1. What Would You Do If There Was A Shortage In The Blood Supply? Helping Hospitals Prepare… Version 2: March 31,2008

2. 2 If there are any changes to this document please indicate so by adding your hospital logo. Outline  Background  Definitions  Phases of the Blood Shortage Plan  Key elements of an Emergency Blood Management Plan  Summary  Conclusion  References

3. 3 If there are any changes to this document please indicate so by adding your hospital logo. Background  Contingency planning against the global threat of pandemic flu continues to gain attention  Some disruption to the blood supply is expected  Blood shortages can result from other causes  The goal is to ensure secure access to safe blood components or products for patients who are most in need of them in times of critically low inventory levels  Regulatory requirement

4. 4 If there are any changes to this document please indicate so by adding your hospital logo. CSA Z902-04 National Standards on Blood & Blood Components  4.2.1.5 Each facility shall have an emergency plan that provides specific procedures to be followed in response to incidents that could endanger the safety, quality, efficacy or level of supply of blood or blood components, or the safety of donors or recipients.

5. 5 If there are any changes to this document please indicate so by adding your hospital logo. Ontario Laboratory Accreditation (OLA) Requirements: ver. 4 Dec 2007  I.C.5 Laboratory management shall be responsible for strategic and emergency planning, setting goals and if appropriate, directing research and development.  Guidance: TM180 The emergency plan shall address the safety, quality, efficacy and level of supply of blood components / products during an emergency or disaster.

6. 6 If there are any changes to this document please indicate so by adding your hospital logo. Ontario Contingency Planning Working Group (CPWG)  Subcommittee of Ontario Blood Advisory Committee (OBAC) – offers advice on blood issues to MOHLTC Blood Programs Coordinating Office (BPCO)  Hospitals, OHA, OBAC, Patients, CBS, ORBCoN and MOHLTC represented  Development of plan in consultation with hospitals  Distributed to hospitals on January 31, 2008 via email  ‘Toolkit’ developed to aid hospitals in preparing facility specific plans  Working and sharing with other provincial blood offices to ensure smooth interface with CBS

7. 7 If there are any changes to this document please indicate so by adding your hospital logo. Survey of Ontario Hospitals  May 2007 – ORBCoN sent a survey to 158 Ontario hospitals asking about inventory management practices and the status of contingency planning  100 responses were received  Only 18% of hospitals that responded reported that they had a plan in place to address blood supply shortages  Over 94% responded that they believe there should be a consistent approach throughout Ontario

8. 8 If there are any changes to this document please indicate so by adding your hospital logo. Definition of a Blood Shortage  Short Term Regional Shortage:  Event affecting a single regional blood centre  Local disaster (i.e. explosion, large scale trauma)  Short Term National Shortage:  Event affecting more than one regional blood centre  Labour disruption; IT system failure; transportation chain failure

9. 9 If there are any changes to this document please indicate so by adding your hospital logo. Definition of a Blood Shortage (cont’d)  Prolonged and Severe Shortage:  Change to donor deferral policy affecting a large proportion of blood donors  Pandemic flu or other illness resulting in a severe reduction in donor attendance and / or blood centre personnel  Failure of contracted manufacturing supplier (plasma protein product, blood processing or collection supplies)

10. 10 If there are any changes to this document please indicate so by adding your hospital logo. Phases of a Blood Shortage Plan PhaseInventory LevelHospital Action GreenNormal Practice good blood management, develop plan AmberReduction of inventory by up to 50% Reduce inventory held by 50% Initiate internal communication Emergency blood management committee (EBMC) meets Triage blood requests Review elective OR cases, consider deferral RedShortage is severe and anticipated to be prolonged Reduce inventory to critical levels Initiate heightened internal communication EBMC meets and initiate plan for reduction of blood use Blood issued only for life threatening need RecoverySupplier inventory improves Ensure return to normal operations occurs at a gradual and controlled pace

11. 11 If there are any changes to this document please indicate so by adding your hospital logo. Green Phase – Develop Your Plan A.Good Blood Management I.Inventory levels defined II.Protocol to review blood usage and ordering practices to optimize utilization III.Minimize blood component / product wastage B.Develop an Emergency Blood Management Committee I.Include staff who order, issue and administer blood as well as senior administration II.Goal is to ensure all relevant hospital personnel will respond in a coordinated manner III.Strategies for reduction in the use of blood components and / or products must be defined C.Develop a hospital contingency plan to respond to a reduction in the availability of blood components or products

12. 12 If there are any changes to this document please indicate so by adding your hospital logo. Emergency Blood Management Plan (EBMP) – Key elements  Identify key individuals to notify if a severe blood shortage occurs (include Technical, Medical, Nursing and Administrative staff)  Develop a communication strategy around notification  Develop a guide to stepwise reduction of blood use increasing the restriction down to extreme critical levels  Contact and work with nearby hospitals to implement processes to allow for transfer of blood products between sites  Include plan for recovery in a managed and controlled manner to ensure inventory levels can improve and stabilize before usage returns to normal activity

13. 13 If there are any changes to this document please indicate so by adding your hospital logo. Key Individuals  Emergency Blood Management Committee (EBMC):  Transfusion Service Director and Manager, Anaesthetist, Surgeon, Hematologist/Oncologist, Chair of the Hospital Transfusion Committee (HTC), Transfusion Nurse Specialist, ER physician, Risk Manager  Notify:  CEO, Medical and Chief of Staff, Division Chiefs for Surgery, Anesthesia, Trauma/Emergency, Hematology and Medicine, Directors of Laboratory, Diagnostic Services, Nursing, Head of facility disaster planning  HTC members, EBMC members  Risk Management, Patient relations, Public relations

14. 14 If there are any changes to this document please indicate so by adding your hospital logo. Communication Plan  Prepared phrases can be used (templates) and customized as required by the situation  A list of who to contact and at what phase of the plan to contact them should be prepared and approved by the EBMC  Release of communications should be the responsibility of the Transfusion Service Director  Communication should clearly state how decision making around blood issuing will be managed, dependant on the severity of the inventory restriction  Ensure close communication is maintained with the blood supplier – Canadian Blood Services

15. 15 If there are any changes to this document please indicate so by adding your hospital logo. Guide for Restriction of Blood Use  This guide should be developed and adopted by the EBMC, examples include:  Reduce inventory held on site by 50% or more  Close review of blood order requests and follow strict protocol for acceptable ordering  Reduce dosage per treatment where feasible  Review of elective surgical list for possible deferral of cases that have a high probability of blood use  Restrict blood usage to life threatening situations only

16. 16 If there are any changes to this document please indicate so by adding your hospital logo. Transfer of Blood Between Sites  Develop relationships with other nearby facilities  Develop plan for transferring products between sites to optimize available blood inventory during a severe shortage to ensure patients in the most need will be supported  Redistribution plans may already be in development

17. 17 If there are any changes to this document please indicate so by adding your hospital logo. Recovery  Critical piece of plan  Notification of recovery should be issued to those that originally received notification of the shortage  Requests for blood components/products should continue to be restricted for a period of time  Blood usage should resume very gradually and in a controlled manner  Refer to guide for the restriction of use and slowly return in a step wise manner to normal utilization activity

18. 18 If there are any changes to this document please indicate so by adding your hospital logo. Summary Review generic plan from BPCO CPWG and customize Establish EBMC in your facility or region Raise awareness of plan and train Medical, Nursing and Administrative staff Develop communication plan – who will be notified, template of messages, who will liaise with blood supplier Know what your ideal inventory is (min/max) Develop a plan to reduce blood use Develop plan for recovery

19. 19 If there are any changes to this document please indicate so by adding your hospital logo. Conclusion  A blood shortage can occur when it is least expected  Rare occurrence means staff feel unprepared to respond if there is no plan in place and no training has been done  A communication plan will ensure that the appropriate people receive information to improve decision making  Planning and practice improve confidence and the ability to react consistently, rationally and efficiently

20. 20 If there are any changes to this document please indicate so by adding your hospital logo. References Brecher ME Editor, AABB Technical Manual 15th Ed. P67-68 AABB Bethesda MD 2005. Disaster operations handbook. AABB Bethesda MD 2003. Emergency Planning – development of an integrated plan for the management of blood shortages. NHS Gateway ref 3344, Department of Health 23 July 2004. Development of an integrated blood shortage plan for the National Blood Service and hospitals. NHS and NBS Chief Medical Officer’s National Blood Transfusion Committee Dec 2004. An integrated plan for the National blood service and hospitals to address Platelet shortages. NHS and NBS Chief Medical Officer’s National Blood Transfusion Committee. Gateway ref 6514 06 Sept 2006. How do I manage a blood shortage in a transfusion service? Transfusion 2007;47:760-762 Provincial contingency plan for blood component / blood product shortages in Nova Scotia. Draft 4 04/06. Contingency plan for Management of blood product shortages, Ontario BPCO contingency planning working group. Jan 29, 2008. Managing a disaster. Marc Lewis AABB presentation Oct 24/06 Planning for a natural or man-made disaster at hospitals and blood centers. www.cbbsweb.org/enf/disasterprep.html www.cbbsweb.org/enf/disasterprep.html Transfusion Management in Trauma and Mass Disaster, Presentation at AABB 2005, Seattle. Emergency Preparedness, Presentation at AABB 2005, Seattle. The lessons of September 11th. A Dajer. Top Emerg Med 2002; 24(4): 7-11. Hurricane Katrina disaster recovery: Lessons learned. Beryl Lebeau-Laird. AABB presentation Oct 24/06. L’experience. Qu’est-ce qu’on a appris? Anna Urbanek et Ann Wilson. CSTM presentation Quebec City, Que. Feb 16/07. CSA National Standards for Blood and blood components CSA Z902-04. Ontario Laboratory Accreditation (OLA) Requirements version 4 released December 2007.