Objective 3. Promote the safe and efficient use of blood and blood products
In 2019-20 the NBA continued its program to promote the safe and efficient use of blood and blood products through the identification and synthesis of new clinical evidence, development of draft clinical guidance in collaboration with clinical stakeholders, and research and analysis of methodologies capable of retaining the currency of clinical practice guidelines.
Patient Blood Management (PBM)
Over 160,000 hard copies of the PBM modules 1 to 6 have been issued. They have also been downloaded in over 60 countries. They provide evidence-based guidance on optimisation of the patient's own blood, non-transfusion strategies to minimise blood loss and bleeding, and strategies to manage anaemia.
In 2019-20 the nature and volume of evidence published since the release of the perioperative (Module 2), medical (Module 3), critical care (Module 4), obstetrics and maternity (Module 5) and neonatal and paediatric (Module 6) modules was identified. These findings were used to inform the development of a prioritised research question list. The update of the entire critical bleeding/massive transfusion module (Module 1) was paused in 2019-20. It will resume in 2020-21.
During 2019-20, the NBA continued to investigate a more sustainable methodology for updating clinical practice guidelines. Work commenced on the development of Standard Operating Procedures (SOPs) for more targeted updates in response to the emergence of practice-changing information. The SOPs are based on high-level process maps for the preferred guideline model agreed by clinical and government stakeholders in 2018-19.
While the review is underway, the original modules remain available to guide practice.
Guideline for the prophylactic use of Rh D Immunoglobulin in maternity care
In 2019-20 a multi-disciplinary Expert Reference Group (ERG) finalised the draft Guideline on the prophylactic use of Rh D Immunoglobulin in pregnancy care and it was released for public comment. All comments were considered by the ERG and the Guideline was updated accordingly. It will be published in 2020-21.
A core element of ensuring reference material influences the safe and efficient use of blood and blood products are activities that support their implementation. In 2019-20 the NBA continued its focus on activities to support implementation of measures to reduce wastage of blood and improve appropriate use through the National Patient Blood Management Implementation Strategy 2017-2021 and the National Blood Product Management Improvement Strategy 2018-22. The strategies address a significant proportion of requirements identified in the 2010 Australian Health Ministers' Statement on National Stewardship Expectations on the Supply of Blood and Blood Products.
Promotion and communication
The NBA promotes improved inventory management and appropriate clinical use of blood and blood products at a range of relevant national and international forums.
In 2019-20 the NBA continued its promotion and communication campaign to increase awareness of the need to improve clinical practice and inventory management in relation to blood products. This included representation, promotion and education activities at a range of clinical and health sector conferences and events, including the following:
International Society on Thrombosis and Haemostasis (ISTH) 2019 Congress, July 2019
Australasian Society of Clinical Immunology and Allergy (ASCIA) 2019, September 2019
Haemophilia Foundation Australia (HFA), October 2019
National Immunohaematology Continuing Education (NICE), October 2019
Blood 2019 (formally HAA), October 2019
Rural Medicine Australia (RMA), October 2019
Guidelines International Network (GIN), October 2019.
Education and Training
BloodSafe eLearning Australia
BloodSafe eLearning Australia provides online education and training resources for health professionals in Australia. The program aims to improve knowledge of patient blood management and clinical transfusion practice in order to improve patient outcomes.
BloodSafe eLearning Australia is funded by the National Blood Authority on behalf of all Australian governments. During 2019-20 the BloodSafe eLearning Australia program:
delivered 255,239 hours of education
had 177,634 courses completed by users, with 14,803 courses completed on average each month, approximately one course completed every three minutes
registered 62,185 new users
was used by more than 1,500 Australian health care organisations including hospitals, pathology laboratories and staffing agencies to improve staff knowledge and assist them to meet their accreditation requirements
promoted the courses in professional journals and at scientific, medical and nursing conferences, and provided resources for organisations to undertake their own promotions
developed new courses on Iron Deficiency Anaemia: Chronic and Complex, Iron Deficiency Anaemia: Heavy Menstrual Bleeding, Neonatal: major haemorrhage and Intraoperative cell salvage
produced a series of videos including Consent for paediatrics: a shared decision, Administering blood, Pre-transfusion samples, Transporting blood, and Specimen collection
began a review and update of courses to include Lifeblood rebranding and started the development of electronic medical records content for the second Clinical Transfusion Practice Refresher.
National Safety and Quality Health Service Standards
The National Safety and Quality Health Service (NSQHS) Standards were developed by the Australian Commission on Safety and Quality in Health Care (ACSQHC) with the Australian government, state and territory partners, consumers and the private sector providing input and feedback.
The primary aim of the NSQHS Standards is to protect the public from harm and improve the quality of health care. They describe the level of care that should be provided by health service organisations and the systems that are needed to deliver such care.
The Blood Management Standard - Standard 7 aims to improve outcomes for patients by identifying risks and using strategies that optimise and conserve a patient's own blood, as well as ensuring that any blood and blood products that patients receive are safe and appropriate. The Blood Management Standard covers all elements in the blood management and clinical transfusion process and includes the principles of patient blood management (PBM).
During 2019-20 the NBA continued to work with the ACSQHC and other stakeholders in the implementation of the second edition of the NSQHS Standards.
Research and Development
National blood sector research and development priorities
Under the National Blood Agreement, the NBA is required '...to facilitate and fund appropriate research, policy development or other action in relation to new developments by relevant government or non-government persons or bodies'. The National Blood Research and Development Strategic Priorities are under review. The identified priorities are intended to provide a useful resource to guide research proposals and may be used by researchers to support funding requests, including from the National Health and Medical Research Council, by identifying that their research aligns with priorities communicated by governments.
National blood sector research and development program
In September 2015 the NBA received approval from funding governments to implement a pilot program to directly fund some research and development activities in the blood sector.
The program targets the following topics, where the priority for research has been identified through pre-existing strategic programs of the NBA and governments in the blood sector:
patient blood management evidence gaps, as identified in each module of the PBM Guidelines
efficient and effective use of immunoglobulin products, as highlighted through the Ig Governance Program.
The overarching objectives are to identify and fund research that will:
enhance the sustainability and affordability of the national supply of blood products, including through increased efficiency and reduced blood product usage and wastage
identify appropriate use and reduce inappropriate use of blood products
maintain or enhance clinical outcomes for patients by providing evidence or new knowledge to:
understand the biological action of blood products
identify optimum treatment, dosing or indications for use for blood products
compare the use of blood products with alternative strategies and treatments.
In 2018 an evaluation of the pilot confirmed the viability and value of research and development funding to support a National Blood Sector Research and Development Program. Round 5 is underway.
The NBA has received a substantial level of high quality input from clinical, academic, research and government experts who participated in the review process and assisted the NBA in determining the mix of research projects to be funded within the Program's limited budget. The NBA is confident that the funded research will be a valuable contribution towards achievement of the blood sector's research outcomes. The outcomes of each grant funding round are reported on the NBA's website.
Six projects were completed successfully in 2019-20, with one publication being accepted in a peer reviewed journal and eight journal manuscripts are in draft. Research funded under the R&D Program has been presented at conferences within Australia and overseas. Outcomes from the R&D Program support future research, the evolution of the Criteria and the PBM Guidelines.