Irradiation Survey Purpose: To further confirm variability in the provision of irradiated blood components to patients across the country (NAC discussion April 2012) Limitations: Survey was not circulated beyond NAC members (except NB). Support to circulate beyond NAC not received from PTs Responses: Survey completed by each province with the exception of Ontario Not all respondents provided answers to all questions Responses reflect practice of large TM hospitals within provinces ‘small’ large hospitals and medium/small sized hospitals not represented (except NB) Most responding sites do not transfuse pediatrics

Irradiation Survey all survey respondents stock and issue irradiated blood components

Irradiation Survey Existence of established policy/protocol outlining clinical criteria for the requirement of irradiated blood components irradiated blood components: 6 – yes 1 – no 3 - skipped question

Irradiation Survey Other triggers for the provision of irradiated blood components: ALL on Dana Farber protocol Leukopenia CLL on campath Upon request of pediatrician Some facilities have a more restrictive policy than others, but it comes down to what the physician orders. Myeloma patients on bortezomib CLL getting alemtuzumab; fludarabine; cladribine; pentostatin Aplastic anemia getting Atgam

Irradiation Survey Patient alert tags – 100% respondents do not issue to patients at risk for graft vs. host disease System (electronic or other) by which a patient's special requirements for transfusion (irradiation) are documented and retained – 100% respondents YES

Irradiation Survey Sharing of information with other hospitals: Physician summary letter. We are working on a transfer of information between blood transfusion services Markers are placed on patient record, physician orders are communicated to other hospital facilities (no formal process for this) Irradiation appears as a transfusion directive in our local transfusion information system (Traceline) and is automatically electronically transferred to the provinical transfusion server accessible to all blood banks in the province

Irradiation Survey Sharing of information with other hospitals (con’t): 1-page notification (developed by TMS with BMT) sent from BMT clinic to home hospital TMS at discharge. Compliance poor. SCT recipients are provided with application for medic-alert bracelet. Estimated uptake 70% This is done at the discretion of the ordering physician Letter of notification when patient is discharged from site initiating irradiation request goes to new physician, hospital blood bank likely to see patient in future and to CBS Patient Testing services. If it is a patient requiring irradiation following stem cell transplant, that information is captured in the provincial electronic health record Within province, one lab information system containing this information.

Irradiation Survey Are standing orders for irradiated blood components reviewed on a regular basis? YES – 5 NO – 2 Skipped question - 3 If yes, by whom? Technologists and if outside guidelines by supervisor and pathologist Decision support tool for RBC/platelet order prompts ordering MD to review requirements for irradation on reverse of page Transfusion medical director who will then send letters to the appropriate attending physician if it is unclear as to whether or not to continue.

Irradiation Survey Next steps? Decision Point – Does NAC want to pursue the development of national recommendations highlighting appropriate clinical triggers for the provision of irradiated blood components to adult patients?