May 2017 Newsletter

Educational Videoconference Symposium: Another Great Success 

By: Tracy Cameron, ORBCoN Project Coordinator, NE Ontario  
Since 2007, a partnership has existed between Canadian Blood Services (CBS) and the Ontario Regional Blood Coordinating Network (ORBCoN) to plan, co-chair, provide funding for, and execute annual transfusion medicine conferences. Each year a videoconference event is coordinated by ORBCoN and CBS, and is hosted at a community hospital. Hosting at a community hospital serves two purposes – the first is to provide the speakers with an on-site audience which helps in the delivery of the presentations; the second is to meet the objective of the event, which is to provide basic transfusion medicine education for non-transfusion specialists in community hospitals. The host site is also involved with the planning and often provides a local speaker whenever possible. This year we had two co-hosting sites, Health Sciences North and University Health Network – Toronto General. Topics are usually picked based on feedback from our community hospital partners on issues they often encounter and look for help with from larger centres, as well as suggested topics from previous year’s attendees.

This year’s conference focused on managing patients with GI bleeding and liver disease, with the objective of identifying key factors that determine the need for transfusion in community hospital emergency rooms when dealing with a GI bleed. There were four dynamic speakers that highlighted some tools to help assess the severity of the GI bleed, provided best practices for treating bleeding in patients with advanced liver disease, compared the available options for anticoagulant reversal in the GI bleed setting, and discussed strategies for improving red blood cell utilization.
 

How do we measure the success of this event?
One hundred and seven healthcare facilities joined the conference either by videoconferencing or webcasting through the Ontario Telemedicine Network. Twenty-three of those 107 sites were from out of province making this event a national one. There were also 9 Canadian Blood Services sites that attended, along with two pharmaceutical companies and 1 post-secondary institute. We believe that our high attendance rate and seeing our event uptake expand across the country is a good indication that this event is providing the necessary information for those who attend.

Who attended?
There were 1038 in attendance between the morning session and the afternoon session. The afternoon session was a repeat of the morning session and is designed to allow for flexibility in attendance due to conflicting responsibilities during working hours.

The figure below illustrates who was in attendance for this year’s event.

How did attendees evaluate the event?
96% of the attendees said they would recommend this educational event to their colleagues, and 77% indicated that after attending this event they would somewhat modify their practice behavior. Some of the comments received from attendees have included;

 

“This is a great learning experience, with wonderful speakers. I was able to come away with a better overall picture as to the care and decisions towards a patient.” 
“Very good topics, I believed they covered everything and it was really interesting”
“I liked that you had the two sessions, very helpful for staff that were on the job”


If you missed the presentations, you can access them via archive through the ORBCoN website on our webcasting centre and they will be available for one year. The PowerPoint presentations are also available on our “What’s New” on our main page and also in our presentation library under the ORBCoN Resources page.
 
If you have any suggestions for future topics that you would like to see covered by this event please send them to info@transfusionontario.org

 

Informed Consent for Transfusion

By: Dr. Allison Collins 
Transfusion of blood components and blood products may be life-saving, but is not without risk. As with other medical treatments, informed consent is required for blood transfusion. Justice Horace Krever, in his report on the blood system in Canada, defined the requirements for informed consent as follows:

  1. that the treating physician obtain informed consent from the patient, barring incompetency or an emergency procedure,
  2. that risks, benefits, and alternatives be presented in language the patient will understand and in a manner that permits questions, repetitions, and sufficient time for assimilation,
  3. that the discussion take place well in advance of the therapy to enable the patient to employ alternatives to allogeneic blood transfusion and,
  4. that the treating physician document in the patient’s chart that the risks, benefits, and alternatives to blood transfusion have been discussed (1). According to the Canadian Standards Association, transfusion services must have policies in place to ensure that informed consent is obtained before transfusion (2).

The Canadian Society for Transfusion Medicine has published recommendations to facilitate the process of informed consent to transfusion (3). These include providing prescribing physicians with up to date information about the risks, benefits, and alternatives to transfusion, providing orientation and ongoing education for physicians and other health care providers involved in the transfusion process, and auditing compliance with the informed consent process. Compliance with the informed consent process of less than 90% should prompt action to improve it.
 
The Canadian Medical Protective Association (CMPA) states that the obligation to obtain informed consent rests with the physician who orders the treatment (4). It also recommends that, even when patients waive aside all explanations or seem to be prepared to undergo a procedure or treatment without discussion, it should be explained that the risks should still be discussed. Print material, videos, and other handouts all support the consent discussion but do not replace it (5).
 
Nurses are important members of the health care team, but are not responsible for obtaining informed consent for transfusion. They will, however, explain the transfusion process to the patient and determine if informed consent has been obtained. The College of Nurses of Ontario Practice Guideline states that a nurse should not provide a treatment if there is any doubt about whether the patient understands and is capable of consenting to the treatment, even if there is an order (6).
 
The Ontario Regional Blood Coordinating Network (ORBCoN) provides lanyard cards summarizing the elements of informed consent and the risks of transfusion. Additional information is available in the ORBCoN publication “Bloody Easy 4”. Both can be ordered from ORBCoN if the transfusion medicine laboratory does not already have them on site (7).

References

  1. Krever, H. Commission of Inquiry in the Blood System in Canada, final report, Appendix H. Government of Canada publications. 1997
  2. CSA Standard Z902-15. Blood and Blood Components, clause 11.2.1. Canadian Standards Association 2015.
  3. Informed Consent – Position Paper. Canadian Society for Blood Transfusion 2012.
  4. Evans KG. Consent: A guide for Canadian physicians, fourth edition. Canadian Medical Protective Association May 2006, updated June 2016. Available at www.cmpa-acpm.ca
  5. Canadian Medical Protective Association Risk Fact Sheet Informed Consent 2016.
  6. Consent Practice Guideline. College of Nurses of Ontario 2017.
  7. Ontario Regional Blood Coordinating Network www.transfusionontario.org