonatal and paediatric (Module 6) modules. The findings are being used to:

  • identify changes to the evidence since the modules were published
  • inform whether the existing themes of the PBM Guidelines should be retained or amended
  • inform a research question list.

A review of the PBM Guidelines is underway. The review is considering a broader scope across the suite of modules rather than updating each module in isolation. The review of the PBM Guidelines is also seeking to identify and implement a more sustainable guideline model where clinical guidance can be updated and disseminated as the evidence base and clinical practice evolves. During 2018-19 research and analysis of methodologies was undertaken.

While the review is underway, the original modules remain available to guide practice.

PBM Guidelines publication covers

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

Guideline for the prophylactic use of Rh D Immunoglobulin in maternity care

In 2018-19 the multi-disciplinary Expert Reference Group (ERG) overseeing the development of an evidence-based guideline on the prophylactic use of Rh D Immunoglobulin in maternity care finalised the research protocol, considered the synthesised evidence, and commenced the guideline drafting process.

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 2018-19 the NBA continued its focus on activities to support implementation of measures to reduce wastage of blood and improve appropriate use through PBM the National Patient Blood Management Implementation Strategy 2017-2021 and the National Blood Product Management Improvement Strategy 2018-22 (Improvement Strategy). 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.

Promotion and communication

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

In 2018-19 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, promotion and education activities at a range of clinical and health sector conferences and events, including the following:

  • Australian Society of Clinical Immunology and Allergy (ASCIA), September 2018
  • Blood 2018 (formally HAA), October 2018
  • Rural Medicine Australia (RMA), October 2018
  • Perioperative Patient Blood Management Symposium, February 2019
  • Royal College of Pathologists of Australia (RCPA) Pathology Update, February 2019
  • Australian Private Hospitals Association (AHPA), March 2019
  • International Plasma Protein Congress, March 2019
  • Australian and New Zealand Association of Neurologists (ANZAN), May 2019
  • Plasma Protein Forum, June 2019.

Education and Training

BloodSafe eLearning Australia

BloodSafe eLearning Australia 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.

BloodSafe eLearning Australia is funded by the National Blood Authority on behalf of all Australian governments. During 2018-19, the BloodSafe eLearning Australia program:

  • delivered 216,148 hours of education
  • had 153,618 courses completed by users, with 12,802 courses completed on average each month, approximately one course completed every three minutes
  • registered 56,987 new users
  • was used by more than 1,500 Australian health care organisations including hospitals, pathology laboratories, staffing agencies to improve staff knowledge and assist them to meet their accreditation requirements
  • promoted the courses in professional journals and scientific, medical and nursing conferences, and provided resources for organisations to undertake their own promotions
  • developed new courses on viscoelastic haemostasis testing, a clinical transfusion practice refresher course, and patient blood management in neonate and paediatric settings based on the national Patient Blood Management Guideline Module 6
  • undertook a major review and update of courses on Patient Blood Management Essentials and iron deficiency anaemia.

National Safety and Quality Health Service Standards

The National Safety and Quality Health Service (NSQHS) Standards were developed by the Australian Commission on Safety and Quality in Health Care (ACSQHC) with the Australian government, state and territory partners, consumers and the private sector providing input and feedback.

The primary aim of the NSQHS Standards is to protect the public from harm and improve the quality of health care. They describe the level of care that should be provided by health service organisations and the systems that are needed to deliver such care.

The Blood Management Standard - Standard 7 aims to improve outcomes for patients by identifying risks and using strategies that optimise and conserve a patient's own blood, as well as ensuring that any blood and blood products that patients receive are safe and appropriate. The Blood Management Standard covers all elements in the blood management and clinical transfusion process and includes the principles of patient blood management (PBM).

During 2018-19 the NBA continued to work with the ACSQHC and other stakeholders in the implementation of the second edition of the NSQHS Standards.

BloodSafe eLearning Australia

EDUCATION AND TRAINING

The first course, Clinical Transfusion Practice, was released in late 2007. The course catalogue has since expanded to 31 courses, one mobile device application ('app') and a range of other resources, with further courses in development. All courses are based on published guidelines, evidence-based practice and expert opinion.

New Courses

Some highlights from 2018-19 include the development of new courses:

  • viscoelastic haemostasis testing
  • clinical transfusion practice refresher
  • patient blood management in neonate and paediatric settings based on the national Patient Blood Management Guideline Module 6.

BEA also undertook a major review and update of courses on Patient Blood Management Essentials and iron deficiency anaemia bringing the total number of educational courses available to 31.

The average number of course completions per month is more than 12,000 with the Iron Deficiency Anaemia Essentials course - only released in April 2019, having over 1,000 course completions.

In 2018-19 user feedback was overwhelmingly positive with users expressing appreciation for the courses, and indicating that they have learnt new knowledge that can be applied in their workplace.

‘...the course, carries a lot of detail and encourages further exploration through its links. I followed up with several of these which added to the interest.'
Medical Consultant/Specialist March 2019

Conferences

The NBA partners with promoting BEA courses at many of the scientific conferences in Australia including:

  • Blood 2018
  • Rural Medicine Australia (RMA18)
  • Pathology Update Melbourne
  • Australian Private Hospital Association National conference
  • Australian and New Zealand Association of Neurologists Conference.

bloodsafe elearning australia

BLOOD 2018 AWARDS

Blood 2018 Awards sponsored by the National Blood Authority

Blood 2018 is the annual combined scientific meeting of the Haematology Society of Australia and New Zealand (HSANZ), the Australian and New Zealand Society of Blood Transfusion (ANZSBT) and the Thrombosis and Haemostasis Society of Australia and New Zealand (THSANZ). The NBA actively participates in this meeting, and sponsors two key awards. Since 2014, the ANZSBT Council has been awarding a prize sponsored by the NBA for the best poster or oral presentation with a transfusion focus by a young investigator, and since 2017, for the best poster or oral presentation on haemovigilance.

Young Investigator Award

In 2018 the recipient of the $500 Young Investigator award was Ms Alexis Perros, a research scientist at the Australian Red Cross Blood Service, Brisbane, Australia. Alexis is in the final stages of her PhD at the University of Queensland, and her main research focus is investigating immunomodulation after transfusion. Alexis presented her research, "Transfusion modulates leucocyte populations in cardiac surgery patients" in the ANZSBT Presidential Symposium, and also had two poster presentations, "Underlying inflammation influences immunoregulatory cell immune responses in a model of platelet concentrate and packed red blood cell transfusion" and "Assessment of transfusion-related immune modulation in cardiac surgery patients". Coronary artery bypass grafting is a complex surgical procedure which triggers a systemic inflammatory response that may be exacerbated by transfusion. Alexis' research, a collaboration between the Blood Service and The Prince Charles Hospital, found that multiple leucocyte subsets were modulated following transfusion in coronary artery bypass grafting patients. Modulation of the patient's immune response may contribute to adverse patient outcomes, including increased rates of infection and mortality. Increasing our understanding of how transfusion and cardiac surgery modulate a patient's immune system may help predict adverse patient outcomes.

Ms Alexis Perros

Alexis is supervised at the Blood Service by A/Prof Melinda Dean, Dr Helen Faddy and Prof Robert Flower and at the University of Queensland by A/Prof Stuart Kellie

Haemovigilance Award

In 2018, the recipient of the $500 Best poster/oral presentation on haemovigilance award was Ms Christine Akers, a Transfusion Nurse within the Victorian Blood Matters program. The program is a collaboration between the Victorian Department of Health and Human Services and the Australian Red Cross Blood Service. Her award winning presentation was titled 'Transfusion associated circulatory overload: promoting awareness and reporting'. Chris showcased the education campaign aimed at raising the awareness of transfusion associated circulatory overload (TACO) within 79 health services in Victoria for a single month in 2017. The team used a number of educational tools (available on the Blood Matters website) to raise awareness with clinical staff. The campaign resulted in an increased number of TACO notifications through the Serious Transfusion Incident Reporting (STIR) program.

Ms Christine Akers
Best Poster Haem

Research and Development

National blood sector research and development priorities

Under the National Blood Agreement the NBA is required '...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 under review. This is intended 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 program

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

The program targets the following topics, where the priority for research has been identified through 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 fund research 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 nine successful research grant applications from Round 1 of the Pilot. Seven from twenty three high quality applications were funded in Round 2 under the pilot. Grants for these projects commenced early 2017-18. Six from seventeen high quality applications were funded under the grant program. Grants for these projects commenced in 2018-19. Round 4 attracted twenty two high quality applications which were under consideration at the end of the 2018-19 financial year.

In 2018, an evaluation of the pilot confirmed the viability and value of research and development funding to support a National Blood Sector Research and Development Program.

The NBA has received a substantial level of high quality input from clinical, academic, research and government experts who participated in the review process and assisted the NBA in determining the mix of research projects to be funded within the Program's limited budget. The NBA is confident that the funded research will be a valuable contribution towards achievement of the blood sector's research outcomes. The outcomes of each grant funding round are reported on the NBA's website.

Several projects have completed successfully to date with publications being accepted in peer reviewed journals. Funded research has been presented at multiple conferences within Australia and overseas. Outcomes from the R&D Program support the evolution of the Criteria and the PBM Guidelines.

National Blood Sector Research
and Development 3rd and 4th Round

National Blood Sector Research and Development Program

The National Blood Sector Research and Development Program has continued with two further funding rounds (Round 3 in 2018 and Round 4 in 2019). Funding may be available for up to three years in each round. Projects of various types and durations have been considered in the process.

Applications for grant funding fall into one of the following categories:

  • project grants (up to 3 years)
  • seed grants (up to 1 year)
  • scholarship grants (up to 1 year).

Round 4 has closed and applications are currently under consideration. Round 4 attracted a large number of applications across the immunoglobulin and patient blood management streams.

The NBA assembled a high quality expert review panel comprising:

  • clinical experts
  • academics
  • researchers
  • senior government personnel.

The expert review panel will consider the applications against the R&D Program's key criteria which focus on:

  • research focus
  • scope and potential value
  • quality
  • governance and ethics
  • efficient and effective use of funds.

Strict management of conflicts, or potential conflicts of interest was adopted. The round 4 process is expected to be completed in time for newly funded projects to commence in early 2020.

Thank you from the National Blood Authority

The NBA could not fulfil its role in the blood sector without the extraordinary help and support of the clinical, scientific and consumer community.

All external stakeholders in the blood sector provide the NBA with advice that allows the NBA 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:

  • Patient Blood Management Guidelines Clinical Consumer Reference Group
  • Rh D Immunoglobulin (Anti-D) Guideline Expert Reference
  • National Immunoglobulin Governance Advisory Committee and 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
  • National Patient Blood Management Steering Committee
  • Haemovigilance Advisory Committee
  • BloodNet User Reference Group
  • Immunoglobulin User Acceptance Testing Group
  • MyABDR User Reference Group
  • National Blood Authority Audit and Risk Committee
  • National Ig Interest Group (supports Ig governance arrangements)
  • National Blood Sector R&D Program Expert Review Panel.

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.

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