Transcript What would you do in a disaster? Helping hospitals in

What Do You Need to Know
About Management of
Blood Shortages
Helping Hospitals Prepare…
Version 2: Oct 30, 2012
Outline
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Background
Standards
Ontario Emergency Blood Committee
Phases of a Blood Shortage
Key elements of an Emergency Blood
Management Plan
 Conclusion
 References
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Background
 Demand for blood continues to grow while
donors are aging – raising concerns around
sustainability of supply
 Other causes of a supply shortage include a
new transmissible disease, manufacturer
supply challenges, pandemic disease affecting
balance of supply and demand
 The goal is to ensure secure access to safe
blood components or products for patients who
are most in need of them
 Standards requirement to have a plan
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CSA Z902-10 National Standards on
Blood & Blood Components
 4.2.1.6 Each transfusion service shall have
an emergency plan that provides specific
procedures to be followed in response to
incidents that could endanger the safety,
quality, or efficacy of blood or blood
components, or the safety of recipients and
facility personnel. The emergency plan shall
be consistent with the emergency plan and
emergency systems of the health care facility
in which it operates.
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Ontario Laboratory Accreditation
(OLA) Requirements: v 4.1 July 2008
 I.C.5 Laboratory management shall be
responsible for strategic and emergency
planning, setting goals and if appropriate,
directing research and development.
 Guidance: TM180 The emergency plan shall
address the safety, quality, efficacy and level of
supply of blood components / products during
an emergency or disaster.
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Ontario Emergency Blood
Management Committee (OEBMC)
 Represents stakeholders in blood system and
manages communication during a blood
shortage, develops / maintains provincial
EBMP
 Hospitals, OHA, OBAC, Patients, CBS,
ORBCoN and MOHLTC represented
 Version 2 of Ontario Plan and Toolkit
released Fall 2012
 Working and sharing with other provincial
blood offices to ensure smooth interface with
CBS
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Phases of a Blood Shortage Plan
Phase
Inventory Level
Hospital Action
Green
Normal
• Practice good blood management,
• Establish Emergency Blood Management Committee (HEBMC),
develop and test emergency blood management plan
Amber
Reduction of
inventory by up to
50%
• Reduce stock inventory by 25-50%
• Initiate internal communication
• Emergency blood management committee (EBMC) meets
• Triage blood requests
• Review elective OR cases, consider deferral (document)
Red
Shortage is severe
and anticipated to
be prolonged
• Reduce inventory to critical levels (25% of optimal)
• Initiate heightened internal communication
• EBMC meets and initiates and monitors plan for reduction of blood
use (blood issued only for life threatening need)
• Decisions are documented
Recovery
CBS inventory
improves
• Ensure return to normal operations occurs at a gradual and controlled
pace
7 revise plan as needed
• Review event and
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Green Phase – Develop Your Plan
A. Good Blood Management
I. Inventory levels defined
II. Protocol to review blood usage and ordering practices to optimize
utilization
III. Minimize blood component / product wastage
B. Develop an Emergency Blood Management Committee
I. Include staff who order, issue and administer blood as well as
senior administration
II. Goal is to ensure all relevant hospital personnel will respond in a
coordinated manner
III. Strategies for reduction in the use of blood components and / or
products must be defined
C. Develop an Emergency Blood Management Plan
I. Identify Triage team / officer
II. Train staff on plan
III. Test plan through mock exercise and revise if required
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Key Elements of a Hospital
Emergency Blood Management Plan
(HEBMP)
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Identify key individuals to notify if a severe blood
shortage occurs (include Technical, Medical, Nursing
and Administrative staff)
Develop a communication strategy around notification
Develop a guide to stepwise reduction of blood use
increasing the restriction down to extreme critical levels
and provide tools to document decisions
Contact and work with nearby hospitals to implement
processes to allow for transfer of blood products
between sites
Include plan for recovery in a managed and controlled
manner to ensure inventory levels can improve and
stabilize before usage returns to normal activity
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Key Individuals
 Emergency Blood Management Committee
(EBMC):
 Transfusion Service Director and Manager, Anesthetist,
Surgeon, Hematologist/Oncologist, Chair of the
Hospital Transfusion Committee (HTC), Transfusion
Nurse Specialist, Transfusion Safety Officer, ER
physician, Risk Manager
 Notify:
 CEO, Medical and Chief of Staff, Division Chiefs for
Surgery, Anesthesia, Trauma/Emergency, Hematology
and Medicine, Directors of Laboratory, Diagnostic
Services, Nursing, Head of facility disaster planning
 HTC members, EBMC members
 Risk Management, Patient relations, Public relations
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Communication Plan
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Prepared memos that can be used (templates) and
customized as required by the situation
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A list of who to contact and at what phase of the plan to
contact them should be prepared and approved by the
EBMC
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Release of communications should be the responsibility
of the Transfusion Service Director or Chair of HEBMC
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Communication should clearly state how decision
making around blood issuing will be managed,
dependant on the severity of the inventory restriction
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Ensure close communication is maintained with the
blood supplier – Canadian Blood Services
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Guide for Restriction of Blood Use
 This guide should be developed and adopted by
the EBMC, examples include:
 Reduce inventory held on site by 50% or more
 Close review (triage) of blood order requests and
follow strict protocol for acceptable ordering
 Reduce dose per treatment where feasible
 Review elective surgical list for possible deferral of
cases that have a high probability of blood use
 Restrict blood use to life threatening situations only
 Follow guidance provided from OEBMC / MOHLTC
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Transfer of Blood Between Sites
 Develop relationships with other nearby
facilities
 Develop plan for transferring products
between sites to optimize available blood
inventory during a severe shortage to ensure
patients in the most need will be supported
 Redistribution plans may already be in place
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Recovery
 Critical piece of plan
 Notification of recovery should be issued to those
that originally received notification of the shortage
 Requests for blood components/products should
continue to be restricted for a period of time
 Blood usage should resume very gradually and in
a controlled manner
 Refer to guide for the restriction of use and slowly
return in a step wise manner to normal utilization
activity
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Conclusion
 A blood shortage can occur when it is least
expected
 Rare occurrence means staff feel unprepared
to respond if there is no plan in place and no
training has been done
 A communication plan will ensure that the
appropriate people receive information to
improve decision making
 Planning and practice improve confidence
and the ability to react consistently, rationally
and efficiently
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References
1. Ontario contingency plan for management of blood product
shortages and Toolkit, Ontario BPCO contingency planning
working group. V2 June 30, 2012.
2. National plan for the management of shortages in labile blood
components. National Advisory Committee on Blood and Blood
Products & Canadian Blood Services; January 18, 2012.
3. CSA National Standards for Blood and blood components CSA
Z902-10.
4. Ontario Laboratory Accreditation (OLA) Requirements version 4
.1released July 2008.
5. Development of an integrated blood shortage plan for the National
Blood Service and hospitals. NHS and NBS Chief Medical Officer’s
National Blood Transfusion Committee Dec 2004.
6. An integrated plan for the National blood service and hospitals to
address Platelet shortages. NHS and NBS Chief Medical Officer’s
National Blood Transfusion Committee. Gateway ref 6514 06 Sept
2006.
7. How do I manage a blood shortage in a transfusion service?
Transfusion 2007;47:760-762
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