- The plan should include fundamentals of change outlined in the National Quality Forum (NQF) safe practices, including awareness, accountability, ability, and action \cite{at36}.
- Hospital governance and senior administrative leadership must commit to increase awareness of this major performance gap in their own healthcare environment.
- Hospital governance, senior administrative leadership, and clinical/safety leadership must close their own performance gap by implementing a comprehensive approach to addressing the performance gaps identified above.
- A time line with defined deliverables should be set to implement the plan to address the gap with measurable quality indicators - “Some is not a number. Soon is not a time" \cite{sonot2}.
- Specific resource allocations for the plan should be evaluated and approved by governance boards and senior administrative leaders.
- Clinical/safety leadership should endorse the plan and drive implementation across all providers and systems.
Practice Plan
- Establish a Patient Blood Management Committee and appoint an individual to be responsible for leading this group.
- Patient Blood Management Coordinator and her/his team should engage in early communication to key stakeholders (stakeholder management).
- The committee should establish a comprehensive plan for anemia management
- Measurable outcomes with benchmarks for individual and departmental goals
- A comprehensive education program should be developed for emergency and elective admissions. This should be targeted to medical students, physicians, nurses, pharmacists and other health care staff, and focused on Patient Blood Management program’s goals, structure, and scope.
- Online E-Learning course and receive a “Patient Blood Management certificate”
Interdisciplinary Blood Conservation Modalities\cite{Goodnough_2013}
- Reduce unnecessary laboratory tests, the frequency of sampling, the “discard” volume when samples are obtained from indwelling lines, and the blood waste by the use of closed blood sampling systems for arterial and central venous lines, are recommended.
- Introduce a protocol for management of platelet inhibitors and other anticoagulants preoperatively.
- Consult the appropriate blood conservation specialists early in cases with physiologic deterioration or complications.
- Guidelines, for anemia therapy including transfusion thresholds, checklists and SOPs should be established in cooperation with all stakeholders.
Anemia Management