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) or Blood Conservation Program (BCP)  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.

  • Formed in 2002, the ONTraC program is a unique initiative supported by the Ontario Ministry of Health and Long-Term Care (MOHLTC) Blood Programs Coordinating Office (BPCO) 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 65% of blood used in Ontario.  
  • The program is coordinated through St. Michael’s Hospital by the Program Manager, Alanna Howell RN, and the Program Director, Dr. John Freedman.  
  • This multidisciplinary, multifaceted program aims at transfusion practice change involving anesthesiologists, surgeons, internists, hematologists, nurses, technologists, hospital administrators, and patients.  
  • The program objectives are:
    • 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.  
  • 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
    • interact with physicians, nurses, and patients to promote patient blood management and alternatives to transfusion.  
  • 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)
    • To discuss informed consent and transfusion alternatives
    • Assess the patient at pre-admission clinic (3-5 weeks before surgery)
    • 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 your physician  
  • It is important that the Coordinator sees patients early enough (preferably at least 3-4 weeks before surgery) to identify patients at risk of transfusion ahead of surgery to allow for the detection and correction of anemia and development of an appropriate patient blood management plan. 
  • Targeted data is collected during specified time periods on elective consecutive (by the OR date) procedures. Each site collects data on at least three or more of the following designated targeted procedures depending on the procedures performed and available resources:
    • Knee arthroplasty/replacement (TKA or TKR)
    • Hip arthroplasty/replacement (THA or THR)
    • Coronary Artery Bypass Graft (CABG)
    • CAGB plus valves (aortic and mitral valves)
    • Valves (aortic and mitral valves)
    • Radical Prostatectomy (RP) (discontinued as a targeted procedure in 2014)
    • Gynecological surgeries, open, benign, non-cancer hysterectomies and myomectomies
    • Non-targeted data is collected on patients seen or spoken to by the coordinators during the calendar year. This may include patients in other services to whom the coordinator has been referred.

Reviewed / Updated November 2018.

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