Public health

Blood management standards save $350m

The introduction of national standards has substantially driven down use of blood products and saved the health system over $350 million in the first three years of implementation, a review shows.

The Australian Commission on Quality ACSQHC) says its NSQHS Standard 7 – which became mandatory for hospitals and day procedure services in 2013 – has been a huge success story.

And it now hopes to build on this progress with updated standards that will come into effect in 2019.

The current edition has helped achieve an 18% reduction in demand for red blood cell products between 2012/13 to 2014/15 and led to improved patient outcomes by focusing on optimising and conserving a patient’s own blood. Yearly red blood cell issues noted by the National Blood Authority fell from mid-2010 to mid-2015, from approximately 800 000 units to 667 000 units, the ACSQHC said in its regulation impact statement.

“The NBA noted they had delivered a saving of $355.8 million for governments in the three-year period from 2012 to 2015. They noted the introduction of the NSQHS Standard 7 contributed to this achievement,” it said.

“As a consequence of better management, patients usually require fewer transfusions of donated blood components, thus avoiding transfusion-associated complications,” it added.

The NSQHS standard’s second edition – due to become part of accreditation requirements in 2019 – aims to build on this progress, streamlining processes and addressing gaps.

Dr Marija Borosak, head of laboratory haematology at Eastern Health in Melbourne, said the standard’s focus on blood conservation had led to a “shift in thinking” across its network of three hospitals, which had informed changes to clinical practice.

“We’re more careful to give blood only when reasonably needed and the amount that’s given,” Dr Borosak told the limbic.

“For example (doctors) are now less likely to default to transfusion that they used to in the past and will consider giving one unit of blood rather than two. There has been a shift in thinking.”

The standards have also put the spotlight on waste reduction, leading to new conservation strategies.

These include moving blood that is close to expiry to a bigger network hospital, and more targeted blood collection to reduce the likelihood of donations not being used.

The standard has led to better patient outcomes and substantial savings, she said.

According to the NSQHS, the revised Blood Management Standards have been updated to focus on the patient receiving blood and blood products, rather than only on the blood and blood products

It says the new standards will “focus on effectively optimising and conserving a patient’s own blood, reducing the unnecessary risk of exposure to blood products and associated adverse events”.

Recommendations in the new standards state include:

  • Clinicians will be required to use the blood and blood products processes to minimise inappropriate use of blood and blood products by optimising patients’ own red cell mass, haemoglobin and iron stores, identifying and managing risk of bleeding and determine the clinical need for blood and blood products and related risks
  • Health services will be required to put in place processes to trace blood and blood products from entry into the organisation to transfusion, discard or transfer
  • Health services will be required to manage the availability of blood and blood products to meet clinical need, eliminate avoidable wastage and respond in times of shortage.

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