Blood Conservation and Bloodless Medicine (BCBM)

The BCBM Program was a time-limited Ministry initiative that provided funding in 2001 and 2002 for a variety of pilot programs, clinical trials and research projects. The funding supported 11 projects over two years that were designed to improve patient safety and education, reduce inappropriate use of blood, achieve efficiencies in the blood system and encourage the use of alternatives to blood with the goal of reducing surgical blood use.

Completed in 2005, an evaluation of the BCBM Program found that projects resulted in substantial progress toward the development of ways to reduce red cell use in Ontario hospitals. Many of these projects were continued and expanded to form part of the provincial Blood Utilization Strategy. The evaluation included recommendations to:

1. Continue physician, nurse and public education initiatives by making ongoing updates to Bloody Easy, A Guide to Transfusion Medicine to reflect new developments (i.e. approaches to reduce inappropriate use, encourage the use of alternatives to blood). This handbook provides information to aid clinicians with transfusion decisions and is well regarded by clinicians within Ontario, as well as nationally and internationally.
   
   Bloody Easy 2 is now in circulation and is available in both French and English. Copies of the handbook are provided to Ontario hospitals and medical schools at no charge and a complementary e-Learning program offers Continuing Medical Education (CME) credits. The Patient Edition online course is now available also. For a copy of the Bloody Easy handbook or to access the online courses visit http://sunnybrook.nextmovelearning.com/.
   
    
2. Continue and expand the Ontario Nurses Transfusion Coordinators (ONTraC) Program by hiring more Transfusion Coordinators. Through the ONTraC program, Transfusion Coordinators were introduced into select university/teaching and community hospitals. There are currently 27 Transfusion Coordinators in 25 Ontario hospitals. Transfusion Coordinators:
   
   
   • Work collaboratively with physicians and nursing staff as a clinical bridge between the blood transfusion service and the rest of the hospital;
   • Develop and implement a blood conservation program in each institution; and
   • Act as a hospital-wide educator on transfusion-related issues.
     
     For more information on the ONTRaC program visit www.ontracprogram.com.
     
      
3. Expand Quality Essentials For Safe Transfusion (QUEST) programs - Hamilton and Ottawa area hospitals established regional networks and developed a total quality system of tools that focused on the standardization of transfusion laboratory practice, safe transfusion practice and appropriate utilization and decreased wastage of blood products.
   
   The Ottawa Hospital led the development of quality management tools that could be used by hospital staff and patients including:
   
   

   Standard Work Instruction Manual (SWIM) - a guide for Laboratory Technologists on all aspects of transfusion laboratory practice which seeks to increase compliance with regulatory requirements About Blood Transfusion - a handbook on transfusion basics for nurses and other health care professionals Algorithm for a Transfusion Reaction Website (transfusionontario.org) that provides information on many of the blood utilization projects funded by Ontario, with quality tools developed by Ottawa available to be downloaded. This site is currently under reconstruction. McMaster University led the development of materials and procedures to educate and establish standards in transfusion practice. Overall, these efforts have provided opportunities for education and quality control in transfusion laboratory practice. These tools can be accessed on the McMaster Transfusion Research Program website at www.fhs.mcmaster.ca/mtrp/ and include: Sharing Our Strategies Manual (SOS Manual) National survey on IVIG utilization Provincial survey of the impact of National Standard Z902 Online hospital blood inventory month-end data collection and reporting system

   
    
4. Develop and implement a blood tracking system to analyze product use, identify options for improved management, implement utilization management strategies, and evaluate results.

Other projects included:

• Randomized Control Trial of High Risk Cardiac Surgery (The BART Study): University of Ottawa � A Randomized controlled trial of transfusion options in high risk cardiac surgery
• Plasma Exchange Column Research: Toronto General - Hospital/University Health Network - A study to compare the use of plasma exchange and different doses of IVIG in chronic inflammatory demyelinating polyneuropathy (CIDP)
• Program to Reduce Orthopedic Blood Exposure (PROBE): London Health Sciences Centre - A study to determine whether a comprehensive blood conservation algorithm is more effective than usual care for reducing exposure to allogeneic blood in patients undergoing total hip joint arthroplasty
• A study to determine if aprotinin is superior to alternatives in terms of decreasing massive post-operative bleeding, minimizing exposure to blood, and decreasing fatal/life threatening or serious post-operative complications
• Optimizing Autologous Blood Management Program: The Ottawa Hospital - A study to compare normal autologous donation to a program using the Trima machine with and without erythropoietin for patients undergoing prostate surgery for cancer
• Policy Analysis/ Control Trial of Hospital Chargeback: The Ottawa Hospital - An analysis of the chargeback system for the payment of blood products
• Fractionated Product Utilization Analysis - An analysis of the use of fractionated products in Ontario to identify trends and provide national and international comparisons
• Turnkey Blood Conservation: Anemia Institute for Research and Education - A review of current blood conservation practices in Canada and the United States through which �best practices� were identified and implementation of these practices within Ontario supported