Developing a validated framework for a Patient Blood Management (PBM) toolkit appropriate for the South African healthcare context

Rambiritch, Vanitha

Developing a validated framework for a Patient Blood Management (PBM) toolkit appropriate for the South African healthcare context

Thesis / Dissertation

2025

Publisher

University of Cape Town

Department

Department of Medicine

Faculty

Faculty of Health Sciences

Abstract

Patient blood management (PBM) is a patient-centred, systematic, evidence-based approach to improve patient outcomes by managing and preserving a patient's own blood while promoting patient safety and empowerment. The historic inappropriate use of risk-associated blood transfusions in treating anaemia and blood loss needs to be replaced with evidence-based PBM practices. This study was aimed at developing a validated framework of cost- effective, feasible, evidence-based PBM measures to guide the development of a toolkit that can support PBM implementation in hospitals, and assist clinicians in optimising the care of patients and minimising inappropriate blood transfusions. A mixed-methods research design was applied. One-on-one semi-structured interviews with PBM champion participants in the qualitative phase provided insight into the challenges and barriers to PBM implementation in South Africa, and the educational and clinical practice guiding tools needed to support implementation. The thematically analysed data from the literature and the interviews were used to develop statements that were subsequently rated by a panel of PBM experts in a three-round Delphi survey in the semi-quantitative phase of the study. Consensus was gained on the tools deemed essential for primary, secondary, and tertiary-level hospitals in South Africa, including the educational needs and overall barriers that need to be addressed. The findings revealed four broad categories of tools: (i) definitional tools to contextualise PBM and frame the importance of its implementation in South Africa; (ii) policy and procedural tools to guide evidence-based clinical practices, taking into account resource and infrastructure capabilities in the various levels of hospitals; (iii) education and training tools directed at bridging PBM educational gaps among doctors, nurses, healthcare leadership stakeholders, and patients; and (iv) planning, assessment and evaluation tools to assist hospitals with planning and implementing PBM interventions. The framework for a PBM toolkit as the outcome of this research contributes significant value by proposing an actionable, evidence-based model that adapts international PBM principles to resource-limited settings, promoting safer and more effective patient care while minimising inappropriate blood transfusions. Education supported by the right mix of clinical practice guiding tools informed by the PBM toolkit framework can make PBM implementation possible in South Africa and beyond.