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Hospital Newsletter

In this issue

National Blood Shortages Plan – A summary

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First released in 2009, and routinely revised, the National Plan for the Management of Shortages of Labile Blood Components is a framework developed by the National Advisory Committee on Blood and Blood Products (NAC) in collaboration with Canadian Blood Services and the Provinces and Territories. As a reference for provincial and territorial blood shortages plans, it promotes consistency, collaboration and recommendations to ensure an effective response to and management of a blood shortage.

The National Blood Shortages Plan outlines four inventory availability phases: Green, Amber, Red, and Recovery. It also outlines the respective actions, roles, and responsibilities of all blood system stakeholders.  

GREEN PHASE implies that normal blood component inventory levels exist and supply generally meets demand. This phase includes a broad range of inventory levels ranging from an ideal inventory to shortages that occur periodically and can be managed with existing CBS and hospital/RHA actions.

  • GREEN PHASE ADVISORY implies that CBS inventory levels are low with respect to a particular blood component and that all hospitals need to determine their inventories and the likelihood of crossing into Amber or Red Phase.

AMBER PHASE implies that the national blood inventory is insufficient to continue with routine transfusion practices and hospitals/RHA will be required to implement specific measures, as outlined in this document, in order to reduce blood usage.

RED PHASE implies that blood inventory levels are insufficient to ensure that patients with non-elective indications for transfusion will receive the required transfusion(s).

RECOVERY PHASE implies that blood component inventories have begun to increase and are expected to be maintained at a level.

The NAC oversees the plan with the NAC Blood Shortage Working Group considering enhancements to the document and managing revisions that are often initiated based on stakeholder feedback. This continuous improvement process is vital to ensure the National Blood Shortages Plan remains an effective framework and a centerpiece of great collaboration within the blood system in Canada.

Canadian Blood Services is proud to be a partner and supporter of the plan. All hospital stakeholders are encouraged to familiarize themselves with the National Blood Shortages Plan, corresponding provincial blood shortages plans, and local blood shortage contingency guidance documents.

Cytomegalovirus – It’s a Complicated Topic

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Cytomegalovirus, or CMV, is a virus that does not cause any notable symptoms for the majority of general population, or for most patients.  About 40 to -50 per cent of adults have been exposed to CMV without any clinical impact.  After an exposure, CMV is reported to remain in our white blood cells, and can cause infection if the immune system becomes compromised.  CMV can be transmitted by various body fluids, sexual activity, transfusion and transplantation, or from mother to child.

Of particular concern, CMV can cause life-threatening pneumonia in at-risk patients.

The risk of transfusion-transmitted CMV can be reduced by using special filters to remove the majority of white blood cells from cellular blood components. The process is called leukoreduction.  Blood components that have been leukoreduced are also referred to as “CMV safe”.  Canadian Blood Services implemented universal pre-storage leukoreduction by filtration in June 1999.  They also offer “CMV seronegative” blood components made from donors who have tested negative for the CMV antibody to further reduce the risk of CMV transmission by transfusion. There is conflicting literature regarding the benefits of providing leukoreduced blood components as well as CMV seronegative blood components to prevent infection in at-risk patients.  For more background, see The Use of CMV Products by Dr. Christine Cserti-Gazdewich.

In an effort to provide clarity for the transfusion community on this topic, the National Advisory Committee on Blood and Blood Products posted a statement on their website (dated August 2014) regarding the appropriateness of use of CMV seronegative versus CMV safe products.

"The National Advisory Committee recommends that CMV safe and CMV IgG seronegative products be considered equivalent for the majority of patient populations including adult and pediatric Hematopoietic stem cell recipients, CMV seronegative patients who may require future transplant and immunodeficient patients. Due to significant controversy and lack of evidence on the need for the provision of CMV seronegative products in addition to leukodepletion in the following  patient groups — intrauterine transfusion, neonates under 28 days of age and in elective transfusion of CMV seronegative pregnant women, NAC recommends to follow local policies."

To promote optimal utilization of CMV seronegative platelets, Canadian Blood Services issued a BloodBrief on CMV platelets in March 2015 The data in the BloodBrief highlight the varying demand for CMV seronegative blood components by hospitals in Canada. 

Recently, some hospitals have opted to implement policies that do not require CMV seronegative blood components for any of their patients. A list of these hospitals can be found here.

In the absence of definitive data on this topic, hospitals will continue to follow local policies that they feel are most appropriate for their patient population.

Understanding Hospital Inventory

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In 2013, the National Advisory Committee on Blood and Blood Products made recommendations for monitoring red blood cell inventory in hospitals using an “inventory index” with suggested minimum necessary data elements during an inventory shortage.

These data elements include calculating an average daily red cell demand (ADRD) using red blood cell disposition data (transfused+outdated+wasted) dividing by a specific time period (90 or 365 days) and further using the ADRD to determine an inventory index from actual inventory levels (inventory index = actual inventory/ADRD).

Although recommended for use during an inventory shortage situation, the Utilization Team at Canadian Blood Services recognized the value in developing a tool using these data elements to better engage with hospitals and understand hospital inventory levels during times of optimal inventory.

Work is underway to have regularly updated hospital-specific inventory trend reports available to all hospitals served by Canadian Blood Services. The reports will facilitate conversations with hospitals regarding red blood cell inventory requirements to better understand what a specific red blood cell inventory level means in consideration of actual red blood cell usage over time. These inventory trend reports are foundational to further evolve collaborative inventory initiatives between Canadian Blood Services and hospitals.

Your hospital liaison specialist will let your hospital transfusion service know when the hospital-specific inventory trend reports will be available to all hospitals.

SickKids boosts new donors and donations in Toronto’s spring mini-challenge

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SickKids Hospital more than doubled year-over-year donations during this year’s Spring Toronto Hospital Challenge—and nearly tripled the second-best competitor’s new-donor tally—thanks to an internal campaign that revved employee enthusiasm for the cause.

The hospital was one of the smallest of six to participate in this year’s Toronto challenge, though size proved to be irrelevant. It generated 51 units of blood and 11 new donors.

“SickKids is a classic example of how champions can make a huge difference,” says Hailu Mulatu, Territory Manager, Donor Relations, South Central Ontario (SCO). He created the mini-challenge two years ago to address a glaring dip in donations during April, just after college and university students have left the city for summer vacation but before the start of the larger south central-wide Hospital Challenge.

“I do the exact same thing with all hospitals, but clearly SickKids has done much more with it,” he says. “Their public affairs and communications teams championed the cause, engaged employees and succeeded in ways that other, hospitals haven’t yet. That’s all them, not me.”

Strength in numbers

Though the month-long challenge was aimed to boost donations and new donors, Mulatu also saw it as an opportunity to promote Partners for Life, given that five of the six competing hospitals are members.

“Thousands of hospital employees, some of whom are regular donors and who donated in April, were not registered with their affiliated hospital, which is a shame because their hospital won’t get credit for it through the program,” he says. “That’s why, during the challenge, we try to make people aware of how Partners for Life works and encourage them to register online with their organization.”

Hospital Highlight: Alberta North Zone

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Canadian Blood Services recognizes that all hospital customers work very hard to optimize the utilization of blood components and plasma protein products.  In this column we take the opportunity to highlight some of that hard work and new initiatives underway at hospitals across the country. The Alberta North Zone is the focus of our Hospital Highlight for this issue of BloodNotes.

Optimizing Blood Inventory in Northern Alberta—a research project

By Astrid Maguire, Transfusion Safety Officer, Alberta North Zone

Medical Laboratory Science students are required to do a research project in their fourth year. This year, the project chosen by Chantal Laliberté, a student at the University of Alberta was titled Optimizing Blood Inventory in Northern Alberta. Chantal collected and analyseddata from Meditech and from Canadian Blood Services. She used this data to create site specific tools to help determine the level of red cell inventory that should be stocked by the hospital. The level is determined based on hospital usage, trauma support needs, services provided at the site, and transport routes available including distances for STARS to travel.

With this information, Alberta North Zone was able to align hospital sites with more appropriate red cell stock levels. The data is also helpful when discussing inventory levels with physicians and technologists. Evaluating the optimum inventory for each site aimed to find a balance between holding adequate stock levels for patient trauma while avoiding excessive redistribution or discard rates.

 

Below is an  example of the how the inventory tool works using  data for Slave Lake:

Current Stock:

Slave Lake

O+

A+

B+

AB+

O-

A-

B-

AB-

Stock

3

0

0

0

2

0

0

0

 

 

 

 

 

Suggested Inventory:

 

Rh Positive

Rh Negative

 

O

A

B

AB

O

A

B

AB

Slave Lake

3

0

0

   0

3

0

0

0

 

 

Suggested Min/Max Inventory levels:

Slave Lake

O

A

B

AB

O

A

B

AB

Minimum Inventory held

2

0

0

0

2

0

0

0

Maximum Inventory held

4

1

0

0

4

0

0

0

 

Explanation:

Slave Lake will order when inventory falls to 2 group O Pos or Neg

Slave Lake will order up to a maximum of 4 group O’s and 1 group A

 

Group O was increased from the suggested after considering the following:

  • Hospital should have enough to address a trauma (4-6 units) in emergency
  • Obstetrical services offered at hospital
  • 9-hour wait for STAT blood order requests, and STAT requests are regular (up to once a week)

In addition to optimal inventory levels, Chantal produced data showing the impact of starting redistribution of blood components at just one of the North Zone sites.

Chantal’s project was presented as a poster at the Canadian Society for Transfusion Medicine Conference in May 2016.  

We commend Chantal for her work. It resulted in an effective tool that will be applicable for blood inventory management in other Alberta North Zone sites.

Is your hospital working on utilization optimization or inventory management initiatives? We want to hear from you! To share your success story in a future BloodNotes issue, please contact your local Hospital Liaison Specialist. 

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View Past Issues:

March 2016
September 2016

Upcoming Events:

14th Annual Canadian Blood Services International Symposium

News:

Research Funding Opportunities

Clinical Guide to Transfusion: New Chapter 5 – Coagulation Factor Concentrates

Video:

Changes in clinics:

A quick overview of the new process that will be starting in clinics on July 4.