Trace Line Project Realizations NAC Meeting Dr. Debra Lane

Traceline Locations

Rationale for Province-Wide Transfusion Medicine Laboratory Information Solution Patient Safety Inventory Management of Blood Components and Derivatives Utilization information Electronic traceability of products (vein to vein) Reduce the need for red cell and platelet products to be returned from Winnipeg hospitals to the CBS Crossmatch for re-issue Reduction in rural Manitoba hospital red blood cell (RBC) in-date discards (25% to 5%). Extensive perinatal database to determine best practices in managing antibody cases. Turnaround Time improvements

Was Patient Safety Achieved? Centralized database for patients with special needs across the province to receive the correct products or transfusion protocols: Central patient antibody database with identified transfusion protocols to follow, available in real time Patient special needs such as anti-CMV negative and irradiated blood component requirement protocols available in real time History of untoward reactions to blood components and plasma protein products clearly identified 65% of patients have a historical blood group on file >90% of patients have AB0/Rh performed on automated instruments interfaced to Trace Line

Is There Better Inventory Management? Location of blood inventory transparent to all Manitoba Trace Line locations Less dependence on bus schedules to meet patient transfusion requirements Products can be transferred from site to site with minimal effort Products are assigned to the patient at the time reducing Crossmatch to Transfusion ratio (currently not quantified) Utilization information Now tracking IVIG usage by: Patient Dosage Diagnosis Physician Physician area of practice Transfusion data (date, location, ward)

Is There Better Inventory Management? Electronic traceability of products Interfaces to ePROGESA and SAP eliminated transcription errors related to recording donation/lot numbers received “Confirmation of transfusion” is used as the official system of record to identify patients transfused Ability to provide patients with individual transfusion history records if required without manually searching patient charts

Is There Better Inventory Management? Data for discard reductions is still in the early stages of analysis Boundary Trails Hospital, the discard rate for in-date red cells fell from an average of 21% per month to 1% per month. Portage Hospital in-date discards were reduced from 20% per month to 0.4% Steinbach in-date discards have been reduced from 20% per month to 0% per month. Swan River in-date discards reduced from 8% to 1% For these three sites, this is an annual saving of 450 red cells that would have otherwise been discarded

Is There Better Inventory Management? Reduced number of returned products from Winnipeg Hospitals to CBS from 40,000/year to less than 1,000/year Average unit was issued at least three times before being transfused or disposed Accepting returns, although done in a controlled manner, did increase the safety risk to the product Accepting returns was a significant workload and inventory management issue at both CBS and Hospitals Improper documentation resulted in a significant number (1,000) of unnecessary discard of red cells which is now avoided.

Turnaround Time Changes Winnipeg 41% of requests are ordered STAT Brandon 49% of requests are ordered STAT >90% of all matches are now electronically matched at Hospital Trace Line sites TAT in Winnipeg has been reduced 35 minutes (78%) since 2011 (based on St. Boniface data) If there is an in-date crossmatch sample TAT has been reduced to 15 minutes from 60 minutes (75%). TAT reduction for rural issuing sites not determined but thought to be as much as 24 hours Potential for additional reductions in TAT as “Hub and Spoke” model is implemented

Perinatal DATABASE Data indicate Rh(D) immunization rate in Manitoba is low compared to other provinces 0.68/1000 patients compared to average of 0.81/1000 Anti-K prevalence in Manitoba significantly higher when compared to other provinces 2.05/1000 patients compared to 1.1/1000 patients Women 40-44 years having babies in BC is 5.8% of population versus in Manitoba the rate is 1.4%

Education Multi-facetted enhancements to the medical school curriculum with self-learning components including: More lectures; Tutorials; Case-based learning; Resident education; Pre-clerkship selective Medical staff requirements include best practices on TM

Thank You All for a Job Well Done!