Five Steps to PBM Success

This article appears in the March 2013 issue of HealthLeaders magazine.

The patient blood management program at Eastern Maine Medical Center has compelling data. Irwin Gross, MD, medical director of transfusion services and PBM, attributes the hospital's success to five actions.

1. EMMC leadership gave the nod for him to devote significant time to educate physicians, nursing staff, pharmacists, and perfusionists that "if we transfuse unnecessarily, we could hurt our patients," and that safer practice would be "a team effort."

2. The organization embedded PBM protocols into the hospital's electronic medical record system to extract blood utilization data that was fed back to physicians and surgeons. EMMC also hardwired clinical protocols into a computerized physician order entry system. Those actions removed the old, yet still widely used, tradition in which a decision to transfuse results automatically in two or three units, even if only one is required.

"We drove home that each unit of red cells is an independent clinical decision, and that a standard transfusion should be one unit," after which the patient would be reassessed for each additional unit, Gross says. Now, 85% of orders for blood are for a single unit.

3. Systematic evaluation of elective surgical patients' red cell levels is done before surgery. In some cases, doses of intravenous iron or erythropoietin are provided so the patient is not anemic when undergoing the procedure.

4. The hospital reduced the inventory of blood and cut back on waste associated with expired product.

5. Aggressive use of intraoperative cell salvage is now done to collect blood shed during surgery. Cell savers are now part of the room setup for about two dozen procedures that have high rates of blood loss. "They're in the room before the patient gets there," Gross says.

"We were outliers, or pioneers, five or six years ago," Gross says. "But we're about to become part of the mainstream as these very large and well-respected institutions join with us in promoting PBM."

—Cheryl Clark

This article appears in the March 2013 issue of HealthLeaders magazine.