Joint CBS PT BLC and NAC Face to Face Meeting

Joint CBS PT BLC and NAC Face to Face Meeting

Thursday, April 16, 2015 8:00 – 1:00 pm ET

Fairmont Château Laurier, Ottawa, ON

MINUTES

Participants:
CBS PT BLC
Wendy Peppel , Co Chair MB / Lindy McIntyre, Co Chair CBS / Katherine Fraser, NS
Violet Van Hees, YT regrets / Kim Riles, NT / Sonia Marchand, NU regrets
Wendy Vowles, BC / Glenna Laing, AB / Bernadette Muise, NB
Judy Hoff, SK / Dai Kim, ON / Angela Carpenter, PE
Marilyn Collins, NL / Jean-Paul Bédard CBS
NAC
Brian Muirhead (BrM), Chair NAC, MB / Lakshmi Rajappannair (LR), NB / Shelley Stopera (SS), MB
Susan Nahirniak (SN), AB / David Anderson (DA), NS / Ted Alport (TA), CBS
Jennifer Fesser (JV), PE / Katerina Pavenski (KP), ON / Alan Tinmouth (AT), ON
Debra Lane (DL), MB / Taher Rad (TR), AB / Lucinda Whitman (LW), NL
Kathryn Webert (KW), CBS / Irene Sadek (IS), NS / Rick Trifunov (RT), CBS
Dana Devine, CBS / R / Robert Coupland, BC / R / Doug Morrison, BC / R
Vincent Laroche, QC / R / Darlene Mueller delegate for Doug Morrison and Bob Coupland
PT Guests
Sacha Janzen, MB / Barbara Kraft, MB / Marina Hamilton, NS / T
Samantha Cassie, AB / T / Phillip Davidson, BC / T
CBS Guests
Peter Saunders / Cheryl Doncaster (CD) / Judie Leach Bennett
Margaret Fearon / T / Adrienne Silver / Cassandra Tavares
Amanda Cullen
Other
John Rumboldt (CBS consultant) / T / Gabriella O’Reilly / T = via teleconference
Agenda Items / Discussion/Actions / Action Items/Decisions /
1.0 Welcome and Lead Transition / Opening remarks – transition New Brunswick (NB) to Manitoba (NB).
o  Appreciation extended for NB efforts including the Senior Manager, Bernadette Muise and her staff as well as Dr. Lakshmi Rajappannair as the outgoing National Advisory Committee Chair.
o  Dr. Brian Muirhead, from Manitoba, was identified as the Chair for the next two year term.
o  Dr. Muirhead requested continued NAC membership support.
2.0 Review/Approval of Agenda
2.1 / 2.1 Joint CBS PT BLC / NAC April 16, 2015
Additions
·  Allergic reactions issue
·  Tretton
3.0 Approval of Minutes / 3.1 CBS PT BLC NAC Meeting April 30, 2014 / Approved with minor edits
CBS Customer Letter RE: Tretton / ·  Recent CBS customer letter for Tretton requests hospitals provide personal health information (PHI). PTs noted concern that CBS is requesting PHI directly.
·  Response: CBS has negotiated with the supplier who has agreed to provide rebate for partially used product in paediatric cases as there is only a single vial size available. CBS PT BLC Members reached agreement that the letter and the form require revision; form revisions to include rationale and requirement for weight/age but no other patient information. The customer letter and revised form are to be re-issued. / Action: CBS will revise the form: de-identify the personal health information data request and re-issue the customer letter for Tretton utilization.
IVIG Reactions / ·  Recent series of severe allergic reactions. MB had some reactions as well.
·  SN to circulate a poster from AABB comparing the various manufacturers’ adverse events.
·  Concerns regarding the mechanism for communicating significant adverse events, noting delays occur when only reporting to Health Canada (HC) and the manufacturer of the product.
o  Areas requiring further discussion:
–  NAC cannot be the sole mechanism of identifying and communicating information regarding ‘clusters’ of reactions.
–  A comprehensive process could include Provincial/Territorial (PT) Blood Coordinating Programs; however not all PTs have one.
–  Further consideration to develop a comprehensive information gathering mechanism to inform decision making and next steps; may need to consider that hospitals may be underrepresented using an informal process. / Action: SN to send to MB NAC coordinator for distribution to the membership (See attached).
Action: Defer further discussion to April 17, 2015 Health Canada (HC) presentation.
There is a need to define a mechanism for reporting significant adverse events to HC.
4.0 NEBMC Update
4.1 NEBMC Debrief – Results of survey / 4.1 National Emergency Blood Management Committee (NEBMC): Work continues to identify and address gaps following the potential labour situation in ON affecting CBS staff. A follow up survey aimed to evaluate the process and provided an opportunity to test the current shortage plan and level of preparedness. Most PTs were satisfied with the communication process; however, the teleconferences were not as well managed. Concerns regarding the optics of CBS’ request to Ontario hospitals to hold additional stock. Appeared to other jurisdictions that ON hospitals were stockpiling. Appropriate communications to PTs may resolve this issue. The NEBMC working group will meet in May to review the list of gaps identified.
Secondary discussion about a national plan for the management of platelets in a shortage. The potential labour disruption identified a high possibility of running out of platelets within two days of an actual strike. Follow up communication was revised and CBS agreed to be sent out on behalf of the committee. Following confirmation that no labour disruption was imminent CBS, decided not to send it without further input from the NEBMC committee. An agreed to process was not followed and this needs to be addressed to ensure collaborative communications processes are followed. / Action: NEBMC Working Group will continue to evaluate the survey results in more depth and meet in May. CBS will analyze and bring back to the smaller group.
5.0 Transparency of Inventory Data / 5.1 Briefing Note: See briefing note submitted by CBS. Blood Component and Product Disposition System. Webpage set up for hospitals to report inventory.
MB data is provided through automatic extract from Trace Line, therefore, no additional work required at the hospital. Inventory reports refresh every hour.
The national inventory report is three levels, showing PT roll up. Disposition data used for ADRD calculation is currently at six months but moving to 12 month rolling data. PT support is required as the HLS team identifies how many hospitals from their jurisdiction would constitute 100% reporting.
Discussion Points
·  Current national inventory report is automated and non-anonymized.
·  Transparency of inventory levels
·  IT options to eliminate the manual data entry work by hospitals need to be found.
·  Just over 20% hospitals are reporting disposition data by ABO. Only NL and MB are at 100%.
·  CBS is currently preparing individual inventory trend reports for hospitals; calculating average daily red cell demand, inventory index.
o  Reviewed all provincial shortages plans to determine min amber and min green levels – 2 day, 3 day. Calculated up to 6 day using ADRD and plotted within inventory trend reports.
o  The daily inventory reporting is very important for CBS, however compliance is an issue. Local CBS inventory is included but it is not linked to individual hospitals. It is provided with a provincial context.
o  Consideration of data usage linking to blood ordering systems.
o  CBS indicated there may be opportunities for additional savings once an IT system can be set up to manage. CBS is interested in setting up inventory reporting to coincide with a top up of stock orders. While this may work, CBS will need to ensure jurisdictional requirements are met.
o  CBS requested identification of any potential restrictions to sharing the national report. / Action: Cheryl Doncaster to follow-up with another briefing note requesting decision regarding the distribution of the non-anonymized national/provincial inventory reports.
PT BLC committee will review revised briefing note for decision on the non-anonymized data collection.
6.0 National Plan for Management of Blood Shortages
6.1 Recommendations for further revisions
6.2 Discussion on Inventory / 6.1 Blood Shortages Working Group (BSWG) presentation- Review of the National Plan
Endorsed by DMs in 2009; two committees were established (BSWG and the Inventory Planning Sub-Group)
·  Gaps identified -- only CBS stock inventory data was available.
·  Consensus to retain the title as ‘National’ Plan.
–  Incorporate improvements/gaps identified during recent events. i.e. Amber Alert – relates to Child abduction.
–  Translation to French will be done once any revisions are complete.
–  Purpose and scope clarified. History of shortages now included.
–  Reference to the CBS Continuity plan to be removed.
·  CBS would like to work towards getting regular daily inventory data in order to get accurate average daily red cell demand data. This request will go to the BSWG for further discussion and recommendation.
·  Platelets reporting and usage requirements will likely need some changes based on current information.
·  It was noted that there are two important pieces related to inventory and disposition data in order to look at cost effectiveness and efficiencies.
·  CBS noted that human resources (HR) are a big challenge. CBS is recommending the benefits of daily reporting. Question: Can PTs make a commitment to provide the data weekly? Response: PTs agreed with a caveat: once all the reporting is in place that becomes part of Phase One of the Shortages plan. BSWG is tasked with finalizing the document for distribution in June.
·  CBS will explore automated data collection. Specifically, CD would like to partner with some hospitals to pilot and automate set up. / Action: BSWG meeting to be scheduled in May. BSWG to revise the document and circulate to NEBMC members in June.
Action: Recall notification document to be updated by the NAC Coordinator.
Action: PTs will review and address the DM endorsed reporting process in a shortage situation, within respective Ministries.
The January experience is justification for an ongoing practice.
Request that PTs are in the loop regarding ongoing discussions.
7.0 Blood Utilization Innovation Forum
7.1 Summary of Blood Utilization Innovation Forum Brainstorming Session
/ 7.1 BN & Document
A brainstorming session on development of a blood utilization innovation forum was held in February. The purpose of the session was to establish a mechanism to bring together ideas and set up a more sustainable process to truly tackle utilization issues in Canada. There was consensus among the participants that there was a need "to optimize blood utilization to improve patient outcomes in a cost-effective manner" and that this work was best accomplished collectively with a pan-Canadian approach. A follow-up teleconference of brainstorming session participants was held in April. At this meeting, there was agreement that the Innovation forum would be named the Canadian Blood Utilization Collaborative (CBUC), and that there would be clinical and PT co-chairs named to steer the further establishment of CBUC.
Dr. Alan Tinmouth was identified as the clinical co-chair.
·  The following are discussion points that arose:
o  Concerns that there are several national tables with similar interests and the need for coordination to ensure no duplications (e.g. CBUC, Canadian Blood Coordinating Programs Collaborative (CBCPC), NAC). Participants at the brainstorming session expressed the view that CBUC would have a different mandate than the existing entities but that partnership with NAC and CBCPC would be crucial.
o  The brainstorming session generated enthusiasm and great material as discussed at the PT table.
o  Next steps would be really important to maintain momentum; and top priorities need to be identified.
o  Marina Hamilton (NS) has been identified as the PT Co-Chair.
o  Agreement on the need to conduct an environmental scan of effective utilization activities already underway in PT jurisdictions and to identify opportunities to leverage and amplify these activities for national benefit.
o  Need to be creative re: funding opportunities beyond additional PT funding. PTs are supportive of getting this work done.
o  Co-chairs will need to be diligent in determining actionable items and reasonable priorities.
o  CBS agreed to provide coordination and administrative support on a go-forward basis.
o  Agreement reached that utilization management is a shared responsibility between PT jurisdictions, CBS, Hospitals, etc.
o  Agreement to congratulate the organizers for a very productive meeting with positive momentum – potentially a very transformative opportunity. / Action: Co-chairs to meet and develop a short list of priorities for Canadian Blood Utilization Collaborative (CBUC) focus.
8.0 Ebola Planning Initiatives
8.1 Update on Ebola Planning Initiatives / 8.1 Update on CBS preparedness related to the Ebola outbreak in West Africa.
o  Donors who have travelled to West Africa are deferred according to current malaria deferral policy for one year. CBS now also has a Health Canada approved donor deferral for any donors who are contacts of cases of Ebola virus disease in Canada.
o  CBS has developed a directive to enable the collection of convalescent plasma from an eligible donor who has recovered from an Ebola virus disease, if requested to treat another patient.
o  The current ‘directed donation’ protocol will be used, along with a protocol developed by the WHO. Protocol expected to go to Health Canada (HC) for approval in the late spring.
o  CBS is in the process of investigating the acquisition of Ebola convalescent plasma from the American Red Cross and Cerus Corporation, who hold the U.S. supply. / Action: None
9.0 PPP / Fresh Products Update
9.1 PPP / Fresh Products Updates
9.2 PPP Trending / 9.1 Review of PPP- Data is accurate to the end of February and has been extrapolated out. The data on the fresh product is real-time.
9.2 IVIG – Overall increase of 7.7% nationally. Discussion regarding the ordering/treatment option appropriateness and if this could be due to differences in other alternatives (i.e. Rituximab, plasmapheresis). Most are finding that current usage is appropriate. May be a future increase in IVIG utilization after the CMAJ publication (to be circulated by SN) that reports additional increases for off-label usage.
Albumin – Overall growth is down but there is a significant increase in global demand for albumin such that manufacturers cannot increase in response to any transient trends.
Factor rVIIa (Niastase) – Ontario had a large uptake last year but has dropped off quite a bit; PEI has the highest uptake of rFactor VIII. Has there been a change in Bleeding Disorders treatment practice? Response to be provided by PTS. Significant decrease in the amount of Niastase being used across the country. Is this due to lower rates of new inhibitors, complete lack of off label use or impact of a couple of patients?
Fibrinogen –54% increase - close to 2000 vials this year. How much of this is due to study impact? Question regarding the supply of fibrinogen concentrate- at this time there are no concerns regarding supply. Discussion regarding the dosing that would be re-administered.
PCC -- PCC growth has recently flatten nationally
FEIBA- 7% growth
RBC- 3.8% decrease; approximately 28.2 is the RBC per 1,000 population; Canada is one of the lowest per population of the 40 benchmarking countries; Great work with Blood Conservation. More could be possible as more utilization management strategies come into play. CBS inventory levels are being better monitored. With an aging population – being managed differently now with different products. Other therapies are being used and really impacting the red cell usage. Variances could be related to the types of treatment available in various jurisdictions.
O-Neg usage – 11.9% with a reduction of 3.2%-fairly flat.
CMV Negative – 7%
Platelets– overall decreases.
Plasma–Plasma utilization has decreased by 11.8%. Potential to collaborate with the UK to generate plasma recommendations.
Cryoprecipitate – CBS has started to see a drop in ordering over the last few months.
SD plasma– is increasing and this may continue if it were to be used for all indications. / Action: SN to send the CMAJ publication on IVIG utilization to the NAC coordinator for distribution to the membership.
Action: PTs to provide a response to CBS on potential change in Bleeding Disorders treatment practice that could explain the increase for rVIIa.
Action: PTs to provide response to CBS on information regarding lower rates of new inhibitors, complete lack of off label use or impact of a specific number of patients.
10.0 Going Forward – Summation/Next Steps / 10.1 Summation and overview of actions items:
·  CBS will revise the form: de-identify the personal health information data request and re-issue the customer letter for Tretton utilization.
·  IVIG reactions discussion to be deferred to the April 17, 2015 following HC presentation to NAC.
·  NEBMC Working Group will continue to evaluate survey results and discuss at May meeting. CBS to analyze and bring back to the smaller group.
·  CBS to follow-up with another briefing note requesting decision regarding the distribution of the non-anonymized national/provincial inventory reports; PTs to review revised BN and provide a decision and next steps.
·  BSWG meeting to be scheduled in May. BSWG to revise the document and circulate to NEBMC members in June.
·  Blood Utilization Innovation Forum, the co-chairs to meet and develop a short list of priorities utilization.

Joint CBS PT BLC and NAC Minutes April 16, 2015 FINAL