More than 2 billion people worldwide are plagued with iron deficiency and anemia. Another 600 million deal with bleeding disorders. These issues disproportionately affect women and children. While anemia and iron deficiency are easy to treat, even in areas with low healthcare resources, the problem is often overlooked and unmanaged. In fact, anemia is seen as a “normalized deviation” and is too often ignored by clinicians. Even current thresholds and definitions of anemia from the World Health Organization (WHO) and other professional societies represent a huge disparity between current evidence and tradition, and this has huge implications for individuals, families, and communities.
People suffering from anemia—particularly women—are at risk for a plethora of detrimental health effects and symptoms, including depression, reduced work productivity, poorer clinical outcomes during illness or surgery, restless leg syndrome, impaired academic performance, and exhaustion. Anemia and iron deficiency, which affect more than half of pregnant women, lead to lifelong effects on the baby/child/adult including behavioral issues, learning problems, and emotional and mental health challenges.
While traditionally, issues with anemia and/or bleeding have been seen as easily fixed with blood transfusions as needed, thousands of peer-reviewed publications have demonstrated that transfusions are dramatically overused, associated with poorer clinical outcomes in nearly all patient populations, and responsible for billions of dollars in wasted spending annually.
The practice and science of nursing care, which highly values patient-centered, evidence-based care, would benefit greatly from understanding the newly developed nursing and medical specialty known as Patient Blood Management (PBM), which is defined as “a patient-centered, systematic, evidence-based approach to improving patient outcomes by managing and preserving a patient’s own blood while promoting patient safety and empowerment.”
There are very few clinical or scientific areas where we can do all the things that encompass why we become nurses in the first place—to improve lives, apply evidence to support change and good care, be good stewards of limited resources, and empower patients. We have been able—in just a few years—to change clinical practice around the world by encouraging research, multidisciplinary collaboration, and ethical care. Yet there is so much more to do and so many other groups to help, but we can see the way forward.
Because improving and addressing PBM represents a tremendous opportunity to dramatically impact the health and well-being of individuals, families, communities, and nations, the World Health Organization, in 2021, released a Policy Brief that urges all its member states to implement PBM.
The next steps in operationalizing this WHO Policy Brief include specific implementation guidance and clinical standards currently being developed by a multinational working group, with nursing representation at the table. During the first half of 2024, all WHO member states will receive specific direction on developing scalable hospital-based PBM pilots, with defined public health and economic measures to be both developed and reported.
However, even before this policy brief, numerous nations around the globe have created legislative and public health mandates to implement PBM and educate clinicians throughout the healthcare systems on this important topic. To cite just a few examples, Brazil’s Ministry of Health has recently released a comprehensive set of PBM guidelines for all the countries’ hospitals and providers. Similar things have happened in Portugal, Italy, China, Russia, and Turkey. Australia, in particular, has created PBM-related provider and patient education materials, as well as evidence-based comprehensive care modules in many clinical areas. In fact, all Australian hospitals must demonstrate active PBM-related clinical programs, and this is directly linked to their national accreditation. After several years of implementation of PBM in Western Australia, the healthcare system reported improvements in numerous clinical outcomes, including surgical complications, hospital lengths of stay, decreased mortality, and millions of dollars of savings.
This new concept focuses on the patient’s own blood as the most precious resource—one to be protected and preserved. Nurses play a key role in this in many settings, including primary care and preventive care in the community, bedside care in acute care settings, perioperatively, and with leadership and quality/safety roles. Nurses around the world are working in these titled roles, and currently, the Society for the Advancement of Patient Blood Management is working with the American Nurses Association to designate Patient Blood Management as an emerging nursing specialty.
Sherri Ozawa, MSN, RN, is the Director of Clinical Operations and Delivery at ACCUMEN Inc. and a member of Sigma’s Eta Omega and Rho Upsilon Chapters.