The Platelet Transfusion toolkit was developed on the basis of the findings from the 2017 Provincial Platelet audit and provides recommendations to assist in the screening of orders for, and enhance the appropriate use of, platelet transfusion.  The toolkit contains algorithms for the evaluation of platelet orders for adults, children and neonates as well as recommendations on the use of non-ABO/Rh specific platelets and management of platelet refractoriness.

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Are you a small hospital in Ontario? Dr. Jacob Pendergrast provides guidance on implementing Ontario’s Massive Hemorrhage Protocol – check out the archived presentation from the MHP Symposium here. 

The Provincial Toolkit and archived presentations are available now!

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New Provincial Redistribution Program for Plasma Protein Products Online Reporting System

Alison Wendt, MLT Regional Project Coordinator ORBCoN CE Region

The Plasma Protein Product (PPP) portion of the provincial redistribution program is a partnership between the Ontario Regional Blood Coordinating Network (ORBCoN) and the Factor Concentrate Redistribution Program (FCRP). The program requests hospitals to identify near to expiring products or products they know they will not use and facilitates their redistribution.

The current process which is time and resource intensive, relying on manual data entry processes, was evaluated to identify where it could be improved to create a more user friendly, efficient process for both ORBCoN / FCRP and the hospital users. Based on recommendations, an online reporting system was developed using Research Electronic Data Capture (REDCap) to streamline the process for both hospital users and ORBCoN /FCRP staff. A complimentary interface platform was added to allow data upload and analysis. The process flow of the online reporting is shown in Figure 1 where differences are noted from manual reporting in the first five steps.

Figure 1: PPP Online Reporting Process

REDCap will be used to distribute a bi-monthly invitation email with a unique survey link to all hospitals participating in the redistribution program. The PPP Bi-monthly survey is comprised of three sections:

1. Hospital Information;
2. PPP to Report for Redistribution; and
3. Summary.

The link is not to be shared as it is unique to each hospital and includes populated facility specific information. Hospital users will be able to report PPPs for redistribution in Section 2 of the survey with the ease of a dropdown selection “Product List” and a field for entering the number of vials to redistribute. The form is saved once completed by the user and the process repeated for each PPP to be reported, see Figure 2.

Upon completion of PPP data entry the user will have the opportunity to review all reported PPPs in Section 3 “Summary” which displays the PPP name, lot number, expiry and number of vials. Once submitted, a summary in PDF format will be sent via email for the hospital user’s record, as shown below in Figure 3.

Figure 2: Section 2 of survey for reporting PPPs to be redistributed

Figure 3: Email summary of reported PPPs to be redistributed

ORBCoN/FCRP will identify PPP eligible for redistribution in the interface and/or REDCap and contact potential hospital users, facilitate redistribution and cover courier costs where necessary. Once a product is redistributed, ORBCoN/FCRP can track and document information in the PPP redistribution module.  Each PPP redistributed record will include calculations for both product and courier cost.

The online reporting is currently in pilot stage with stakeholders testing functionality and ease of use. Feedback from pilot participants will be used to improve the online reporting process.

A Plasma Protein Product (PPP) Redistribution Hospital User Guide has been developed which includes instructions and screenshots for data entry. This will be available to all hospitals.

ORBCoN / FCRP is looking forward to the fall rollout of the online reporting system. A provincial communication will be distributed with the date; however, we are targeting to launch in September 2021. A training module will be developed, if needed, based on pilot feedback to supplement the Plasma Protein Product (PPP) Redistribution Hospital User Guide.

If you have any questions regarding the new process please contact your ORBCoN coordinator or email us at transfusionontario@gmail.com.

June 17th: CONCOR-1: Lessons learned from launching a trial during a pandemic presented by Dr. Jeannie Callum

Update on the ORBCoN Provincial Redistribution Toolkit

Tracy Cameron, MLT Regional Project Coordinator ORBCoN NE Region

In 2017 ORBCoN launched the revised Provincial Redistribution Program for Transfusion Services in Ontario Toolkit. This toolkit included templates to help in the redistribution of blood components and products as well as transferring blood with a patient. In keeping with ORBCoN’s resource review plan it was reviewed and revised in the 2020/21 fiscal year. The revisions help to ensure that lab staff follow established, validated procedures for packing components and products and to ensure the relevant standards and accreditation requirements for shipping components and products between facilities (either for redistribution or transferring with a patient) are met.

The Provincial redistribution program facilitates hospitals sending near to expiring blood components and products, that are unlikely to use before expiration to other sites where they may be utilized. This helps to reduce wastage of blood components and products and helps ensure they are available to patients that require them. Figure 1 highlights the number of products redistributed and the associated cost savings for FY 2017-19.

Figure 1: Cost Savings Estimation with Redistribution of Blood Components and Products in Ontario

Figure 2: Tools included in the Provincial Redistribution toolkit

What’s in the toolkit?

	Tools for reviewing inventory stock i.e. setting target inventory levels based upon actual historical utilization
	Information for inclusion of established couriers between hospitals to facilitate redistribution and the process verification of redistributing with these couriers
	Tools to help ensure responsibilities are outlined and standard operating procedures are followed
	Update procedures for redistributing, sending components with patients and reporting for redistribution
	Tools to help staff become more confident in shipping components and products
	Information on how we provide annual data on the performance of the shipping containers used for shipping blood between facilities

Figure 2 lists just a few of the tools that are available in the updated toolkit.

We encourage all staff working in Transfusion Medicine and involved in the packing and shipping of blood components and products between facilities (including with a patient) to review the tools in this toolkit and adjust their processes and procedures as applicable. The full toolkit can be found on our website under Inventory Management.

If you have any questions or concerns regarding redistribution or shipping blood with a patient, please email us at  transfusionontario@gmail.com.

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Massive Hemorrhage Protocol: Quality Metrics Reporting

Troy Thompson,
Regional Manager, ORBCoN CE Region

The use of quality metrics in healthcare is not a new concept. The reporting and analysis of quality metrics promotes improvement and increases transparency within the healthcare system. Standardized quality metrics have been developed for the Provincial Massive Hemorrhage Protocol (MHP) to help assess and improve specific activities over time at individual hospitals and will allow for peer benchmarking. 

There are 8 quality metrics recommended for reporting in the MHP toolkit in order to assess the MHP process at your institution. 

• The proportion of patients receiving tranexamic acid within 1 hour of protocol activation.
• The proportion of patients in whom RBC transfusion is initiated within 15 minutes of protocol activation.
• The proportion of patients (requiring transfer for definitive care) with initiation of call for transfer within 60 minutes of protocol activation.
• The proportion of patients achieving a temperature >35⁰C at termination of the protocol.
• The proportion of patients with hemoglobin levels maintained between 60-110 g/L during protocol activation, excluding certain pediatric populations (e.g. neonates) that may require higher hemoglobin values.
• The proportion of patients transitioned to group specific RBCs and plasma within 90 minutes of arrival/onset of hemorrhage.
• The proportion of patients with appropriate activation (>6 RBC units in first 24 hours; >40 ml/kg/24 hours of RBCs in pediatric patients) or before this level in patients dying due to hemorrhage within 24 hours.
• The proportion of patients without any blood component wastage (including plasma that is thawed and not used within the 5 day limit on another patient).

A Quality Metrics reporting portal has been developed to capture all of the 8 MHP quality metrics.  The reporting portal is a validated and free tool that will allow users to report on and monitor their facility specific quality metrics.  The portal will also be interfaced to a “dashboard” or data visualization tool which will provide a dynamic and interactive tool allowing users to quickly visualize and evaluate their metrics over time as well as against provincial benchmarks.  Graphs as illustrated below will provide users with aggregate data for each quality metric entered by their site.

Site Specific Quality Metric Reporting

The use of a data visualization tool or “dashboard” for healthcare related activities provides hospital sites with a performance management tool that can measure, monitor and manage performance and quality improvement initiatives more effectively.  These tools provide a dynamic platform for transmitting, analyzing and displaying metrics in “real time”.   Access to “real time” data allows users to identify problem areas, root causes and make performance improvements quickly.  The development, standardization and reporting of provincial MHP quality metrics will allow users to benchmark their own performance and provide provincial benchmarks for comparison.  Detecting “outliers” or unacceptable performance will promote quality improvement initiatives ultimately leading to better patient care.

ORBCoN held an educational forum on April 30^th to officially launch the provincial MHP Toolkit. Dr. Avery Nathens discussed in his presentation the importance of reviewing all activations for quality assurance purposes. He highlights strategies to implement and monitor the 8 quality MHP metrics and explains how we can learn and use the data from both the local and provincial metrics.

Dr. Nathen’s archived presentation along with the other presentations from the April 30th virtual event can be found here. 

For more information regarding the Provincial Massive Hemorrhage Protocol (MHP) please visit https://transfusionontario.org/category/massive-hemorrhage-protocol/

References

Callum JL, Yeh CH, Petrosoniak A, et al. A regional massive hemorrhage protocol developed through a modified Delphi technique. CMAJO 2019 Sep 3;7(3):E546-E561.

May 27th: CBS Inventory and Engineering perspectives in Future presented by Mr. Rick Prinzen

Pairing Laboratory and Clinical Knowledge to Provide Better Care for Patients Who are Difficult Matches.

Tracy Cameron MLT ¹, Wendy Owens ART ¹, Waseem Anani MD², Sheena Scheuermann MLT¹, Allison Collins MD¹, Julia Gilmore², Irene Dines², Hertha Hughes MLT³

Ontario Regional Blood Coordinating Network¹, Canadian Blood Services², Quinte HealthCare, Belleville General Hospital³

On April 13^th and 14^th, 2021, the Ontario Regional Blood Coordinating Network (ORBCON) partnered with Canadian Blood Services (CBS) to hold the 16^th annual transfusion medicine educational event. This year, the event combined both practical and theory-based learning for health care professionals in Ontario. The theme of this event was ‘Game, Set and Match’ which focused on patients with a high incidence of alloimmunization.

Approximately one month before the event, blind samples were prepared and shipped to 50 hospitals across the province who had registered to participate. Samples and accompanying case scenarios were provided for three Tiers of testing:

• Tier 1 hospitals with minimal capability to perform transfusion related testing (ABO blood group and Rh type and antibody screen only)
• Tier 2 hospitals licensed to perform basic antibody identification and
• Tier 3 tertiary care sites with the capability of identifying rare and more complicated antibody cases

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The testing was set up so a Tier 3 hospital would receive samples for all three levels, Tier 2 received samples for both Tier 1 and 2 and Tier 1 hospitals received only the samples for that level. The numbers of participating sites by Tier are illustrated in Figure 1.

Hospital Technologists were given approximately 4 weeks to complete their testing and were sent a survey in which to enter their results. Figure 2 shows the number of participants that submitted results for each Tier. Following the completion date, the results of the survey were collated and a presentation was developed. On April 13^th, three webinars were held to review the results and to discuss key learning points about the testing of these samples.

On April 14^th, a virtual learning platform (GoToWebinar®) was used to stream four live presentations, once in the morning and once in the afternoon. The theme of these presentations was laboratory and clinical management of patients presenting with disease conditions for which transfusion is frequently required and the risk of alloimmunization is high. Transfusion experts provided both theoretical, evidence-based and practical guidance on how to best manage these patients.



The first presentation focused on the demographics and clinical care of patients with Sickle Cell Disease (SCD).  These patients are becoming more numerous in Ontario and it was

recommended that hospitals across the province should be able to safely care for them. This talk, given by Dr. Jacob Pendergrast from the University Health Network, defined the principles of and indications for red cell transfusion for these patients, emphasizing the need for careful selection of red cells for transfusion and the importance of recognizing life-threatening hyperhemolysis.



The second presentation, by Dr. Yulia Lin from Sunnybrook HSC, focused on patients with Myelodysplastic Syndrome (MDS) and the approaches required to find appropriate blood products for them. Most patients with MDS become transfusion dependent, which is

associated with a decrease in survival rate and an overall decrease in quality of life. Dr. Lin shared information on transfusing MDS patients as outpatients and recognizing the lack of robust transfusion guidelines for this specific patient population.



The third presentation was given by the team of Ms. Melanie Tokessy and Dr. Johnathan Mack from the Eastern Ontario Regional Laboratory Association and The Ottawa Hospital. During the first half of the presentation Ms. Tokessy discussed how samples are processed in the lab to find the best matched product for patients with autoimmune hemolytic anemia.

She described the procedures for setting up the investigation and requirements for performing a crossmatch to find the most appropriate units for these patients. Dr. Mack discussed the indications for transfusion in this patient population and the reasons why physicians should be cautious when transfusing, but also the importance of not withholding transfusion in patients with life-threatening hemolysis. He described the reasons why response to transfusion should be monitored to guide therapy.  He also provided some alternatives to blood transfusion in this group of patients.



Preliminary attendance numbers are shown in Figure 3. Utilizing the GoToWebinar® platform worked very well, providing an easy way for participants to ask questions of the speakers. The sessions were recorded and are available for viewing on the www.transfusionontario.org website.

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April 14 2021 at 9:00 am – 4:00 pm

GAME, SET, MATCH:  FINDING BLOOD FOR DIFFICULT TO MATCH PATIENTS

CBS/ORBCoN Wet Workshop Review Session

CBS/ORBCoN 16th Annual TM Education Webconference

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