ONTraC for Healthy Surgery
- August 2002
If projections are correct, there will be a crisis in this country, as the need for available blood increases by 8% and the amount of blood donated decreases. Before the crisis hits, hospitals like the Niagara Health System are implementing the Ontario Nurse Transfusion Co-ordinator (ONTraC) program, designed to help conserve precious blood by suggesting alternatives to patients as they prepare for surgery.
ONTraC, now in 23 hospital systems across Ontario, is the result of the Krever Commission recommendations from the tainted blood inquiry several years ago. The Ministry of Health and Dr. Freedman of St. Michael's Hospital in Toronto have spearheaded this campaign for blood conservation.
The overall objectives are to reduce transfusion of donor blood in Ontario by 10 to 15% and to institute informed patient consent preceding transfusion. This can be achieved through education, resulting in having informed patients who consider non-blood/blood products as a treatment choice. This will lead to improved quality of care practices involving blood/blood products.
Sue Gagné is the Nurse Transfusion Co-ordinator for this newly born program in Niagara. "My role is to work with patients, family physicians, surgeons, anaesthetists, the NHS surgical departments and laboratories to promote better utilization of blood resources and alternatives to blood transfusion.
During surgery, a patient may require one to six units of blood (one unit is about 300 cc's or 10 oz of packed red blood cells). During major surgery, or in a critical emergency situation, the volume of blood required can climb to 10-20 units. As well, Sue points out that today, we are performing complex surgeries that were only dreamed of 30 years ago.
In Niagara, the NHS is piloting two types of booked surgeries to launch ONTraC. They are total knee replacement, done at Greater Niagara General and Welland Hospital Sites, and abdominal aortic aneurysm repair, done at St. Catharines General Site.
What can patients booked for this type of surgery do to minimize the volume of blood transfusions they require? First of all, explains Sue, 4-6 weeks before surgery the patient's surgeon, family doctor or the pre-admission surgical nurse, will discuss blood conservation and determine which plan of care will be best for the individual. Physicians are key in implementing this program, and will order a blood test to determine hemoglobin levels. Hemoglobin is the oxygen and iron-carrying cell in the blood. Normal levels of hemoglobin are 140-160 grams/litre for men and 120-140 grams/litre for women.
If the hemoglobin level is low, the patient may be placed on iron supplements and possibly a medication called Eprex or EPO, which stimulates red blood cell production. EPO may be covered by insurance benefit plans.
Autologous blood donation is the term used to describe a patient who pre-donates his or her own blood in preparation for surgery. "The blood a patient donates is used only for him or her during surgery," Sue says. In Niagara, patients can make autologous blood donations at the Canadian Blood Services centre at Henley Plaza on Ontario Street in St. Catharines. At Welland Hospital Site, autologous blood donation is collected for patients who will undergo surgery at that site. Patients having surgery can donate up to a total of 4 units of blood until approximately 1 week before surgery. However, Sue cautions, this is contingent on the physician's determination that the patient is a healthy candidate for the autologous donations.
"Many patients are not candidates because they have low hemoglobin levels and are somewhat anemic," Sue says. Another goal of the ONTraC program is to work with physicians to help a patient before surgery attain a healthy level of hemoglobin and not be anemic.
Do patients who have been part of the ONTraC program feel any differently after surgery? "Research shows that people undergoing surgery in a healthy state have increased vigor and muscle strength after surgery. Also, they are often able to go home sooner after surgery," said Sue. The NHS plans to eventually offer the ONTraC program for most pre-booked surgical procedures. "This program is an excellent way to reduce donor blood transfusions by educating the patient about informed consent and blood conservation. We want to work together to help people be as healthy as possible before surgery."
For more information on the Ontario Nurse Transfusion Co-ordinator program, please contact Sue Gagné at 905-684-7271, ext. 6570.