The Mission of the Provincial Blood Coordinating Program is to support through leadership and collaboration, the delivery of a safe and cost effective Transfusion Medicine Program for patients within the provincial health care system.
The Vision of the Program is:
- to establish and maintain a program to optimize the utilization of blood products and their alternatives;
- to establish and maintain a surveillance program for adverse reactions and major errors related to transfusion medicine; and
- a quality systems approach is utilized to ensure Standards for Blood and Blood Components are implemented and maintained throughout the province as it relates to blood transfusion therapy.
The Provincial Blood Coordinating Program focuses on three key areas:
Utilization Management
Blood components and blood products are in increasing demand on an annual basis. This valuable resource must be managed in a safe and efficient manner so that when the need arises, the right blood components and blood products are available for the right patient at the right time. There are numerous indications for blood components and blood products and as a result it is necessary to evaluate and monitor utilization to ensure usage is evidence based. Collaboration with the Regional Health Authorities (RHAs) and the Provincial Blood Coordinating Program permits data collection, evaluation of utilization practices and the development of guidelines that promote evidence based utilization.
A Blood Reference Advisory Group (BRAG) has been established to review and assess the impacts of various initiatives that impact the RHAs. The membership of the Blood Reference Advisory Group includes representation from Physicians, Nurses, Transfusion Medicine Laboratory, Risk Management, Canadian Blood Services, Department of Health and Community Services and the Provincial Blood Coordinating Program.
In February 2006, the Intravenous Immunoglobulin (IVIG) Data Collection Program was launched to capture data related to the utilization of IVIG throughout the hospitals in NL. Newfoundland has the third highest usage of IVIG in Canada. The cost of IVIG for this province is approaching $6 million and represents an increase of seven percent year over year since 2003/04.
Another aspect of utilization that is monitored is the inter-hospital transfer of blood components, specifically red blood cells. A validated process for transportation has significantly reduced the amount of blood red blood cells that out date annually. The development of an inter-hospital transfer program has facilitated better inventory management and utilization of blood components.
Blood components and blood products are provided to hospitals within Canada (except Quebec) from Canadian Blood Services. Hospitals in the province of Quebec are served by Héma-Québec.
Surveillance
As with all medical interventions, there is a risk of an adverse transfusion events occurring. Monitoring, reporting and data collection are tools used to facilitate surveillance of such events throughout the health care system within the province. In collaboration with the Public Health Agency of Canada, data can be used to determine the frequency of moderate and severe adverse events related to blood transfusion. This information may be used to develop interventions to minimize transfusion reactions. Surveillance also provides the opportunity to recognize emerging or changing trends in adverse event occurrences.
The Krever Inquiry into the national blood system made recommendations for the development of a surveillance system for the reporting of adverse reactions associated with the transfusion of blood products within Canada. The development of the Transfusion Transmitted Injuries Surveillance System (TTISS) by Health Canada in 1999 is one of the blood safety programs used to capture the incidence of adverse events to blood and blood products.
One of the initiatives of the Provincial Blood Coordinating Program includes participation in the adverse event reporting of transfusion related events through the TTISS program. It is well noted that transfusion related injuries are under-reported.
To develop and/or enhance the reporting program within the province, assessment of transfusion practices and policies must occur at each blood transfusion service in the hospital setting. Education to Physicians, Nurses and Laboratory Technologists on the types of adverse transfusion reactions, the associated degrees of severity and the effective reporting of transfusion associated incidents must be conducted throughout the province. An Adverse Event and Transfusion Policy Working Group was established to assess practice and policy requirements and work toward the development of a provincial standard that is compliant with the CSA Standards for Blood and Blood Components. The working group includes Nurse Managers, Nurse Educators, Transfusion Laboratory Technologists and Risk Managers. A provincial blood transfusion policy has been developed by the Provincial Blood Coordinating Program to standardize practice.
The Transfusion Policy includes reporting adverse transfusion events aligning Newfoundland and Labrador with other provinces along the road to safety through compliance to the CSA Standards.
The Transfusion Transmitted Injuries Surveillance System utilizes a database that tracks and trends adverse events, indicates the categories in which reactions occur, and the types of blood components implicated in the various categories of events. The database will provide a source for benchmark data.
Quality Systems
The Canadian Standards Association has developed and published Standards for Blood and Blood Components which are endorsed by the federal government through Health Canada. The Canadian Society for Transfusion Medicine has developed Standards for Hospital Transfusion Services that extract the clauses from the CSA Standards that apply to hospital transfusion medicine services to provide hospitals with a specific resource. The Provincial Blood Coordinating Program collaborates with the Regional Health Authorities (RHAs) to achieve compliance with the standards thus further ensuring the safety of the blood system.
The CSA Standards for Blood and Blood Components Standards was created to maintain and enhance the quality and safety of blood collection, processing and transfusion. Compliance is achieved through the implementation and maintenance of a quality system. This approach to Quality Management is both new and overwhelming for most blood transfusion services resulting in significant impacts.
The Provincial Blood Coordinating Program will assist RHAs in developing their quality systems thus becoming compliant with the CSA Standards.
The Provincial Blood Coordinating Program has developed a Quality Manual for Transfusion Medicine Laboratories and a Transfusion Medicine Best Practices within the province.
The Canadian Society for Transfusion Medicine (CSTM) has released standards for Hospital transfusion services which highlight the sections of the CSA Standards applicable specifically to hospitals transfusion services.