Reducing the use of blood for better patient outcomes
Latest News 30 April 2019 | In early 2018, Counties Manukau Health initiated a patient blood management (PBM) programme that saved around 600 blood units during that year. The appropriate use of blood is one of the key recommendations put forward by NZ Choosing Wisely; a global campaign promoting high-value treatment decisions.
“To achieve better patient outcomes, we are improving ways blood is used and intervening with other therapies when indicated,” says Service Manager Laboratory Don Mikkelsen.
The project has two facets. The first is the use of a Clinical Nurse Specialist based in the Blood Bank to review all requests for non-urgent Red Blood Cell (RBC) transfusions. Often, after reviewing the request together with laboratory results, alternative therapies are recommended (such as iron therapy) or a reduction in the number of units to be transfused.
The second facet is the use of a PBM nurse to review patients prior to elective surgery to ensure any iron deficiency anaemia present is treated before the surgery starts. It is common for someone who comes for elective surgery and has a history of bleeding, to have anaemia. The standard practice in these situations has been to give blood to increase their haemoglobin level, but the use of blood transfusion comes with greater risk of complication and potentially longer recovery. The improved management of patients with anaemia involves experienced clinical nurse specialists advising and managing treatment alternatives, such as iron infusion or oral iron instead of transfusion prior to surgery.
“Since our project initiation, the rate of RBC transfusions has been dropping – it is now in line with or lower than rates seen at other similar sized DHBs. We have seen better and quicker recovery from surgery for patients, cost savings from reduced RBC transfusions and we believe that we will also see a measurable decrease in length of stay in hospital.”
The next step will be to expand PBM to other services in the hospital.