O Neg RBC Audit 2013 (Jan Feb Mar) 3735 AVG N=34 28 (0.7%) 408 (11.0%) Total O Neg RBCs Txd Rh positive due to Massive Transfusion Protocol (MTP) Rh positive patients due to soon to outdate units With antibodies other than Anti-D No blood group on file Only one blood group on file A Neg, B Neg or AB Neg with Anti-D. Non-O Neg patient with antibodies (O Neg provided by CBS) Non-O Neg patient (without antibodies) who requires phenotypically matched red cells O Neg to non O Neg neonates O Neg CMV- IRR to non- O neg 2013 (Jan Feb Mar) 3735 AVG N=34 28 (0.7%) 408 (11.0%) 493 (13.2%) 117 (3.1%) 81 (2.2%) 44 (1.2%) 509 (13.6%) 418 (11.2%) 45 13 (0.3%) 2014 3460 AVG N=31 47 (1.4%) 431 (12.5%) 520 (15.0%) 94 (2.7%) 16 12 423 (12.2%) 364 (10.5%) (0.0%) D. Lauzon presented O Neg rbc audit results and raised an issue with the current utilization. See the presentation for details. ORBCoN conducted an O Neg rbc audit twice with hospitals in the Central region, one for January 2013 to March 2013 and one for January 2014 to March 2014 with different set of hospitals and found that a large per cent of O Neg rbc are used for patients with antibodies and also for those who need phenotypically matched. Many of the smaller, remote sites stock only O Neg and O Pos. This accounts for a large number of O Neg rbc units provincially. Audits are currently underway in Southwest and Northern and Eastern regions. Results should be available by the end of summer. Potential strategies for Ontario to address this issue were presented. 1) Small hospitals that do not do obstetrics should stock O Rh Pos exclusively; 2) Quality indicator to monitor O Neg issued to non-O Neg patients.   Discussion: Trauma surgeons, nurses who are trained with the Advanced Trauma Life Support (ATLS) start resuscitation with O Neg and this might be out of date. D. Lauzon suggested that, if there are no guidelines or recommendations made by OBAC or the ministry, the O Neg utilization practices, especially at smaller community hospitals, are unlikely to improve. However, OBAC was reluctant to recommend guidelines for O Neg use and felt that it may be more appropriate for NAC to take this on – K. Pavenski can raise this at the November 2014 NAC meeting. It can also be put on the Choosing Wisely Canada Campaign. Canadian Institute for Health Information (CIHI) has data for our use to change the policy/practice around O Neg use. OBAC decided to revisit this issue with more details at the next meeting in fall 2014 as further information can be gathered on this at the next NAC meeting and the next Quality Focus Day. It is positive to see changes in practice at some sites already as the O Neg utilization issue was communicated to the hospitals at the previous year’s site visits. Last update- Apr. 28/2014

O Rh Negative RBC – Small Hospital Stock Region # Small Hospitals # O Neg RBC stocked Average O Neg RBC per site Central 16 75 4.6 Northern and Eastern 42 171 4.1 Southwest 14 43 3.1