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March 2024

In This Issue

  • Ministry of Health / ORBCoN Immune Globulin Quality Improvement Project
  • ORBCoN Immune Globulin Resources – 2024 Update
  • Upcoming Events
    • CSTM 2024
    • 19th Annual Transfusion Medicine Education Web Symposium 
    • Transfusionists Talk
    • U of T Rounds

Ministry of Health / ORBCoN Immune Globulin Quality Improvement Project

Laura Aseltine, ORBCoN Regional Project Coordinator, SW Office

In December 2020, the Office of the Auditor General of Ontario released the Value for Money Audit on Blood Management and Safety. The audit identified 13 recommendations for the Ministry of Health (MOH) to support an ongoing safe and stable supply of blood and blood products for Ontarians provided within a cost-effective and evidence-based context. Recommendation three spoke to management of supply and demand of immunoglobulins (IG) in Ontario, making sure they are available to those who need them most and avoiding the costs of wasted product, specifically “collect more complete data from hospitals on how immunoglobulins are being used and identify emerging conditions that may warrant inclusion in the provincial utilization guidelines.” 1

Currently in Ontario, paper request forms detailing the MOH approved IG indications are available for prescriber use when submitting requests to the Transfusion Medicine Laboratory (TML). Although all paper request forms must be submitted to TML for review and approval2 none of the stakeholders, including Canadian Blood Services (CBS), the MOH or the Ontario Regional Blood Coordinating Network (ORBCoN), collect comprehensive electronic data on how IG products are prescribed in hospitals (e.g., labelled medical indication for use, assessment of appropriate dose, or to what extent IG is being utilized to treat conditions for which there is limited/no evidence to support their use3). The lack of this data challenges investigation of the expanding IG utilization and the rate of guideline compliance. In the past, ORBCoN performed audits to evaluate practice and prepared formal reports to increase awareness of appropriate use4,5,6.

Upon release of the Value for Money Audit, ORBCoN set to work on the Immune Globulin Quality Improvement Project (IG QIP) to develop an IG request form electronic database to collect the rich information that is currently gathered on the paper MOH IG Request Forms. The team’s aim was to ensure that this process was mutually beneficial to both the MOH, as well as the hospital users choosing to share their IG data. Utilizing the Research Electronic Data Capture (REDCap®)7 platform (familiar to Ontario TMLs based on previous ORBCoN projects), a database was designed. The following beneficial features were implemented:

  • Organizing the REDCap electronic record form to mirror the information collected on the paper MOH IG Request Form would limit TMLs searching sources/systems for the essential data.
  • Embedding the IG “Dosing Using Adjusted Body Weight” calculator within the REDCap electronic record form facilitates real time data entry by end users, limiting the need to link to additional web-based programs.
  • End users with established sophisticated electronic data sets in their Laboratory Information Systems can electronically upload IG data into REDCap, avoiding people resource intensive manual data entry.
  • Site specific electronic alerts are generated when an IG request has reached its 6-month or one year renewal date, saving TMLs time (an alternative to manually searching paper MOH IG Request Forms) when determining requests requiring prescriber review.
  • Providing templated reports for users who wish to download their IG data and present it to their transfusion committee or quality improvement teams to evaluate hospital utilization and workflow.

The MOH, via ORBCoN, has launched the IG QIP in response to recommendations within the Value for Money Audit, Blood Management and Safety1. Furthermore, to endorse best practice for hospitals and their patients, ORBCoN has developed an efficient means to delineate IG utilization based on current provincial guidelines and evolving evidence-based indications. At present, hospital participation is voluntary. As the benefits are realized, it is anticipated that adoption of the IG QIP process will grow.

If your hospital would like more information about the IG QIP, please reach out to Laura Aseltine (ORBCoN IG QIP project lead) at aseltinl@mcmaster.ca.

References

  1. Value-for-Money Audit: Blood Management and Safety (2020) [Internet]. Office of the Auditor General of Ontario. 2020. p. 1–68. Available from: Value-for-Money Audit: Blood Management and Safety (2020) (auditor.on.ca)
  2. The Ontario Regional Blood Coordinating Network. Ordering IG in Ontario [Internet]. 2018. Available from: https://transfusionontario.org/en/category/ivig-scig/ordering-igin-ontario/  
  3. Shih AW, Jamula E, Diep C, Lin Y, Armali C, Heddle NM, et al. Audit of provincial IVIG Request Forms and efficacy documentation in four Ontario tertiary care centres. Transfus Med. 2017;27(2):122–31.
  4. ORBCON (Ontario Regional Blood Coordinating Network). Intravenous Immune Globulin (IVIG) 2012 Audit Report [Internet]. 2012. Available from: https://www.mendeley.com/catalogue/intravenous-immune-globulin-ivig-2012-audit-report/
  5. The Ontario Regional Blood Coordinating Network. Audit of Intravenous Immune Globulin (IVIG) Indications and Effectiveness in Ontario Tertiary Care Centres [Internet]. 2015. Available from: https://transfusionontario.org/wp-content/uploads/2020/05/Audit-of-Intravenous-Globulin-IVIG-Indications-and-Effectiveness-in-Ontario-Tertiary-Care-Centres-2015.pdf
  6. The Ontario Regional Blood Coordinating Network. IG QIP Project Protocol [Internet]. 2023. Available from: IG QIP – Transfusion Ontario
  7. PA Harris, R Taylor, BL Minor, V Elliott, M Fernandez, L O’Neal, L McLeod, G Delacqua, F Delacqua, J Kirby, SN Duda, REDCap Consortium, The REDCap consortium: Building an international community of software partners, J Biomed Inform. 2019 May 9 [doi: 10.1016/j.jbi.2019.103208]

ORBCoN Immune Globulin Resources – 2024 Update

Donna Berta, ORBCoN, Clinical Project Coordinator Nursing

Immune Globulin (IG), both intravenous (IVIG) and subcutaneous (SCIG), is an extensively used blood product. To fulfill the Ontario Regional Blood Coordinating Network’s (ORBCoN) mission, “inspiring and facilitating best transfusion practices in Ontario”1 a wealth of IG resources are available on the ORBCoN website.

The IG landing page was introduced to streamline and simplify navigating ORBCoN’s website. From the ORBCoN website, https://transfusionontario.org/en/, select the Resources tab, and then click the heading “IVIG/SCIG” to explore the landing page (refer to Figure 1).  

Figure 1: ORBCoN Website: IVIG/SCIG Landing Page

The landing page identifies each of ORBCoN’s IG resources on a card. A synopsis and time stamp of each of these IG resources is presented (refer to Table 1).

One page summary regarding using the MOHLTC IG Request Form.
Ontario MOHLTC IG Request Form Neurology and
Ontario MOHLTC IG Request Form Non-Neurology
(including fillable formats).
Version January 31, 2018.
Recommended IG indications (with additional information) as well as dose and frequency of administration are listed by clinical service. Some indications where IG is not recommended for routine use are also detailed.
Seven IG utilization strategies for all hospitals where IG is prescribed.
Version January 31, 2018
The patient’s sex, height, and weight are entered to calculate:
Ideal body weight and dosing weight
IVIG dose (select dose) and rounded dose
Body mass index (BMI).
A mobile app is available with these calculations as well as the recommended IG indications information.
Version January 31, 2018
Centralized repository for IG utilization data to endorse continuous audit and feedback for IG stewardship (voluntary participation). Includes protocol, user guide, tracking log, survey for registration to participate link, and REDCap repository log on link. 
Version September 2023
MOH/ORBCoN IVIG audit reports 2012 and 2015.
Incorporates six resources in one document:
Ordering IG in Ontario, Utilization Management Guidelines,
Dosing Using Adjusted Body Weight, Facts for Patients,
Travelling with IG and Infusion Guide and Adverse Events.
Version January 31, 2018
Downloadable and print ready IG information (what, why, how, risks, and side effects) for outpatients who are being treated with IVIG.
Version October 31, 2015
This resource is being revised; an updated version is anticipated April 2024.
Information regarding receiving infusion of IVIG outside of Ontario, with IVIG supplied by an Ontario hospital (participation agreement/ patient responsibilities, letter from treating physician to travel destination health care prescriber, and IVIG travel letter for the patient regarding their IVIG vials and ancillary supplies).
Version January 2018
Reviews general practices when administering IVIG (pre, during, and post infusion), infusion rate increment tables (IVIG brand specific, adults, five-kilogram weight range categories), and an adverse reaction chart listing signs and symptoms, possible etiology, as well as suggested treatment/actions and strategies to mitigate.
Version March 10, 2022
Table 1: Description of ORBCoN’s IG Resources

Resources specific to SCIG are structured within the ORBCoN Home Infusion Toolkit. This toolkit outlines the requirements for hospitals that issue home infusion products to patients. Example documents to support and manage such programs are also provided.

ORBCoN has developed IG resources to assist hospital Transfusion Medicine laboratories and health care providers to treat patients following best practice, evidence-based standards. The Utilization Management Guidelines (as well as Ordering IG in Ontario, which is informed by the Utilization Management Guidelines) are currently being evaluated for additional evidence-based information. To learn more about the newest resource, the IG Quality Improvement Project (IG QIP), refer to that article in this March 2024 Newsletter.

Feedback regarding these resources or suggestions for alternate resources that would be of benefit is most appreciated. Reach out to your regional ORBCoN office (contact details found at https://transfusionontario.org/en/contact/).


References

  1. Ontario Regional Blood Coordinating Network. About us [Internet]. Toronto ON; Ontario Regional Blood Coordinating Network; 2006 [revised 2020 cited 2024 Jan 23]. Available from: https://transfusionontario.org/en/about/
  2. Ontario Regional Blood Coordinating Network. IVIG/SCIG [Internet]. Toronto ON; Ontario Regional Blood Coordinating Network; 2023 Dec [cited 2024 Jan 23]. Available from: https://transfusionontario.org/en/category/ivig-scig/
  3. Ontario Regional Blood Coordinating Network. Home Infusion Toolkit [Internet]. Toronto ON; Ontario Regional Blood Coordinating Network; 2019 Dec [cited 2024 Jan 23]. Available from: https://transfusionontario.org/en/category/toolkits/home-infusion-toolkit/

Upcoming Events

CSTM 2024

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Transfusionists Talk

Register

19th Annual Transfusion Medicine Education Web Symposium

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U of T

March 28, 2024 @12pm-1pm

Subscribe to U of T Transfusion Medicine Rounds mailing list to get registration details