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ARCHIVED - Summative Evaluation of the Blood Safety Contribution Program - Final Report

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We have archived this page and will not be updating it.

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V. Conclusions

The PHAC undertook this summative evaluation of the BSCP to assess its relative impact on health surveillance activities, as well as its impact on the safety of the Canadian blood supply. The results of the evaluation will inform and support the renewal of the Program’s Terms and Conditions, scheduled to occur in 2009.

The evaluation focused on the continued contextual relevance of the program, the degree to which desired outcomes have been achieved, the extent to which the program has helped achieve outcomes, value for money, and resources required to fill gaps and continue improving the program.

The following table provides an overview of specific answers to each of the evaluation questions:

Table 2: Overview of Answers to Specific Evaluation Questions
Evaluation Question Brief AnswerTable 2 - Footnote 1*
*There is a high level of confidence in the completeness of the answers to most of the evaluation questions. However, there is less confidence in the completeness of the answers to question 12, 13 and 14 due to pragmatic constraints of the evaluation project itself (i.e., scope, budget, availability of data, etc.).
1. Is there a continued need for the BSCP? Yes, BSCP’s purpose is still as relevant as ever.
2. Are the BSCP target audiences and activities appropriate in light of societal/environmental requirements? Yes, target audiences and activities are appropriate.
3. Does the program continue to be consistent with departmental and government-wide priorities?

Yes, but it could benefit from‘re-alignment’ with more pressing priorities that are currently receiving greater attention, such as example patient safety.
4. What are the best practices and lessons learned from the development and implementation of the five components that make up the BSCP? 

Challenges/Lessons Learned:

  • Lack of recognition for BSCP accomplishments,
  • Data quality (for TTISS and TESS),
  • Under-utilization of data,
  • Departmental bureaucracy,
  • Lack of consistent strategic leadership,
  • Under-resourcing of CTOSS, and
  • IT demands.

Opportunities/Best Practices:

  • Collaborative relationships,
  • Canada’s role as a world leader in blood safety, and
  • Potential for recognition and support within Canada.
5. Are the accountability measures for the three surveillance systems and lines of accountability clear to stakeholders, including funding recipients?

Lines of accountability and accountability measures are reasonably well documented, however, they are not entirely clear to all stakeholders.
6. To what extent has the BSCP been successful in engaging its stakeholders For the most part, BSCP has been successful in engaging its stakeholders. Delay in agreement renewal and funding negatively impacts engagement.
7. To what extent have the short-term outcomes of the BSCP been achieved?
  1. A fully operational adverse event surveillance system in each province/territory
  2. A fully operational national error surveillance system
  3. A fully operational national cells, tissues and organ transplant surveillance system
  4. Linkages with Public Health Information Networks (PHINs) established
  5. Blood sample archive for high risk populations established
  6. Risk identification for high risk populations established


TTISS is almost fully operational.



TESS is almost fully operational as a sentinel system.

CTOSS is not yet operational.


Some progress has been made to establish relevant linkages with PHINs in several P/Ts.

A blood sample archive for high risk populations has been established.

Risk identification for high risk populations is occurring to some extent.
8. What remains to be done before each component of the BSCP is fully operational?

TTISS

  • Fully engage all P/Ts, including capture of at least 70% of transfusion activity
  • Address ongoing data quality issues
  • More timely reporting

TESS

  • National level reports need to be produced
  • Determine number & type of sites needed to be representative
  • Engage more sites if necessary
  • Streamlining of error coding system may be needed

CTOSS

  • Planning, resourcing, piloting, refining, etc.

Linkages with PHINs

  • Relationships need to be established consistently in all P/Ts

Risk identification for High Risk Populations

  • The Blood Borne Pathogens Surveillance Project has only done baseline testing – agreements need to be reached to enable further testing and identification of risks
Do more analyses of TTISS data related to high risk groups
9. / 10. What progress has been made towards the intermediate and long-term outcomes of the BSCP?

a) Enhanced capacity to identify and assess risks (IO) and develop mitigating strategies (LTO)









b) Enhanced capacity to identify and assess risks (IO) and develop mitigating strategies (LTO) for high risk populations



Risks have been identified, assessed, and mitigated for transfusion-related adverse events/errors. Mitigating strategies include the development of guidelines for investigation of suspected bacterial contamination and guidelines for identifying TACO and TRALI.

Risks have not yet been identified, assessed, and mitigated for transplant-related adverse events/errors.


Risks for high risk populations have reportedly been identified, assessed, and mitigated for transfusion-related adverse events, but no specific examples were provided.

Risks have not yet been identified, assessed, and mitigated for transfusion-related errors or transplant-related adverse events/errors.
11. Have there been any unintended (positive or negative) outcomes of the BSCP activities? If so, what are they, and what actions were taken as a result?

Positive

  • International recognition of Canada as a leader in hemovigilance
  • Development of communication network between PHAC, HC, provinces/territories, and blood manufacturers
  • Hospital staff better at recognizing and reporting adverse reactions à improved transfusion safety

Negative

  • No negative unintended outcomes were identified.
12. How have the contributions flowing to each of the funding recipients impacted the achievement of BSCP outcomes and contributed to national surveillance systems?

The BSCP likely contributed to the development of surveillance capacity in the P/Ts.

Most stakeholders thought it would be more difficult to identify and assess risks without the BSCP data.
13. Is BSCP as designed the most appropriate and efficient means of achieving its objectives? The BSCP appears to provide good value for money. Delays related to agreement renewal and funding negatively impact program efficiency.
14. What resources are required to sustain, strengthen or enhance blood safety surveillance? It is not clear precisely what resources will be required. However, the annual overall costs of maintaining a surveillance system may actually be the same or higher than the initial annual start-up costs.

 

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