January 2018

Physician Engagement: Discovering a Common Purpose

By: Stephanie Cope, Administrative Project Coordinator, ORBCoN CE Region

All healthcare professionals, regardless of their role or expertise have the same purpose, ensuring the best possible care for ‘their’ patients. In order to ensure the best possible care is provided, healthcare organizations and physician groups must be able to identify, implement and monitor the available evidence in medicine to ensure best practice(s) are being utilized. One of ORBCoN‘s mandates is to collaborate with transfusion medicine experts and end-users to provide high quality, relevant, evidence-based transfusion medicine educational resources. Achieving buy-in or acceptance for practice changes from the intended end-user groups requires a champion that is well respected, has adopted the new behavior/change and one who has the ability to model and lead their colleagues into current evidence based practices to provide the highest quality of care.

  

ORBCoN regularly evaluates the utilization and accessibility of its educational resources, ensuring they are meeting the educational needs of end-user groups. In 2015-16, it was determined that although the Bloody Easy (10 module) eLearning program was very comprehensive, it took a considerable amount of time to complete, resulting in underutilization by its intended users. Subsequently, this eLearning program was discontinued in order to focus our attention on creating new educational resources that would better meet the end-users’ needs.

  

A first step in increasing physician engagement with transfusion medicine educational resources was to conduct a qualitative analysis. This qualitative analysis would display a better understanding of the effectiveness and relevance of the current formats used to provide transfusion medicine continuing education to ordering physicians/TM Medical Directors. A transfusion medicine educational needs assessment survey was created (LimeSurveyTM) and distributed to all Ontario hospitals through the Laboratory Medical Director and Transfusion Committee Chairperson.

  

Thirty six responses were received. While the number of responses was lower than desired, 22 (61%) of the respondents were from the intended target audience (end-user) and represented all sizes of hospitals.

  

Table 1. What is your motivation when choosing a CME course?

Table 2. How do you prefer to access educational resources?


Table 3. Which of the following are you familiar with? 

As the world of transfusion medicine advances, the importance of providing relevant, current and evidence-based educational resources becomes paramount. Ensuring the potential content is evaluated by the end-user is critical in meeting educational requirements and standardizing transfusion medicine best practices. According to utilization statistics, the Bloody Easy resources are widely used throughout Ontario, Canada and beyond but a gap in user groups is recognized. In future, ORBCoN will strive to promote resources to healthcare practitioners outside of transfusion medicine to extend our education to ordering physicians (of other specialties) to encourage best practice and increase patient safety. A small number of hospitals have made Bloody Easy Lite completion a mandatory requirement for certain healthcare professionals, providing evidence that supports updating the content and the content delivery format. A top priority of ORBCoN is to ensure educational resources are relevant, user friendly and meet the needs of our intended end-users and help hospitals meet the ever increasingly stringent accreditation requirements.

  

ORBCoN would like to thank the following individuals/organizations for providing their support in ORBCoN’s evaluation initiatives over 2015-17: Canadian Blood Services, Choosing Wisely Canada; and Drs: Allison Collins, Elaine Leung, Lani Liebermann, Yulia Lin, Lois Shepherd and Michelle Zeller.

 

  

Bloody Easy on the Road

By: Allison Collins, MD, FRCPC, Clinical Project Coordinator, Transfusion Medicine Physician, ORBCoN

This is an article that does not ask you to do anything, or to learn a new concept, or to embark upon another project, so you can simply relax (or skip it). I am just going to review briefly my experience “on the road”, promoting evidence-based transfusion practices to community hospital physicians over the past four years. It’s been a really fun journey, and I can safely say that this is the best job that I have ever had!

  

The position of ORBCoN Physician Clinical Projects Coordinator was created in November 2013. By then ORBCoN had already made great strides working with hospital blood banks improving inventory management, re-distributing blood products, and auditing transfusion ordering practices, among many other things. Now it was time to give some more educational support to the prescribers of blood, with some friendly reminders about how to order safe and effective transfusions (and obtain informed consent for them). Not being a transfusion medicine specialist, but a general pathologist, I first had to scramble to ensure that my grasp of the subject was even just slightly firmer than that of the people in my audiences, many of whom ask very probing questions. Naturally, the real experts in this field are far too busy to travel any more than they already do, so my position fills in a few of the gaps. Which reminds me to give a big ‘thank you’ to all of the transfusion medicine specialists in Ontario and beyond who have been so generous with their advice and help over the years, and whose slides I so shamelessly borrow and adapt – you know who you are.

  

I have travelled all over the province, sometimes via the Ontario Telemedicine Network, but usually in person. The rough count of presentations so far is about eighty, concentrated mainly in the spring and fall to avoid freezing rain, blizzards, and slippery airport runways. My audiences range from four people to well over a hundred, and include nurses, laboratory technologists, midwives, pharmacists, other hospital staff and, of course, physicians. I suppose I ought to include the audiovisual tech guy at one meeting, who knew nothing about blood but who thought the talk was amusing (potential blood donor?). The knowledge and dedication of the laboratory technologists whom I meet never ceases to amaze me. Perhaps my real role is simply to reinforce the messages that they are already trying to get across in their hospitals, reinforcing the old adage that “no prophet is accepted in his own country”. Although not technically in the job description, I have rearranged meeting room chairs, signed for the delivery of the catering, and served as a source of advice for patients trying to navigate the parking pay machines and exit gates at various hospitals, the latter admittedly with the selfish goal of getting out of the parking lot myself.

  

ORBCoN audits have shown that we need to focus on the indications for and dosing of blood components such as red cells and plasma, which I do. However, I try to tailor the topics to the things the doctors want to hear about (if somebody tells me in advance) or to the things the blood bank staff wants the doctors to know more about (they are pretty good at telling me this in advance). So, we get into platelets, PCCs, warfarin reversal (yes, some people are still using plasma), direct-acting oral anticoagulants, albumin, cryoprecipitate, RHIG, informed consent, transfusion reactions, and on it goes. I have been to a few hospitals multiple times, and asked one anesthesiologist “What on earth is there left for us to discuss next year?”, to which he replied “Just go back to your first talk, we have probably forgotten it by now”. Very reassuring.

  

Finally, a little plug. If you would like to arrange for a presentation to your medical staff you can find me at allison.collins@sw.ca. Our resources at ORBCoN are not unlimited but I will do what I can; the more notice the better.

 

  

  

When should a post-transfusion hemoglobin sample be drawn?

  

The sample can be drawn anytime between 15 minutes and 24 hours post-transfusion1. There are no significant differences in hemoglobin levels over this time frame. Therefore, if a hemoglobin level is part of your patient assessment to determine if another unit of RBCs is required, there is no reason to delay the sample draw past 15 minutes, as excellent hemoglobin correlation exists at the post-transfusion sample draws of 15, 30, 60, and 120 minutes, as well as 24 hours2.

  

References:

  • Wiesen AR, Hospenthal DR, Byrd JC, et al. Equilibration of hemoglobin concentration after transfusion in medical inpatients not actively bleeding. Ann Intern Med 1994;121:278-80.
  • Elizalde JI, Clemente J, Marin JL, et al. Early changes in hemoglobin and hematocrit levels after packed red cell transfusion in patients with acute anemia. Transfusion 1997;37:573-76.