Developing and implementing standard 7 blood and blood products

The National Safety and Quality Health Service (NSQHS) Standards are part on an ongoing series in AHHB. General Manager of the National Blood Authority, Leigh McJames explains how Standard 7 – Blood and Blood Products is leading improvements in the blood sector.
Standard 7 – Blood and Blood Products is an important deliverable in the implementation of the Australian Health Ministers’ Statement on National Stewardship Expectations on the Supply of Blood and Blood Products issued on 12 November 2010. The development of Standard 7 also demonstrates the effectiveness of the long term partnership between the National Blood Authority (NBA) and the Australian Commission on Safety and Quality in Healthcare (Commission). Standard 7 was one of the first of the NSQHS Standards to be written and the only standard that was predominantly drafted by an organisation external to the Commission.
Why a standard on blood and blood products?
The use, management and administration of blood and blood products effects almost all areas of a hospital and is one of a few treatments that crosses a range of disciplines. There are a number of reasons why it is important to have a standard specific to blood and blood products:
Blood is a precious and valuable resource given voluntarily by generous donors. As such, there is a moral and financial responsibility to manage it appropriately. There is a growing weight of evidence that allogeneic blood transfusion has potentially a wider range of adverse clinical outcomes than any other current medical intervention. A significant proportion of the current clinical use of blood and blood products is not evidence based, is unnecessary and is causing increased patient morbidity and mortality in some circumstances. There is significant wastage of blood and blood products. This is unacceptable given these products are provided by voluntary donation and provided free of charge to patients.
The quality improvement cycle
It is exciting to have safety and quality standards that are so focussed on quality improvement, rather than solely focussing on accreditation. The NBA drafted the content for the Standard 7 Safety and Quality Improvement Guide, which was designed to help health service organisations undertaking improvement processes by guiding them step-by-step through the criterion in the standards. This guide highlights the ongoing quality improvement activities expected under the standard, and suggests that all health services have a Transfusion Quality Improvement System, with a Transfusion Governance Group responsible for assessing risks, and implementing actions to reduce risks.
Activities to support health services improve blood related safety and quality
The NBA is working with a number of stakeholders to deliver programs and activities to support implementation of the standard, these include:

1. Patient Blood Management Guidelines – Standard 7 requires health services to have policies, procedures and protocols that are consistent with national evidence based guidelines. The NBA recognises that there is strong evidence suggesting that some transfusions are unnecessary and has worked with stakeholders to develop national evidence-based Patient Blood Management Guidelines. Patient blood management is important in improving patient outcomes and aims to improve clinical outcomes by avoiding unnecessary exposure to blood components by optimising blood volume and red cell mass, minimising blood loss and optimising a patient’s tolerance of anaemia.


2. The National Blood and Blood Product Wastage Reduction Strategy – Standard 7 requires health services to regularly monitor blood and blood product wastage. The NBA has published the National Blood and Blood Product Wastage Reduction Strategy. This identifies strategies for reducing wastage of blood and blood products. As part of this strategy, the NBA has developed and implemented a Fate Module in BloodNet (the national online ordering system operated by the NBA) to enable laboratory staff to easily report all discards for blood and blood products.


3. Inventory Management - The NBA has also developed 10 Tips to Help Manage you Blood Product Inventory as well as Managing Blood and Blood Product Inventory: Guidelines for Australian Health Providers. These publications identify better practice activities to help health services manage their inventory effectively and efficiently and reduce their wastage. The NBA is currently collaborating with the Australian Red Cross Blood Service to pilot a National Inventory Management Framework for Red Blood Cells. This project aims to have a comprehensive, efficient and effective national inventory management framework and provide guidelines for setting inventory levels at health providers to ensure there is a secure supply of red blood cells that meet clinical demand, improve financial performance and reduce discards.


4. Education about implementation of Standard 7 – The NBA continues to collaborate with the Commission to assist health services implementing the standards. The NBA has presented to accreditors to assist them in understanding the expectations on health service organisations, and to standardise accreditation practices across the varying accrediting bodies. Webinars with interested health providers have also proven to be popular. In September 2013 the NBA, Commission and respective state governments will partner to host the first National Blood Symposiums in Sydney, Melbourne and Adelaide. This year’s symposium program is solely dedicated to Standard 7.


5. Case studies – the NBA is working with health services to identify areas of best practice already in existence across the country, record and document these practices for others to view and further develop in their own workplace. The NBA has published a number of case studies highlighting best practice.


6. Further work – the NBA is in the process of developing or identifying further resources to assist in implementation of Standard 7. Keep an eye on the NBA website – www.blood.gov.au – for the latest resources.

Benefits of having Standard 7
The development of a standard specific to blood and blood products has focussed the attention not only of staff responsible for quality, but also clinicians, scientists, other healthcare staff, hospital administrators and governments on the need to improve practices relating to blood. All health services are encouraged to use the standard as a tool to ensure that the precious resource of blood is used efficiently and appropriately.
Appointed in April 2012, Leigh McJames is the General Manager of the National Blood Authority (NBA). The NBA is an independent statutory authority responsible to all Australian and state and territory governments for the management of a budget of over $1.1 billion to ensure the adequate, safe, secure and affordable supply of blood and blood products in Australia.
Leigh has extensive management experience in government spanning the defence and health sectors. In previous health sector appointments, he was the Transition Manager for the formation of Albury Wodonga Health (AWH), the first cross border health service in Australia, and subsequently served on the AWH senior executive.
Prior to his work in the health sector, Leigh held a diverse range of positions in Defence, including senior roles in the management of government corporate support, acquisition and procurement, logistics and the development and implementation of strategic international defence policy. He has also filled representational advisory appointments at the Australian Embassy in Washington and in Baghdad as part of the senior civilian advisory team with the Coalition Provisional Authority.