Joint (PT CBS BLC and NAC) Meeting National Plan for the Management of Shortages of Labile Blood Components Recommendations for Revisions Discussion on Inventory Dr. Susan Nahirniak April 16th, 2014 Joint (PT CBS BLC and NAC) Meeting

History of The Plan In times of severe shortages, the allocation of blood components could present a significant challenge to the provision of health care. In January 2007, to prepare for such a challenge, the Canadian Blood Services (CBS) Provincial/Territorial (P/T) Blood Liaison Committee asked the National Advisory Committee on Blood and Blood Products (NAC) to develop a framework to determine the equitable allocation of labile blood components in times of severe shortage. In response to that request, NAC, in collaboration with CBS and other stakeholders produced a framework document and on September 28 2009, the final document was implemented. On December 07, 2009, the Deputy Ministers agreed to endorse the National Blood Shortages Plan; approve the simultaneous distribution of the plan within each jurisdiction as deemed appropriate by that jurisdiction and, to direct officials to interface their provincial plans with the national plan.

Objectives of the Plan The specific purpose of the Plan is to maximize the effectiveness of a response to any crisis which impacts the adequacy of the blood supply in Canada. The Plan also recommends a proactive approach to inventory management through various Green Phase activities.

Evolution of the Plan Evolution of the Plan There are 2 Committees working together for continuous improvements to the Plan. Blood Shortage Working Group The BSWG is to ensure that the Plan is effective in managing blood product shortages in jurisdictions served by Canadian Blood Services (CBS), allowing for equitable access to blood products across the country. Inventory Planning Sub-Group This subcommittee of the BSWG is mandated to explore and address blood product inventory issues in relation to the Plan. Specifically appropriate hospital inventory levels reflective of the various national blood level phases identified in the national plan.

Revisions since the occurrence of the Nov. 14, 2013 simulation exercise Hold 2 regular teleconferences per year First call to review the Plan for currency Second call to increase awareness Revised Triage Tools Patient Record Triage Tracking Log Job Aid Created A “job aid” - developed by the BSWG to support the NEBMC during an actual blood shortage. This aid summarizes the mandate of the NEBMC, describes the shortage phases/their implications for transfusion, and provides a high-level summary of how communications should unfold once the NEBMC reaches decisions  

The Plan - Edits/Revisions Removed the word “National” from the title as misleading since Quebec is not included Purpose and Scope clarified – process for convening the NEBMC is fluid and can move in many directions ( not just top down) History of Blood Shortages in Canada updated by CBS to reflect a period from 2009 to 2014. Improved CBS Inventory Levels at Green, Amber and Red Phases. This data along with the provision for Hospitals to enter inventory levels into the Inventory Level webpage within the CBS Blood Component and Product Disposition system will enable assessment of TOTAL blood product inventories (blood supplier and hospital combined) across the country in near to real time criteria.

The Plan - Edits/Revisions Link to the CBS’ Business continuity removed as these plans are only posted  internally at CBS and there are many (for various reasons and locations)  which change frequently. Link the Recall notification document to The Plan since a large recall situation could potentially lead to a shortage situation and vice versa, etc. Update Appendices, added duties of for the Secretariat, etc.

The Plan - Edits/Revisions NEW: The BSWG to incorporate all improvements as a result of the NEBMC Evaluation: National Planning for the potential OPSEU strike at CBS (Dec-Jan 2014/15) - Includes improved platelet inventory criteria and management Terminology improvements ( clarity regarding alert versus advisory) Improvements in communication streams with more standard templates / communication briefs provided for hospital medical directors to utilize Clarity regarding the number of days (ie. 365 vs. weekdays only)

Inventory Management Current status: In August of 2013 the CBS PT BLC agreed to support the concept of inventory management with transparent national inventory with an eventual goal of “real time” inventory. Caution noted that real time inventory could be a costly endeavour and that implementation may be many years in the future and dependent on funding. Since May 2014, hospitals may enter inventory levels into the CBS Inventory Level webpage within the Blood Component and Product Disposition system. During situations that require issuing of advisories and/or alerts, hospitals or hospital groups, reporting daily inventory enables CBS and the NEBMC to assess the Total Blood Inventories (CBS and Hospital) across all jurisdictions served by Canadian Blood Services. With this data, CBS and the NEBMC are better equipped to determine appropriate actions required to manage the shortage.

Inventory Management Preferred Goal of BSWG: Hospitals and/or hospital groups would provide daily / regular inventory reporting to CBS through the Blood Component and Product Disposition system during the Green advisory phase, the Amber alert phase, the Red alert phase and the Recovery Phase of a blood shortage. This can be done via the various jurisdictional inventory management tools Actual inventory would then be broken down by group (hospital and provincial) and the use of a unique identifier Inventory Index = Inventory (Group specific or total)/ADRD* *ADRD - Average Daily Red Cell Demand

Inventory Management Real Time Data would provide: Blood Inventory Transparency CBS and the NEBMC with early warning signs of potential shortages making all players better equipped to determine appropriate actions required to manage the shortage. Information regarding hospital inventories in order to assist policy makers with optimal inventory levels.

QUESTIONS