1. Manitoba Report for NAC October 15,16 2015
Debra Lane, MD FRCPC

2. The Manitoba Innovation Awards for the 2015 Health Innovation Conference / LEAN Congress
Recognizes leadership in innovation and to celebrate excellence in quality improvement.
Award nominations were submitted for Program Teams and/or Individuals in five categories.
The Knowledge Transference and Training Award recognized initiatives that have enhanced knowledge transference
Knowledge Transference and Training Award for 2015 was awarded to the submission for the  Best Blood Manitoba website – Diagnostic Services Manitoba
The Manitoba Innovation Awards for the 2015 Health Innovation Conference / LEAN Congress recognize leadership in innovation and to celebrate excellence in quality improvement.  Award nominations were submitted for Program Teams and/or Individuals in five categories.
The Knowledge Transference and Trainingrecognizes initiatives that have enhanced knowledge transference and training within or across organizations and health care professions to improve access to care, scheduling, service availability, accessibility, accommodation, affordability, acceptability and reduced time between health care events.
Manitoba is proud to share that the Knowledge Transference and Training Award for 2015 was awarded to the submission for  Best Blood Manitoba – Diagnostic Services Manitoba

4. Choosing Wisely Canada
Transfusion Medicine 10 Recommendations

5. Choosing Wisely for Transfusion Medicine
1. Don’t transfuse blood if other non-transfusion therapies or observation would be just as effective.
Blood Conservation Service is available to assist physicians and their patients on the use of alternatives to transfusion. See
2. Don’t transfuse more than one Red Cell unit at a time when transfusion is required in stable, non-bleeding patients.
Blood Management Rounds and the Manitoba Nursing Working Group have discussed this. Additional education information available on the Provincial Transfusion Practices endorsed poster “Transfuse Safely”

7. 5. Don’t routinely use plasma or prothrombin complex concentrates for non-emergent reversal of vitamin K antagonists.
Education currently being provided to Community sites and hub sites around reversal of vitamin K antagonists.
Additional information and educational videos are available on Best Blood Manitoba.
6. Don’t use immunoglobulin therapy for recurrent infections unless impaired antibody responses to vaccines are demonstrated.
Information on the utilization of IVIG by diagnosis and physician has occurred.
Additional resources required to take further action on this project.

8. 7. Don’t order unnecessary pre-transfusion testing (type and screen) for all pre-operative patients.
Current guidelines are set by Clinical programs. Abuse has not been identified.
8. Don’t routinely order perioperative autologous and directed blood collection.
Use of Autologous and Directed blood is very rare. No Directive donation for 7 years. Only done for rare blood types. Autologous was 25 a day and now 25 a year.

9. 9. Don’t transfuse O negative blood except to O negative patients and in emergencies for female patients of child-bearing potential of unknown blood group.
Manitoba has had this policy in place for many years. Compliance is excellent.
10. Don’t transfuse group AB plasma to non-group AB patients unless in emergency situations where the ABO group is unknown.
Rural sites now have additional groups of plasma in stock to ensure this recommendation is followed.

10. Choosing Wisely Recommendations not yet addressed
3. Don’t Transfuse plasma to correct a mildly elevated (<1.8) international normalized ration (INR) or activated partial thromboplastin time (aPTT) before a procedure.
4. Don’t routinely transfuse platelets for patients with chemotherapy-induced thrombocytopenia if the platelet count is greater than 10 x 10⁹ (utilization of platelets in Manitoba requires further audits. Transfusion Medicine physicians on call are monitoring any order >2 doses)

11. WHY: Province-Wide Transfusion Medicine Laboratory Information System
Patient Safety
Inventory Management of Blood Components and Derivatives
Utilization information
Electronic traceability of products (vein to vein)
Improve Turnaround times (samples came from Hospitals to CBS Crossmatch Laboratory for testing and issuing of red cells and platelets)
Reduce red cell and platelet returns from Winnipeg hospitals to the CBS Crossmatch Laboratory
Discontinue red blood cell in-date discards for rural Hospitals (blood was not returned from rural hospitals for re-issue)
Sharing of perinatal database to manage Perinatal antibody cases.

12. Traceline Locations

13. Was Patient Safety Achieved?
Centralized database
Protocols visible to all sites
Previous transfusion reactions identified
75% of patients have a blood group on file
90% of patient testing done on automated equipment to reduce technologist errors

14. Is There Better Inventory Management?
Electronic traceability of products
Interfaces to ePROGESA and SAP eliminated transcription errors related to recording donation/lot numbers received
“Confirmation of Transfusion” is used as the official system of record to identify patients transfused
Ability to provide patients with individual transfusion history records if required, without manually searching patient charts

15. Is There Better Inventory Management?
Reduced number of returned products from Winnipeg Hospitals to CBS from 40,000/year to less than 1,000/year
Accepting returns was a significant workload and inventory management issue at both CBS and Hospitals
Improper documentation resulted in a significant number (1,000) of unnecessary discard of red cells which is now avoided.

16. Reductions in Discards Post-Traceline
Name of site
Date of implementation
RBC Discarded units 6 months pre-implement
RBC Discarded units 6 months post implement
RBC Average monthly discards pre-implement
RBC Average monthly discards post implement
RBC Average units saved per month
Selkirk
2012 October
122 21
20.3
3.5
16.8
Portage
2014 February
109 33
18.2
5.5
12.7
Steinbach
2014 December 68
11.3
7.8
Boundary Trails 42 24 7 4
1.3
Swan River
2014 June 75 59
12.5
9.8
2.7

18. Turnaround Time Changes
Winnipeg 41% of requests are ordered STAT
Brandon 49% of requests are ordered STAT
>90% of all matches are now electronically matched at Hospital Trace Line sites
TAT in Winnipeg has been reduced 35 minutes (78%) since (based on St. Boniface data)
If there is an in-date crossmatch sample, TAT has been reduced to 15 minutes from 60 minutes (75%).
TAT reduction for rural issuing sites not determined but thought to be as much as 24 hours
Potential for additional reductions in TAT as “Hub and Spoke” model is implemented

20. Massive Transfusion
Implemented at largest site –Health Sciences Centre
Second largest site-St Boniface- to be implemented November 2015