Blood and blood products are vitally important in health care and, while they can be lifesaving, their administration to patients may also be hazardous. Allergic and immunological complications, infections, incorrect blood transfusions and other adverse outcomes are not uncommon. Prescribing practices vary widely in relation to blood and a significant proportion of blood transfusions might have been unnecessary or could have been avoided.
Patient Blood Management (PBM) is a multidisciplinary approach that promotes appropriate care for patients and reduces exposure to unnecessary blood transfusions. To reduce unnecessary clinical variation and morbidity and mortality associated with pre-operative anaemia, the Commission has established the National Patient Blood Management Collaborative (the Collaborative).
A systematic review has identified an independent association between pre-operative anaemia and increase morbidity and mortality1, and an increased likelihood of red blood cell (RBC) transfusion2. As pre-operative anaemia management could reduce RBC transfusions and reduce post-surgery morbidity, mortality and length-of-stay in hospital1, the Collaborative will focus on improving the management of anaemia for patients having elective surgery. Elective gastrointestinal, gynaecological and orthopaedic surgery will be included in the Collaborative. The Collaborative will encompass the scope of the patient journey, from the time that the need for surgery is identified, through inpatient care, and then subsequent care back in the community.
NSQHS Standard 7: Blood and Blood Products aims to ensure that patients who receive blood and blood products do so appropriately and safely. To support appropriate PBM and the implementation of NSQHS Standard 7: Blood and Blood Products, the National Blood Authority (NBA) developed the Patient Blood Management Guidelines to assist clinicians in making decisions about the management of a patient’s blood. By facilitating the uptake of PBM and the NBA’s Patient Blood Management Guidelines, and supporting compliance with NSQHS Standard 7: Blood and Blood Products, the Collaborative, aims to improve patient care by optimising haemoglobin and iron stores by the time of elective surgery.
Following a call for expressions of interest, 46 submissions were received from public and private hospitals, in most of the states and territories. Twelve teams from health services across Australia were selected to participate in the Collaborative. They covered both metropolitan and rural areas and include public, private and not-for-profit hospitals. Each health service was networked with public and private hospitals and general practitioners.
Between 2015 and 2017, the teams were supported to develop and trial strategies in clinical practice and health service to enhance PBM and the effective use of the NBA’s Patient Blood Management Guidelines. Teams implemented changes in small manageable stages, through a series of Learning Cycles. Through implementation teams completed:
Practice changes were measured to assess their impact and success. By identifying practice changes that increase the number of pre-operative patients with optimised haemoglobin and iron stores, the Collaborative helped reduce the following:
Practice changes were identified, as well as improving surgical outcomes which were shared with health services nationally.
The Collaborative built on the work underway by the NBA and the states and territories, to promote appropriate care in relation to the use of blood and blood products across Australia.
The Collaborative was undertaken in consultation with the NBA, jurisdictions, and public and private health services and was funded by the Australian Government Department of Health.
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1. Patient Blood Management Guidelines
2. Thomson A, Farmer S, Hofmann A, Isbister J & Shander A. Patient Blood Management – a new paradigm for transfusion medicine? Vox Sanguinis. 2009; 4(2): 423-435.