The World Health Organization (WHO) supports PBM and has identified a number of priorities for action at international, national and hospital level (see reference). WHO has also developed Aides-Mémoire on key topics in transfusion safety to convey important messages to ministries of health and health professionals around safe and appropriate clinical use of blood. These are available here. 

Establishing a PBM strategy needs leadership and support at all levels, from national and regional government policymakers and managers, to executive management and health professionals from various clinical disciplines within hospitals, and active participation by patients. Patient are at the centre of PBM and active participation of patients in the planning, implementation and evaluation of PBM programs is essential. 

At an operational level, the cornerstone of a PBM program is the multidisciplinary team.

General practitioners, surgeons, anaesthetists, nurses, haematology/transfusion medicine and laboratory staff all have important roles to play in surgical PBM and should be engaged in the development and implementation of the PBM strategy. In the non-surgical setting, PBM strategies also apply for paediatrics, haematology, obstetrics and other clinical specialties. Many examples of how to develop and establish a PBM strategy and supporting tools and other materials for patients and staff are available, including:

 

The key elements are

At national/regional level:

1. Define a PBM strategy with department of health and executive support

2. Define key areas for action and the potential benefits

3. Define the framework with resources and personnel to support implementation

4. Identify standards that can be used to assess participation and compliance 

5. Develop guidelines and tools to support implementation and monitoring that can be adapted locally by hospitals

At hospital level:

1. A hospital PBM policy based on national/regional guidance above supported by the Hospital Transfusion Committee with senior medical/ nursing/ management support

2. Hospital-wide awareness and education

  • Medical, nursing, laboratory staff, in all clinical areas that administer blood and components
  • Identify clinical champions in key disciplines
  • Include in induction for new staff
  • Clear messages: posters, intranet, newsletter

3. Guidelines promoting appropriate use of blood and components and alternatives

4. Inform and involve patients 

5. Review information technology available to support PBM to collect blood usage data, support audit, computerised physician order entry (CPOE) systems

6. Audit and data collection – consider benchmarking internally and externally; feed back data to all relevant teams

 

 

The authors

Erica Wood

Erica Wood

Professor, Transfusion Medicine Specialist, Transfusion Research Unit, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia

Shubha Allard

Shubha Allard

Consultant Haematologist, NHS Blood and Transplant and Royal College of Pathologists, London, UK.