Patient blood management has been defined as any intervention that helps decrease the patient's likelihood of needing a blood transfusion during their hospital stay. Fairly liberal transfusion practice for anemic patients was the standard of care throughout the world. However, in the last decade there is evidence of many adverse outcomes associated with blood transfusion, especially when given during or immediately after a surgical intervention.
The greatest predictor of whether a patient will need a transfusion is their preoperative hemoglobin level. The Holland Centre at Sunnybrook performs over 3,000 orthopaedic surgical procedures annually. In 2011, it introduced routine CBC (complete blood count) preoperative screening of all surgical candidates to identify anemic patients, manage potential anemia and refer high risk patients to the Blood Conservation Clinic for anemia optimization before surgery.
All preoperative patients are given oral iron for one month. If patients are anemic, they are referred to the Blood Conservation Clinic (BCC) four to six weeks preoperatively for consideration of IV iron or Eprex. The project involved an interprofessional team that included Anesthesia, Hematology, Nursing, and Orthopaedic Surgeons. A preoperative blood conservation algorithm was designed and broad staff education was conducted. Patient education materials were also developed. Transfusion rates during the study period were 3.6 per cent compared to 5.1 per cent previously. The estimated cost-savings associated with fewer transfusions in this patient population was $75,000 (Health Standards Organization 2013).
With a focus on providing quality care, the Transfusional Medicine Committee at Sainte-Justine UHC put forth a recommendation to introduce transfusion practice certification for all transfusion staff. Thereby, a transfusion practice training and certification program was implemented at Sainte-Justine UHC in 2005. Sainte-Justine is the first hospital centre to have implemented a certification of such calibre. The program seeks to decrease the number of transfusion accidents and promote professional development among nursing staff. Certification applies to nurses, transfusion inhalotherapists, perfusionists and phlebotomists. Licensed Practical Nurses will be included next. With recertification taking place every two years, an internal study was conducted to evaluate the suitability of maintaining this program within the organization (Health Standards Organization 2012).