April 2017 Newsletter

Transfusion Quality Improvement:
One Hospital’s Story 

By: Krista Walters, Charge Technologist, Mary Green, Laboratory Manager Niagara Health System (NHS) and Denise Evanovitch, ORBCoN Regional Manager, SW Ontario  

Niagara Health System (NHS) consists of five community hospitals: Douglas Memorial in Fort Erie, Greater Niagara General in Niagara Falls, Port Colborne, St. Catharines and Welland. NHS also provides Transfusion services to Hotel Dieu Shaver Rehabilitation Hospital.


Like other hospital transfusion services, NHS is continually looking to improve quality and safety in many areas, including transfusion. We have looked to ORBCoN and the Ontario Transfusion Quality Improvement Plan (OTQIP) for guidance, and actually, NHS was one of the hospitals that piloted the e-tool designed to collect and analyze the relevant quality improvement data.


Our successes to date include:

  1. An audit of all blood components to establish a baseline of appropriateness.
  2. Utilization guidelines for blood components and accompanying order set which was approved and deemed mandatory for use on February 9, 2017 by the Order Set Committee. This committee acts on behalf of the MAC on specific issues. The Chair of Order Set Committee, a physician, supports the use of order sets and regular auditing to gauge compliance. Follow up and discussions will occur with physicians and departments when components orders fall outside of the hospital’s guidelines.
  3. The % single unit RBC transfusions (ordered and transfused) rate is now a Corporate Quality and LHIN wide Indicator. We found this raised profile of TM issues within the corporation and we are hopeful that it will assist with physician buy in.

For the future, we will be:

  1. Auditing compliance post implementation of order set
  2. Implementing reflex laboratory tests once components are ordered for post transfusion testing. E.g. CBC post RBC and platelet transfusion, fibrinogen level after cryoprecipitate, etc.
  3. Auditing compliance after implementation of reflex orders.
  4. Ongoing audits to monitor progress.

Like all hospitals, we are not without challenges. MLTs who are core trained rotate through all departments and may only be scheduled in TM a few days a month. We ensure quality by constantly monitoring our key indicators, ensure our yearly competencies are completed and up to date and have excellent communication to keep staff informed.


Although staff may not feel comfortable screening transfusion orders and providing feedback to physicians, we encourage them to discuss unusual orders with the physician. Although we do not have a transfusion safety officer we connect with other hospitals within our network and work closely within our team to bring quality improvement initiatives forward and strive to encourage appropriate blood orders. We will be reporting our successes and opportunities for improvement to ORBCoN via their e-tool found on their website. We encourage all Ontario hospitals to do the same.

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The Ontario Regional Blood Coordinating Network (ORBCoN): Looking Back on 10 years of Collaboration and Networking

Just like in the word team, there is also no “I” in ORBCoN—although we do know individuals who pronounce it as such! In other words, the quality and volume of work that ORBCoN produces could not be accomplished without the collaboration and dedicated volunteerism of the entire “network” of transfusion stakeholders (regionally, provincially and nationally). This includes the continued support of the Ministry of Health and Long-Term Care.


In 2006, the three ORBCoN offices were born:

  • The Northern and Eastern Office housed at The Ottawa Hospital
  • The Central Office located at Sunnybrook Health Sciences Centre
  • The Southwest Office situated at McMaster University

ORBCoN’s mission, vision and values were established in a strategic planning session in 2007. Our five goals evolved from this strategy: 
Figure 1 ORBCoN Goals


For utilization improvement, ORBCoN has continually supported the proof of concept for a provincial data strategy, conducted and produced many audits and audit tools for utilization of FP, IVIG, RBC and platelets and of bedside administration of blood and specimen collection. Recommendations and guidelines for utilization and administration of these blood components/products encourage standardized progress towards best practice for appropriate and safe transfusion.


The educational tools and toolkits ORBCoN has produced over the past decade are numerous and support a wide variety of health professionals, patients and their families. We are particularly well known for our Bloody Easy series and the numerous provincial educational events we plan and host.


Following the use of inventory calculators and benchmarking and the implementation of a provincial redistribution network, hospital RBC outdate rates in Ontario have been greatly improved over the past 10 years (see figure 2).


Figure 2 RBC Outdate Rates in Ontario Hospitals


The Ontario Contingency Plan for Blood Shortages first released in 2008, helped to ensure that Ontario hospitals developed a standardized approach to blood shortage management that aligns with the National Emergency Blood Management Plan. Testing the Ontario plan through blood shortage simulation exercises helps to continually update and improve hospital plans on a provincial level.


For communication, ORBCoN is fortunate to have the ability to meet with our hospitals in partnership with colleagues at Canadian Blood Services (CBS) on an annual basis at our joint CBS-ORBCoN site visits. Over the past 10 years, we have built relationships with our hospital partners and developed a network that crosses regional boundaries and helps to continually improve the quality of our transfusion medicine community. Our website is a helpful communication resource that is used widely and frequently along with our regular newsletter, The ORBCoN Report. We also regularly meet with hospital peer/networking groups, our Regional Advisory, Steering and Ontario Blood Advisory Committees to stay tuned in to the current issues and challenges we face in transfusion medicine in Ontario.


Although quality is our foundational cornerstone, we also have initiatives contained within this goal such as our Ontario Transfusion Quality Improvement Plan and specific educators for our hospitals’ nurses and physicians.


In addition to partnering with CBS and hospitals, ORBCoN also forges relationships with our sister blood programs like the Ontario Transfusion Transmitted Injuries Surveillance System (ON-TTISS), Factor Concentrate Redistribution Program (FCRP) and Ontario Transfusion Coordinators (ONTraC) making us truly a provincial transfusion network.


Over the past decade, ORBCoN has evolved into a robust network that provides support through communication, education and networking to hospital transfusion services in the province of Ontario. We act to connect the Ministry of Health and Long-Term Care with the transfusion medicine community by identifying issues, advocating for hospital transfusion laboratories and by developing supporting resources to ensure Ontario transfusion services are complying with current standards, encouraging best practices and minimizing waste to ultimately ensure the best possible care for all patients in the province with respect to blood transfusion.

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