G.R. Baker Hospital was recently presented with two awards from the Provincial Blood Coordinating Office.
The Quesnel hospital won an award for Outstanding 0% Expiry Rate of All Factor Products for using all blood products and derivatives, such as coagulation factors, before they expired. The hospital also won an award for Outstanding 0% IVIG Discard and Outdate Rate for using all IV immune globulin (IVIG) before its expiration date.
Both awards were presented for the hospital’s work in 2017-18.
The transfusion medicine service provides many more products besides blood. The lab at G.R. Baker Hospital usually stocks five kinds of products that can help people’s blood to clot, and care needs to be taken to ensure the products are ready to be used and are not close to expiring, explains Christine Goodhew, charge tech of transfusion medicine service and hematology.
“The factor products, basically most of those, they help people’s blood to clot, so it’s either patients who are missing or have deficient clotting factors or if someone has a major traumatic experience and they’re bleeding,” she said. “We can use some of those products to help slow that blood loss. In an emergency situation, they are definitely useful.”
Because they never want to waste any product that someone has taken the time to donate, these products are often transported to larger centres to ensure they are used before expiration dates.
“As part of working in the blood bank, we have guidelines that if we don’t use it within a certain time or it’s three months to expiring, we try to send it on to St. Paul’s or Vancouver General Hospital or bigger centres where hopefully it can be used,” said Goodhew. “It’s not really a cost thing, because it costs money to transport it, but it is recognition of the fact you don’t want to be wasting these products. It’s always kind of a balancing act between what we need and what we have on stock.”
The other award is for IVIG discard, and Goodhew says the IVIG is quite expensive, at $65 per gram.
This award recognizes that the G.R. Baker lab not only used the product before the expiration date, but it also handled it with care during shipping and receiving and placed it in temperature-controlled storage before being used for various approved conditions other than weakened immune systems.
IVIG is produced from healthy human blood to help fight infections for patients with a weakened immune system. There are provincial guidelines as to who can receive this product, and there is an approval process in place once a physician requests this product.
“IVIG is basically something your body produces to help fight infections, so either people who have a chronic disease that weakens their immune system or if their body has an immune system that turns around and attacks itself, not just causing issues but causing life-threatening conditions,” said Goodhew. “Once a physician requests it and it does get approved, then it’s up to us to make sure we have the product here on time to give it to the patient, but also we have to communicate with ambulatory care because they’re the ones who have to call in the patient and transfuse it because it has to be done in a hospital setting. Even though we get that award, there’s a huge amount of work that goes behind it.
“With the transfusion department, we work quite closely with the ambulatory care and the chemotherapy unit.”
The transfusion medicine service has to order and stock this product for each patient requiring it. As with any product, staff have to ensure the product is at the hospital and ready to be used, and if it is getting close to its expiry date, it has to be rotated to a larger centre so it can be used and not discarded.
Goodhew says the staff of the chemotherapy unit and ambulatory care are instrumental in scheduling these patients to have their products in a timely manner and co-ordinating with the lab to ensure best patient care.
When people are put on IVIG, generally, they get a certain dosage, which is dependent on weight. A dose is generally anywhere between 20 and 75 grams per dose, and a patient will require the dose every three or four weeks, generally for six months or a year, explains Goodhew.
“So it’s quite a big commitment and quite a big juggling act,” she said. “Right now, we have about 12 or 13 patients on that.”
Goodhew believes this is the first time the hospital has won the two awards at the same time, and she says that while the laboratory staff were the ones recognized, this success involves a lot of players.
“The management of all blood products is a balancing act between what we need to have, what is used and what needs to be rated so that it is not wasted,” she said. “This involves many different parties, including Canadian Blood Services, which is the supplier; the provincial blood co-ordinating office, which helps to ensure that blood is rotated and used within the province; the Northern Health lab, which sets policies and procedures to ensure that products are received, kept, used or rotated to prevent waste and reduce cost; the physicians who ensure the correct people are receiving sometimes limited resources; lab staff who are doing the actual receiving and shipping of products correctly; and the nursing staff who ensure the correct patient is receiving the correct product in the correct manner.”
The laboratory at G.R. Baker is staffed from 6 a.m. to 11 p.m., and then there are is staff on-call overnight.
The laboratory offers a range of services and includes a chemistry department, a hematology department, a microbiology department and a blood bank.