Ontario Nurse Transfusion Coordinators (ONTraC)
A Provincial Patient Blood Management Program
The Ontario Nurse Transfusion Coordinators (ONTraC) Program is a Provincial Patient Blood Management (PBM) Program that attempts to enhance transfusion practice by promoting alternatives to donor or allogeneic blood transfusion in surgical patients, improving patient care and well-being in a cost-effective manner.
About ONTraC
- Formed in 2002, the ONTraC program is a unique initiative supported by the Ontario Ministry of Health to implement a peri-operative patient blood management program in 25 hospitals throughout Ontario. The institutions, large and small, were chosen on the basis of blood utilization and geographic distribution, and are a combination of teaching and community hospitals and represent approximately 70% of blood used in Ontario.The program is coordinated through St. Michael’s Hospital.
- Nurse coordinators were placed in each of the institutions. The intent is to enhance transfusion practice outside of the blood bank by acting as a clinical bridge between the Blood Transfusion Service and the rest of the hospital, and interacting with physicians, nurses, and patients to promote patient blood management and alternatives to transfusion
- The Nurse Coordinators assess patients (preferably at least 3-4 weeks before surgery) to identify those patients at risk of transfusion ahead of surgery in order to allow for the detection and correction of anemia and the development of an appropriate patient blood management plan
Program Objectives
- To develop and implement a peri-operative patient blood management program;
- To avoid allogeneic blood transfusions where possible, and when necessary to transfuse, to transfuse as little as possible;
- To facilitate correction of preoperative anemia (seen in one third of surgical patients);
- To collect accurate data on transfusion practices to allow benchmarking and evaluation of program success.
Area of Focus
The focus of the program is primarily on the following targeted procedures:
- total knee arthroplasy
- total hip arthroplasty
- coronary artery bypass grafting (CABG)
- valve surgery (aortic and mitral)
- coronary artery bypass grafting and valve surgery
- gynecological surgeries: open, benign hysterectomies and myomectomies
Role of the Coordinators
The program offered varies in each institution with respect to available resources and alternatives, but there is a general approach considered by each of the ONTraC Coordinators which includes:
- To identify patients at risk of transfusion ahead of surgery (≥10% risk of a transfusion)
- Assess the patient at pre-admission clinic (3-5 weeks before surgery)
- To discuss informed consent and transfusion alternatives
- Investigate, diagnose and treat anemia (e.g. by family doctor, surgeon, anesthesiologist, hematologist)
- Discuss the use of Erythropoietin and / or oral or intravenous iron
- Stop anticoagulants/anti-platelet drugs if safe to do so and directed by the physician
Reviewed / Updated March 2023