National Blood Authority Transfusion (NBA) Update Melbourne 15 May 2014 By Jo Bothroyd

I attended the day-long Clinical Practice update session of this event as the Consumer Lead on the ACT Standard 7 Blood and Blood Products Committee.  HCCA sponsored my registration.

Most presentations were very well received and focused on projects or programs designed to help health services develop their Transfusion Quality Improvement Systems so that they comply with Standard 7 which requires;

“Clinical leaders and senior managers of a health service organisation implement systems to ensure the safe, appropriate, efficient and effective use of blood and blood products. Clinicians and other members of the workforce use the blood and blood product safety systems.”

and on the accreditation criteria listed at the bottom of the post.*

Both the Australian Red Cross Blood Service and the National Blood Authority have developed of smart phone/IPad applications (apps) to provide information and support for transfusion services. A WA Red Cross Blood Service app designed for services treating people with high iron/ferritin levels was reported as achieving reduced times from referral to treatment and cost savings for health services.  High iron and related conditions are apparently becoming more common because people are living longer and are more readily diagnosed.

Through the NBA app transfusion service can access information about:

1. Use and management of blood and blood products in accordance with national evidence-based guidelines.

2. Risk mitigation, education and safety and quality improvement programs for the management and use of blood and blood products.

3. Reporting and feedback mechanisms into risk management processes for adverse events, incidents and near misses relating to transfusion practice.

4. Policies, procedures and protocols for documenting transfusion details in the patient clinical record.

5.  Appropriate management of blood and blood products.

6. Informed consent is documented for transfusions.

From my point of view development of smart technology apps will provide a new level of immediate access to evidence based information and therefore should reduce delays in determining the best approach to treatment. The alternative up until now (when beside computers were not available) was access to information via a desktop.

A presentation on informed consent revealed that there is no agreed approach to obtaining consent in terms of blood and blood products.  Some services get separate consent for each type of blood product; some services appear to use the general consent signed on admission to hospital as consent for blood and blood products; and some presenters suggested their organisation is considering getting separate consent for each unit of blood or blood product given to a consumer.

My impression was that there is good communication between the NBA and State Based Transfusion Services and between individual State and Territory services.

Participants did say that they valued the opportunity to network and develop links with other services and individual clinicians.

Jo Bothroyd

*Standard 7 four key Accreditation Criteria

Governance and systems for blood and blood products prescribing and clinical use - Health service organisations have systems in place for the safe and appropriate prescribing and clinical use of blood and blood products.

Documenting patient information - The clinical workforce accurately records a patient’s blood and blood product transfusion history and indications for use of blood and blood products.

Managing blood and blood product safety - Health service organisations have systems in place to receive, store, transport and monitor wastage of blood and blood products safely and efficiently.

Communicating with patients and carers - Patients and carers are informed about the risks and benefits of using blood and blood products, and the available alternatives when a plan for treatment is developed.

Blood culture to change, but not at any price

Russell McGowan recently attended a national seminar, run by the National Blood Authority in Sydney. He has written the following post on a few issues that emerged.

I learnt that blood is not actually free, but comes at a price. That price can be up to $1000 per unit of fresh red cells transfused, and more like $2500 per patient assisted. In fact, the cost of blood accounts for as much as 5% of all health expenditure.Now I have been a frequent user of blood and blood products in the past – at one stage receiving as many as six units a month as my enlarging spleen started to consume all the blood my bone marrow could produce.

Subsequently, I became a heavy user of IVIG, a fractionated derivative of blood plasma, to boost my immune system following my bone marrow transplant. As a result I have followed the evolution of blood service arrangements in this country with some interest. The latest development is that private hospitals in NSW are to be charged for the blood that they use. (see article from The Age, 15 November 2008).

This will be seen by some as exploitation of donors (including my daughters) who give blood freely to help the health system do its job. Fortunately I won’t have to refund the health system for all the blood I have received over the years, but what will it mean for other consumers?Why would a State Government break ranks with its counterparts and start charging for blood? The answer is quite simple – we don’t value what we don’t have to pay for.

Blood is often used inappropriately in health care when other therapies would be more cost effective and probably would produce better outcomes for consumers. So at a time when threats to the blood supply are looming larger than ever before, it makes a lot of sense to set some price signals to help control use of a scarce resource.Surgeons can operate successfully without resorting to blood transfusions – they do it already for Jehova’s Witness patients. Haematologists can learn not to resort to transfusions for anaemia when mere infusion of intravenous iron can achieve an equivalent or better effect.

In the ACT, the TCH blood team has recently attacked wastage of blood in operating theatres where excess units are provided for surgery just in case they are needed, but are left lying around at room temperature for too long in the process and then need to be discarded rather than being used elsewhere. A good start to dealing with an insidious inefficiency.

I am more than happy to discuss these issues with any readers interested in them. In addition there is an opportunity for consumer input to a professional and community forum being conducted by the National Blood Authority here in Canberra in early December.It is to be hoped that blood culture can be changed in the health system to ensure better outcomes for consumers and that politics generated the NSW Government action will not railroad reforms into a dead end siding.

Russell McGowan