The national patient blood management collaborative

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Blood and blood products are vitally important in health care. Sourced from the Australian and international donor community, and commercial manufacturers, they are important elements of clinical practice and are of great benefit to patients. While blood and blood products can be lifesaving, there are also hazards associated with their administration to patients.

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These hazards include allergic and immunological complications, storage-related complications, infections, incorrect blood transfusions and other adverse outcomes. Research has also indicated that a significant proportion of blood transfusions may be unnecessary, or could have been avoided. There is also high variation in prescribing practice in relation to blood and blood products.
A systematic review of evidence has found that preoperative anaemia is independently associated with an increased risk of morbidity and mortality. Preoperative anaemia has also been found to increase the likelihood of red blood cell transfusion. Anaemia management, prior to elective surgery, can improve a patient’s pre-surgery clinical status, and reduce post-surgery morbidity, mortality and length of stay in hospital.
For a patient’s wellbeing, it is important to establish a definitive diagnosis of anaemia; whether it is related to the patient’s current condition and if it is correctable. While some forms of anaemia cannot be prevented (if caused by a failure in the cell production process), other forms, such as anaemia caused by blood loss and dietary deficiency, can be prevented and managed.
Unless there is a primary disorder of the marrow or some influence suppressing marrow function, most forms of anaemia are correctable without red blood cell transfusion within two or three weeks. If surgery is urgent, red blood cell transfusion may be provided. However, anaemia may recur in the weeks following surgery. If red blood cell transfusion is used to correct anaemia in the short term, the cause of the anaemia will need to be followed up and/or the anaemia monitored to ensure it is resolved.
There has been an increasing focus on Patient Blood Management (PBM) over the last decade. In conjunction with the clinical community, the National Blood Authority (NBA) developed evidence-based guidelines to support healthcare professionals in making clinical decisions regarding blood and blood products. Jurisdictions have also been active in improving PBM and established programs using both locally developed and NBA strategies.
The National PBM Collaborative
The Australian Commission on Safety and Quality in Health Care (the Commission) has been engaged by the Australian Government Department of Health to lead a National PBM Collaborative focusing on anaemia management for patients having elective surgery. Three categories of surgery will be considered: abdominal, gynaecological and orthopaedic.
The National PBM Collaborative will have four components:

• identification of specific and measurable aims for service improvement


• measurement of improvements over time


• identification of changes that facilitate the desired improvements


• a series of learning cycles where teams implement identified changes.

The collaborative will consider and incorporate:

• the six evidence-based PBM guidelines now being delivered to health providers through the National Blood Authority’s (NBA) PBM education, training and promotion program


• the experience of states and territories in implementing PBM programs


• the growing evidence of a dose dependent increase of morbidity and adverse outcomes associated with transfusion, which may also be increasing the length and complexity of hospital admissions.

The National PBM Collaborative will commence in 2015 and will fast-track the benefits of PBM protocols, guidelines and programs for participating health services.

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“Anaemia management, prior to elective surgery, can improve a patient’s pre-surgery clinical status, and reduce post-surgery morbidity, mortality and length of stay in hospital.”

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For more Information visit www.safetyandquality.gov.au/national-priorities/pbm-collaborative. Or the NBA at www.blood.gov.au.