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Appropriate use of blood in Australia

There has been an increased focus on appropriate use of fresh blood products in Australia in recent years. The 2010 Australian Health Ministers' Conference Statement for National Stewardship Expectations on the Supply of Blood and Blood Products (Stewardship Statement) requires that blood should be managed in ways to ensure all blood products are used in a clinically appropriate manner in accordance with relevant professional guidelines and standards. The NBA has developed Patient Blood Management (PBM) Guidelines and carried out a range of implementation activities in relation to the PBM Guidelines to improve the appropriate use of fresh blood products.

PBM Guidelines

The NBA has published five modules of the PBM Guidelines:

Over 100,000 copies of the first four 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 early 2015, the NBA published Module 5: Obstetrics and Maternity. Module 6: Paediatric and Neonatal is currently being developed by the Clinical/Consumer Reference Group. Module 6 will be released for public consultation on 2 September 2015 and will be published in 2016.

Implementation of PBM Guidelines

In 2013–14, the NBA carried out a range of activities to 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.[52]

Best practice tools

The NBA intensified its development of best practice tools to support health providers to implement improvements in the management and use of blood and blood products, including development of:

  • guidance for the implementation of a PBM program (not yet completed)
  • materials for the implementation of a single unit transfusion policy
  • guidance for the provision of intraoperative cell salvage
  • a guidance module for inter-hospital transfers as part of the Managing Blood and Blood Product Inventory Guidelines for Australian Health Providers
  • guidance on acute transfusion reaction, recognition and management chart (not yet completed)
  • red blood cell and massive transfusion protocol clinical audit tools (not yet completed)
  • a case study on preoperative anaemia identification, assessment and management
  • a case study on the Prince Charles Hospital implementing point of care testing
  • promotional products for use within hospitals to raise awareness of wastage of blood and blood products.

Promotional and communication activities

With the increased focus on appropriate use of fresh blood products, opportunities to promote the guidelines and NBA's key messages at conferences and sector events were leveraged in 2013–14. Through trade stands, presentations or conference advertising, NBA initiatives were promoted at the following key events:

  • Australian Society of Anaesthetists National Scientific Congress, Canberra, September 2013
  • Australian and New Zealand Intensive Care Society (ANZICS) Annual Scientific Meeting, Hobart, October 2013
  • 2013 Annual Scientific Meetings of the Haematology Society of Australia and New Zealand, Australian & New Zealand Society of Blood Transfusion and the Australasian Society of Thrombosis and Haemostasis (HAA), Gold Coast, October 2013
  • Australian Private Hospitals Association (APHA) 33rd National Congress, Melbourne, March 2014
  • Combined Royal Australian College of Surgeons (RACS) Annual Scientific Congress and Australian and New Zealand College of Anaesthetists (ANZCA) Annual Scientific Meeting, Singapore, May 2014
  • World Federation of Haemophilia Congress, Melbourne, May 2014
  • Blood Service Transfusion Update, Melbourne, May 2014.

The NBA also sponsored a number of stand-alone events designed to improve awareness and understanding of improvements required in the management and use of blood and blood products:

  • The NBA engaged the Australian Commission on Safety and Quality in Health Care (ACSQHC) to co‑brand a series of National Blood Symposiums held in September 2013 in Sydney, Melbourne and Adelaide. The symposiums, attended in total by more than 650 health professionals, were focused on supporting the implementation of NSQHS Standard 7.
  • The NBA joined the Western Australian Department of Health to co-sponsor the inaugural National Patient Blood Management Conference, titled "Patient Blood Management as a standard of care in Australia: Past, Present and Future". The conference agenda included presentations from a cross section of international, national and local experts. The conference was acclaimed by over 300 attendees as highly successful with a strong demand for further events focused on PBM.

Education and training

  • National Blood Sector Education and Training Strategy

    In 2013-14, the NBA published 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 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 has proved to be very popular with 252,217 registered users and 65,284 new registrations in 2013–14. On average the site attracts about 5,500 new registrations and 10,500 course completions per month.

    There were 31 per cent repeat registered users during 2013–14 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 2013–14:

    • release of two new modules, one on PBM and one on Perioperative which was based on the NBA's Perioperative module of the PBM Guidelines
    • update of the website at www.bloodsafelearning.org.au to improve access, including compatibility with mobile devices
    • Critical Bleeding and Postpartum Haemorrhage courses recognised as an emergency response activity for ANZCA Continuing Professional Development program
    • review of the Iron Deficiency Anaemia module in response to clinical feedback
    • commencement of the development of a new module based on Module 4 Medical 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. 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 to meet the requirements under NSQHS Standard 7. During 2013–14 the NBA worked with the Commission and other stakeholders to develop resources to support implementation of the Standard.

Research and development

In 2012–13 NBA worked with stakeholders to release the National Blood Research and Development Strategic Priorities 2013-2016. 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 the NBA partnered with the Transfusion Outcomes Research Collaborative (TORC) on a successful NHMRC project grant application to improve outcomes for patients with critical haemorrhage requiring massive transfusion. The project is consistent with the national research and development strategic priorities in that it seeks to:

  • systematically measure and monitor transfusion practice and outcomes in patients with critical bleeding requiring massive transfusion. This will be achieved using data generated by the bi-national expansion of the Massive Transfusion Registry (MTR), which has already been successfully piloted at six Australian sites
  • provide robust national data on blood utilisation for massive transfusion to inform blood supply planning and inventory management and thereby improve equity of access to blood products
  • inform development of future clinical studies of patients with critical bleeding and provide a mechanism to support and measure translation of new findings into practice.