National Blood Supply Contingency Plan
In November 2008, the National Blood Authority (NBA) launched the National Blood Supply Contingency Plan (NBSCP).
This plan provides a defined structure for a coordinated national response to blood product shortages and other threats to the blood supply. ARCBS participated in the development of the plan. The clinical community plays a central role in the NBSCP in ensuring appropriate clinical transfusion and optimal inventory management practices, and the prioritisation of available blood supplies to those patients with the greatest clinical need. Therefore, it is imperative that institutions have in place appropriate arrangements to support the plan. The NBA has produced two quick reference guides to assist the clinical community in understanding the plan and develop approaches to prioritising red cell transfusions.
The NBSCP, its annexes and the quick reference guides are available to download from the NBA website.
NBSCP - The Laboratory Perspective
What should your laboratory be doing in response to the NBSCP?
It is important that your laboratory is familiar with the requirements of the NBSCP, electronic copies of which can be downloaded from the NBA website. Raise institutional awareness of NBSCP
The healthcare facilities to which you supply blood products must also be aware of the NBSCP and its implications.
Governance of transfusion activities is normally the role of a local hospital transfusion committee (HTC) or another appropriate committee incorporating similar responsibilities, of which the laboratory must be an active participant. If such a committee does not already exist, one should be convened.
The HTC (or its equivalent) should, therefore, assume responsibility for local implementation of the NBSCP and coordinating organisational preparedness for blood product shortages.
The NBSCP must be considered part of the organisational (or wider area) emergency planning framework and an organisational Emergency Blood Management Plan (EBMP) should be prepared accordingly.
Appropriate usage of blood products
Maintaining an adequate blood supply requires that the available blood product inventory is used appropriately and not wasted. Proactive management of blood product stocks by the laboratory rather than a reactive response to shortage should be the primary focus.
At the organisational level there should be policies directing appropriate blood product utilisation and minimisation of unnecessary wastage and these should be promoted by the HTC.
Blood product inventory levels
Details of your laboratory’s blood product stock levels will be required to be submitted daily to ARCBS.
This should be done as directed by your local ARCBS Distribution department.
It is important that ARCBS have accurate daily jurisdictional and national figures showing blood product stocks and how the inventory is distributed between the various institutions and ARCBS.
This data is used to populate the ARCBS National Inventory Model on which production and supply decisions, including interstate transfers, are made.
Availability of blood products
When blood product stocks are adequate, your institution’s orders will be met with little or no adjustment.
When ARCBS stocks drop below predefined levels, there will be restrictions on what can be supplied and, where necessary, this will be under the direction of ARCBS Medical Officers in consultation with the local clinician.
If stocks do not improve, the NBA will activate the NBSCP and you will be informed accordingly. You will be expected to follow the requirements of the plan for managing use of blood products including appropriate prioritisation of transfusions. Clinical consequences of activation of the NBSCP
The clinical response to blood product shortages and when the NBSCP has been activated, particularly at the more serious levels, will rely on clinicians and laboratories being able to reduce demand through strong triage and vetting of requests of blood products.
You will liaise with your local clinicians and, where necessary, ARCBS medical staff, as part of the decision making process.
In deciding whether or not to transfuse, clinicians will use their clinical judgement to assess product requirements based on the diagnosis of their patients and knowledge of what products (or alternatives) are available.
Conclusion
The NBSCP is an important document, providing a process for managing critical shortages in the supply of blood product.
The plan should, however, be seen as a living document and regularly reviewed in conjunction with the HTC and other key stakeholders.
Awareness of the document and its implications is essential in preparing your laboratory, and the facilities to which your laboratory supplies blood products, for those situations when the plan is activated.