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

 

IIV. Summary of key findings

Q8: Tasks Remaining Before Systems are Fully Operational
Evaluation Question Brief Answer

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


There are a variety of tasks remaining before each of the BSCP components is fully operational. For TTISS, it will be necessary to ensure adequate participation of the provinces and territories, and more timely reporting. For TESS, additional sites need to be recruited, and reporting carried out at the national level. CTOSS is still in the planning stages, so much still remains to be done. Linkages with public health have begun, but need to be fostered more consistently. The blood sample archive exists, but further testing of the samples is needed before this component becomes useful.

Q9&10: Intermediate and Long-Term Outcomes
Evaluation Question Brief Answer

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.

 

Identify/Assess Risks and Develop Mitigating Strategies
BSCP data have enabled the identification and assessment of risks associated with the use of blood and blood products, and the development of mitigating strategies. The majority of survey respondents indicated that they had used the data for this purpose, and reported that it would have been more difficult without the BSCP data. Two specific examples are:

  • The development of a Guideline for Investigation of Suspected Transfusion Transmitted Bacterial Contamination (2008), which should enable health care workers to identify sources of bacterial contamination more quickly, and thereby take action to quarantine products from the same source, or assess and treat other recipients of products from that source.
  • The development of a set of guidelines or an algorithm for identifying Transfusion Associated Circulatory Overload (TACO) and Transfusion Related Acute Lung Injury (TRALI), which will help physicians recognize and treat these adverse events more quickly.

Because CTOSS is in such an early stage of development, there have not yet been opportunities to identify and assess the risks associated with transplantation of cells, tissues and organs.

Identify/Assess Risks and Develop Mitigating Strategies for High Risk Populations
A small proportion of key BSCP stakeholders have used the TTISS data to identify, assess, and mitigate risks for high risk populations. However, the evaluation did not uncover specific examples of how the data were used. The blood sample archive has not yet been used for this purpose.

Because CTOSS is in such an early stage of development, there have not yet been opportunities to identify and assess the risks associated with transplantation of cells, tissues and organs.

Q11: Unintended Outcomes
Evaluation Question Brief Answer
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.


Some positive unintended outcomes of the BSCP are international recognition for Canada as a leader in hemovigilance, the development of communication networks within the country, and improved identification of adverse reactions by health care practitioners. No negative unintended outcomes were identified by the evaluation.

Q12: Impact of BSCP
Evaluation Question Brief Answer
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.


Stakeholder perceptions, combined with observed relationships between availability of funding and implementation of surveillance systems, suggest that the BSCP likely contributed to the development and implementation of surveillance systems for transfusion-related adverse events and errors. Although some regions might have developed these systems without the BSCP, this may not have happened as quickly or as comprehensively.

Stakeholders believed that it would be more difficult to identify, assess, and mitigate risks related to transfusion of blood and blood products without the TTISS and TESS data.

Q13: Program Efficiency
Evaluation Question Brief Answer
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.

 

In 2007-2008, the annual program budget was approximately $3.92 million, including contributions, staff salaries, and operations costs. As described in the answers to evaluation questions 7, 9, and 10, a considerable amount has been achieved with BSCP program dollars to date.

The cost of administering the program is approximately 40% of the total program cost, based on program budgets. The program does not usually distribute all of the available funds, in part because of delays in signing the contribution agreements and in part because of the PHAC annual budget reduction exercise. The amount varies from year to year, from 63% of the approved funds being distributed (in 2006-07) to 87% (in 2007-08).

Although it is not possible to draw any definitive conclusions about the efficiency of Canada’s system compared with those in other countries, supposition and anecdotal information indicate that Canada has achieved an internationally recognized system with relatively few funding dollars. Stakeholders also indicated that the BSCP provided good value for money. Very few suggestions for improving efficiency were provided.

Q14: Resources to Sustain the Systems
Evaluation Question Brief Answer
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.


To determine the resource requirements for sustaining a surveillance system appears to be challenging, as no formal long-term commitments are present from any of the parties involved. In addition, it is unclear exactly what the resource requirements may be for maintenance of TTISS, and what activities and outputs are required in the long-run for TESS and CTOSS.

The provinces and territories participating in TTISS anticipated that the annual overall costs of maintaining the TTISS system may actually be higher than the annual costs during the initial implementation of the system, possibly because of inflation and the costs of updating the system. The provinces and territories represented in the survey estimated that they would need a total of about $1.2 million per year in BSCP funding to maintain TTISS.

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