NAC meeting November 6-7, 2014

Transition Deputy Minister Dr. Peter Vaughan – April 2014 District Health Authorities will decrease from 10 to 2 effective April 1, 2015 Establishing Programs of Care and Strategic Health Networks

IVIG/SCIG 11.3% increase in IVIG/SCIG distribution in 2013/14 fiscal year for Nova Scotia; Use of IV/SCIG was 339g/PID patient in 2012/13. It decreased to 317grams /patient in 13/14 due probably to the implementation of using dosing body weight for IV/SCIG dose calculations in NS A savings of 1098grams of IVIG 2013/14 due to dosing by body weight

C1 esterase NSPBCP is in the process of compiling CIINH Home Administration Guidelines. There are currently 15 patients being treated with C1INH for Hereditary Angioedema (HAE) in Nova Scotia. Of these, 7 are being treated prophylactically at home through the self administration program.

Red Blood Cells NS RBC working group supported NAC’s recommendation on the use of the AABB Clinical Practice Guideline. Finalizing an algorithm with transfusion triggers and for issuing 1 unit RBCs at a time for implementation throughout NS Reviewing RBC inventory levels based on days on hand and use; decreased inventory by 162 units in NS

Red Blood Cell Dashboard  

PPP Dashboard  

Redistribution of Plasma Protein Products Sites report inventory expiring within 6 months to the NSPBCP who then facilitates the redistribution As a result of the redistribution program, 312 vials of PPPs with a net cost avoidance of $436, 000 have been redistributed within Nova Scotia from April 1, 2013 to March 31, 2014.

Prothrombin Complex Concentrates In 2013/14, utilization (L + UL) increased by 5.7% L/UL-I use = 90.4% UL-N use = 9.6% (22 patients) 16 patients were not on a vitamin K antagonist; 2 patients were on Xarelto (rivaroxaban) 4 patients were on a vitamin K antagonist but the pre-INR was less than 1.7 All patients were either bleeding or requiring an urgent procedure or surgery

Fibrinogen All use in Nova Scotia is currently off-label. In 2013/14, 105 patients received 447 grams. Cardiac surgery - 78.1% Bleeding - 13.3% Liver transplant - 6.7% Other indications - 1.9%

rFVIIa rFVIIa utilization data is captured for use in massive bleeding situations only. Use in massively bleeding patients: 2012/13 - 26 patients received 154 mg 2013/14 - 11 patients received 46 mg (57.7% decrease in the number of patients receiving rFVIIa with a 70% decrease in the volume administered) 2014/15 (Quarter 1) - 1 patient received 12 mg

Massive Transfusion Developing process whereby Paramedic identifies massively bleeding patients to ED and activate the MTP in advance of arrival in order to provide thawed plasma earlier

Bleeding Disorder Clinics Completed a project with adult and pediatric bleeding disorder clinics to document current processes and analyze the adequacy of resourcing levels

Weak D Standardizing Weak D /partial D testing and reporting in Nova Scotia