Patient Blood Management Guidelines: Module 2

Perioperative

Contents

5.2 Delivering patient blood management

The traditional laissez-faire attitude to blood administration results in risk to patients, expense to society and the waste of a gift given to save a life. Organisations should recognise and cherish the privilege of the responsibility of ensuring this gift is used in a way that exemplifies the best in health care. Patient blood management provides an opportunity to safely manage and moderate the use of products within Australia and New Zealand, while improving patient outcomes.

The CRG strongly advises that a nationally coordinated approach be developed for the implementation of perioperative patient blood management programs in Australia and New Zealand. This will require direct involvement by all levels of government. The CRG recognises there are significant challenges at national, jurisdictional and local levels that need to be addressed to facilitate the implementation of such an approach. The allocation of adequate resources is required. The recently established Western Australian Patient Blood Management Program provides a pilot model that is addressing many of these challenges.

A nationally coordinated approach to blood sector data management is needed, with close collaboration between clinical champions, academics, researchers and governments. Data linkage based on a standardised methodology, registry data, and standardised audits and surveys are all required to facilitate a better appreciation of where blood is being used and for what purpose.

The establishment of coordinated patient blood management programs will help organisations to attain accreditation against national standards such as the new Blood and Blood Products Standard developed by the Australian Commission on Safety and Quality in Health Care. It will also help to meet the expectations expressed in the Statement on National Stewardship Expectations in the Supply of Blood and Blood Products endorsed by Australian health ministers. Similarly, in New Zealand, it will help hospitals and blood banks to comply with the standards used by Quality Health New Zealand and International Accreditation New Zealand, respectively.

Blood transfusion practice improvement programs have already been established in Australian jurisdictions. The CRG recommends that these programs be reviewed and adequately resourced to collaborate in the coordination and implementation of patient blood management.

Within this coordinated framework, each health service provider engaged in the delivery of major surgical services will need resources to systematically re-engineer the way perioperative care is delivered. This is crucial in order to initiate and sustain the key elements of a perioperative patient blood management program, including:

The widespread uptake and sustainability of coordinated multidisciplinary, multimodal patient blood management programs is important not only to provide improved clinical outcomes for individual patients, but also to preserve the national blood supply in the face of an ageing population, and the consequent increase in demand for blood component therapy. This also fulfils the ethical responsibility to all blood donors that their gift has improved the life of another.