Objective 3. Promote the safe and efficient use of blood and blood products
In 2015-16, 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 2015-16, the NBA focused on finalising the Australian Haemophilia Guidelines and the sixth and final module of the PBM Guidelines addressing the neonatal and paediatric population. The NBA also progressed the pilot trialling alternative guideline development strategies for the update of Module 1: Critical Bleeding/Massive Transfusion. The lessons learned from the pilot will be used to inform the development of a guideline development model that will enable updates as
evidence emerges.
Better Practice Case Study: BloodMove Platelets South Australia
The BloodMove Platelets project aimed to reduce platelet wastage rates due to expiry. High platelet wastage rates which were previously seen as unavoidable were deemed unacceptable in the current climate of healthcare cost containment.
BloodMove Platelets involves a collaborative platelet inventory concept comprising of moving 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 from known historical high levels to levels previously thought of as unachievable and unattainable.
The BloodMove Platelets Project has realised a substantial 57% reduction in platelet wastage for all metropolitan public hospitals in Adelaide. This reduction has been sustained for over 24 months and is expected to be maintained as it is now standard laboratory operational practice. This has provided important cost savings to State and Commonwealth Governments allowing redirection of funding to other areas within health.
Importantly, BloodMove practices have reduced the wastage of this valuable resource freely provided by blood donors. These initiatives have shown that with good planning, collaboration and education, significant reduction in platelet component wastage due to expiry is attainable.
PBM Guidelines
Over 120,000 copies of the PBM modules 1 to 6 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 2015-16 the NBA published the PBM Guidelines: Module 6 Neonatal and Paediatrics.
National Haemophilia Guidelines
The NBA has continued to work closely with AHCDO during 2015-16 to finalise the new Guidelines for the management of haemophilia in Australia, to replace the Clinical Practice Guidelines for the Use of Recombinant and Plasma - Derived Factor VIII and Factor IX products published in 2006. The new Guidelines are intended to provide practical, multidisciplinary guidance on the diagnosis and management of patients in Australia with haemophilia. The Guidelines are based on the World Federation of Hemophilia's (WFH) Guidelines for the management of hemophilia (2nd edition), but have been adapted for the Australian setting.
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 2015-16, 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.
PBM Guidelines publication covers
Order Copies of the PBM Guidelines Click Here
Copies of the Guidelines and their accompanying Quick Reference Guides can be downloaded or ordered free of charge at www.blood.gov.au/pbm-guidelines
PBM Guidelines Implementation – Anaemia Management in Primary Care
In 2015-16 the NBA focussed on promoting anaemia management in Primary Care. Patient blood management principles are based on the idea that the patient's own blood is optimised before, during and after surgery to improve clinical outcomes. The NBA collaborated with NPS MedicineWise to develop resources for general practitioners managing patients undergoing planned surgery. The fit for surgery materials are available on the NBA and NPS MedicineWise websites. BloodSafe eLearning Australia also developed an educational short video to support general practitioners wanting to manage iron deficiency anaemia with intravenous iron infusion. The NBA was also a sponsor at two conferences attended by general practitioners where the fit for surgery materials were promoted. |
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Fit for surgery
The vital role of primary care
During 2015-16 NPS MedicineWise and the National Blood Authority collaborated to develop a suite of resources to help general practitioners manage patients who are on a surgical waiting list and may require treatment for iron deficiency and anaemia.
The National Blood Authority Patient Blood Management - Perioperative Guidelines recommends:
- in patients undergoing major surgery, preoperative anaemia should be identified, evaluated and managed to minimise blood transfusion, which may be associated with an increased risk of morbidity, mortality, ICU length of stay and hospital length of stay
- patients with, or at risk of, iron-deficiency anaemia should undertake preoperative oral iron therapy.
Around one in five patients undergoing elective surgery will have anaemia. Perioperative anaemia is itself associated with poorer outcomes such as slower recovery.
Promotion and communication
In 2015-16 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:
- Royal Australian College of General Practitioners (RACGP) Conference 2015, Melbourne, September 2015
- Haemophilia Foundation Australia (HFA) 17th Australian and New Zealand Conference, Gold Coast, October 2015
- The Australian College of Midwives (ACM) 19th Biennial Conference, Gold Coast, October 2015
- HAA 2015 (Haematology Society of Australia and New Zealand, the Australian & New Zealand Society of Blood Transfusion and the Australasian Society of Thrombosis and Haemostasis), Adelaide, October 2015
- Rural Medicine Australia, Adelaide, 2015
- Pathology Update 2016 The Royal College of Pathologists of Australia, (RCPA), Melbourne, February 2016
- Australian Private Hospitals Association (APHA) 35th National Congress, Gold Coast, March 2016
- RACS Annual Scientific Congress 2016 Royal Australasian College of Surgeons (RACS) with the Royal College of Surgeons England, Brisbane, May 2016
- Perinatal Society of Australia and New Zealand, Townsville, May 2016
The NBA promotes improved inventory management and appropriate clinical use of blood and blood products at a range of relevant national forums.
Rural Medicine Australia – 2015
As part of the NBA's ongoing commitment to engagement with health professionals across Australia, we were pleased to be a bronze sponsor for the second year in a row at the 2015 Rural Medicine Australia (RMA15) annual conference in Adelaide. RMA15 is the annual conference and scientific forum of the Australian College of Rural and Remote Medicine (ACRRM) and Rural Doctors Association of Australia (RDAA), and is now established as the peak national event for rural doctors.
The NBA continues to work collaboratively to promote and improve patient outcomes and contribute to the development of education, treatment and resources with a wide range of stakeholders, including the rural health care sector.
In keeping with this focus the NBA was pleased to organise and promote the Intravenous (IV) Iron Anaemia Management Workshop with expert presenters Dr Kathryn Robinson, Haematologist; Dr Danny Byrne, GP; and Ms Joy Gailer, Pharmacist.
The NBA was proud to be part of RMA15 as it provided a first-hand opportunity to promote the messages of patient blood management, inventory management, blood systems and general knowledge of blood and blood products directly to health professionals working in rural and remote areas.
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 2015-16, 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 on-line 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 fifteen 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 2016 there are more than 375,000 learners registered with the program who have completed more than 686,000 courses.
For the 2015-16 reporting period the BEA program:
- received 64,587 new user registrations
- had 171,635 courses completed by users, with more than 14,300 courses completed on average each month
- was used by more than 1,300 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
- updated the Iron Deficiency Anaemia app
- repurposed course content and filmed new content to deliver three short educational resources aimed at medical practitioners
- released a course based on PBM Guideline Module 4-Critical Care
- commenced development of new course content based on PBM Guideline Module 5 – Obstetrics and Maternity
- commenced review of Clinical Transfusion Practice course.
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 2015-16 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 2018.
Patient Blood Management Guidelines
Release of Module 6: Neonatal and Paediatrics
- The NBA has managed and funded the development of six evidence-based, NHMRC approved Patient Blood Management guidelines.
- The Guidelines aid decisions on whether to transfuse in the context of specific patient circumstances, and the full range of other available treatments.
- The release of the Neonatal and Paediatrics module in April completed the suite of guidelines.
- The Critical Bleeding/Massive Transfusion module, released in 2011, is now under review.
- The world-leading Guidelines were promoted at many clinical conferences during the year, including the Australian College of Midwives conference in October 2015 and the Perinatal Society of Australia and New Zealand Annual Congress in May 2016.
- Copies of the Guidelines and their accompanying Quick Reference Guides can be downloaded or ordered free of charge at www.blood.gov.au/pbm-guidelines
Trade stand at the Australian College of Midwives annual conference.
Victorian Wastage Summit
Working collaboratively to reduce wastage!
Victorian Wastage Summit 2015
The National Blood Authority (NBA) was pleased to co-host the third annual Victorian Wastage Summit in September 2015. This Wastage Summit is a collaboration between the NBA and Victoria's Department of Health and Human Services, including the Blood Matters Program, and is held to support the work undertaken by all Australian Governments and the NBA to reduce unnecessary wastage of blood and blood products.
The purpose of the Summit is to enhance engagement with stakeholders who work in Victoria's blood sector and to encourage open discussion on issues relating to the reduction of unnecessary wastage of blood and blood products in Victoria. It covers the areas of best practice in blood and blood product wastage prevention, identifying strategies to reduce wastage, developing plans to implement these strategies, and developing a collaborative framework for the future. Presentations were given by local health professionals and scientists from both the public and private health sectors directly to the delegates to share challenges and strategies that have been implemented. These have been made available for ongoing education and training.
The inaugural Wastage Summit was held in 2013 and has continued annually due to the ongoing engagement of laboratory and other health professionals. Its success can be measured through the significant reduction in blood product wastage in Victoria with savings of over $5.5 million available for use in other areas of health. We look forward to continuing with the collaboration and results!
Thank you
Once again we have had a big year and achieved a great deal. We would not have been able to do this without the extraordinary help and support of the clinical, scientific and consumer community.
The National Blood Authority 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;
- Patient Blood Management Guidelines Expert working group
- Patient Blood Management Guidelines Clinical Consumer Reference Group for the Obstetrics and Maternity module
- Patient Blood Management Guidelines Clinical Consumer Reference Group for the Neonatal and Paediatrics 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 and societies 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 at www.blood.gov.au 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'.
Research and Development Strategic Priorities
The NBA has worked with stakeholders to identify 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, 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 for funding of research and development activities in the blood sector.
The Pilot will fund a limited number of projects or activities which are 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 will be targeted at the following topics, where the priority for research has 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, and
- compare the use of blood products with alternative strategies and treatments.
In 2015-16, the NBA invited applications for the first of two planned grant rounds of the Pilot. Round 1 attracted 28 grant applications. The NBA was impressed with the high quality of these applications. The NBA's new grant assessment process ran smoothly and has provided important information to support improvements for Round 2. The NBA 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.
