patient blood management in Italy

1. A PBM model applicable to the italian
contest and the nurse's role
Davide Basso

2. Background
Frequency - more than we think
Risks - higher than many believe
Costs - very high and difficult to quantify
Clinical behaviors - not evidence based

3. How fix it?
Patient Blood Management

4. A. Shander et al. Patient blood management in Europe; British Journal of Anaesthesia. 2012; 109 (1): pagg 55-68
Does PBM works on changing clinical behaviours?

5. In Europe, taking as a reference the transfusion rate of Netherlands and
Ireland, you would get a total annual savings of 5,362,000 units of
packed red blood cells
European benchmarking to get best practice
Modified from: Gombotz H. et al. Last dataset from 2011.

6. Italian program of self-sufficiency
Centro Nazionale Sangue

7. I.R.C.C.S. Policlinico San Donato

8. Muñoz, M., et al. ‘Fit to fly’: overcoming barriers to preoperative haemoglobin optimization in surgical patients. British
Journal of Anaesthesia, 2015; 115 (1): pagg 15-24.
Requirements to support the implementation of Patient Blood
Management programs

9. 12 standard of the Society for the Advancement of
Blood Management - SABM
1. Leadership and program structure
2. Consent process and patient directives
3. Blood administration safety
4. Review and evaluation of the pbm program
5. Transfusion guidelines and peer review of transfusions
6. Preoperative anemia evaluation and readiness for surgery
7. Perioperative autologous blood collection for administration
8. Phlebotomy blood loss
9. Blood loss associated with surgery, procedures and underlying
medical conditions including antithrombotic therapy,
antiplatelet therapy and coagulopathy
10. Massive transfusion protocol
11. Management of anemia in hospitalized patients
12. Management of anemia in non surgical outpatients.

10. NBA & CNS

11. National Blood Authority
Educational platforms and network of discussion on PBM issues
Operational tools and guidelines
PBM Nurses detecting problems and coordinate solutions
Databases
Presence of a strong centralization of policies that can push for change

12. Factors that hinder the change
Poor knowledge of the alternatives to transfusions
Fear about increasing the risk of complications
Fear about the initial cost of PBM implementation
Shortage of staff with the know-how in the PBM field

13. How to implement a PBM program in your
organization?
Create internal guidelines and legal protocols
Staff training
Collection and analysis of data
Involvement and open communication with the internal and
external system

14. advocacy
safety
education
Transfusion Nurse TN specialist or consultant Transfusion Safety Officier
Hemovigilance Officier Specialist Practitioner of Transfusion
PBM Nurse PBM Coordinator
These are educators, researchers and managers
at the same time
What is the nurse's role in this process?

15. Conclusions
Are we ready, in Italy, to train nurses with these skills?
Legge n. 251, 10 agosto 2000
Legge n. 43, 1 febbraio 2006
Bozza di Accordo sulla ridefinizione competenze 2014
Fundamental and necessary step, a revision of the training offer, especially
post bachelor deegree, and as a natural consequence of an extension of
competence and responsibilities.
So why not take up the challenge

16. Document approved by the Central Committee of the Italian Federation of Nursing, 25 April 2015.
Possible evolution of Nursing Skills in Italy

17. Thank you