Treatment Services in the ACT

Bleeding Disorders Treatment at Canberra Hospital

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Canberra Hospital HTC web page

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Canberra Hospital Paediatric Day Stay Unit

As part of the comprehensive care model used by the Haemophilia Treatment Centre (HTC) at Canberra Hospital, paediatric patients of the HTC may also have access to Canberra Hospital’s Paediatric Day Stay Unit (PDSU).

PDSU provides day-only medical treatment for children up to 18 years of age and includes blood transfusions and factor treatment for children with bleeding disorders who have been referred to the PDSU by the doctors or staff of the HTC. Talk to the HTC staff about the PDSU first.

The PDSU is located at Building 11 on level 1 (street level) of the Centenary Hospital for Women and Children, at the Northern end of the Canberra Hospital

Paediatric Day Stay Unit: T  (02) 5124 7371. Please call ahead first.
Hours: 7am to 6:30pm Monday to Friday. The PDSU is closed on Public Holidays.

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Canberra Hospital Physiotherapy Department

Physiotherapy is an essential part of the comprehensive care model used by the Haemophilia Treatment Centre (HTC) at Canberra Hospital.

Patients can be treated by the physiotherapists at the Canberra Hospital after referral from the HTC.  Physiotherapy is available during and after a bleeding episode to aid recovery.

Physiotherapists also participate in regular patient clinics to review patients’ joint health, assist with joint care and provide advice on rehabilitation exercise and regular physical activity.

The Canberra Hospital Physiotherapy Department is located on the ground floor of Building 15, the bright yellow building on Hospital Road

Physiotherapy Department: T (02) 5124 2154

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Visiting the Canberra Hospital Emergency Department

Emergency Department Medication Standing Orders

Introduction

People with bleeding disorders may present to the Canberra Hospital Emergency Department (ED) for treatment, for example, when a serious bleed occurs or when the Canberra Hospital Haemophilia Treatment Centre (HTC) is closed. Medication Standing Orders (MSOs) for the administration of factor replacement in the ED have been developed by the HTC in consultation with the ED specialist clinicians. It is important that patients are aware of these MSOs, as they may facilitate timely infusion of factor replacement.  

Importantly, the existence of these MSOs are to help expedite the quick factor administration within 30 minutes of presenting at the ED but do not guarantee it. Subsequently, patient evaluation by a medical professional remains essential for appropriate dosing in line with the type of bleed. Furthermore, it is crucial that first aid, including Rest, Ice, Compression and Elevation be administered IMMEDIATELY after a suspected bleed.

What do the MSOs do?

The MSOs are medication administration instructions that empower ED doctors and nurses to administer recombinant and plasma-derived factor concentrated at a specified dose to patients with a diagnosed bleeding disorder that present to the ED with a bleeding-related injury.

As at October 2023 there are three MSO's relating to the administration of recombinant and plasma-derived factor concentrate:

• Administration of recombinant factor VIII.
• Administration of recombinant factor IX.
• Administration of von Willebrand factor using plasma derived Biostate.

The MSOs mean that nurses and doctors can administer factor to patients without the need for an individual prescription from the treating specialist. This can expedite administration of factor upon presentation to the ED. The ‘referral criteria’ listed in the MSO notes that ‘factor replacement is always a priority’. This supports best practice in case of a suspected bleed: infusing first before other diagnostic tests (e.g. scans, x-rays, etc) are carried out.

The MSOs were designed in order to reduce the time between a patient’s presentation at the ED and the administration of factor. They provide medical staff with guidance to administer factor quickly and accurately.

The MSOs do not replace clinical judgment on the part of the treating clinician. Medication Standing Orders are a guideline only and can be overruled by ED staff. In this situation, open communication between patient and medical staff is paramount. The patient or their family need to contact the HTC after this presentation to ED.

How can a patient assist staff in relation to use of the MSOs in the ED?

Most ED doctors and nurses should be aware of the existence of MSOs however, casual, fill-in and new staff are constantly joining the ED team and may not be aware of them. When presenting to the ED triage nurse, patients or their carers should mention their diagnosis of a bleeding disorder, and show their "pink" card* or any letter they have from their haematologist as well as their My ABDR card. This will reinforce to ED staff that the patient has a diagnosis and a treating haematologist. During this primary assessment it is worthwhile mentioning that there are specific MSOs for the administration of factor.  

What if ED staff are not aware of or cannot find the MSO?

MSOs are not a substitute for clinical judgment. ED staff are highly trained to deal with any emergency situation and will provide the best possible care. Patients can also facilitate the process of timely administration of factor by bringing relevant documentation relating to their diagnosis when they present to the ED.

Patients who are normally seen by the Canberra Hospital HTC should present their "pink" card* (or a copy on their smartphone), issued by the hospital, on arrival at ED.  This indicates to staff that the patient may require urgent treatment.
If you are not normally a Canberra Hospital patient, or do not have your "pink" card, a patient’s MyABDR Card and access to the latest version of MyABDR on their smartphone will provide identical guidance on factor administration as appears in the MSOs to ED staff.

The MSOs are located on the ACT Health intranet within the “hospital policy” section, which is accessible to all ED staff. All staff should be aware of this policy section even if they are not specifically aware of the bleeding disorders MSOs. Searching this database for the word “haemophilia” will result in all relevant MSOs. These provide ED staff with guidance on administration, including dosage.

* As at October 2023, the "pink" cards are being sent out to patients. Paediatric patients should already have theirs while adult patients should have one soon.  If you or your child do not have a pink card, please contact the Canberra Hospital HTC to request one.

How do I find out more information or seek support?

Please contact the Haemophilia Treatment Centre (details above) for more information on the MSOs, MyABDR and ED procedures. The Haemophilia Counsellor can also offer support in relation to your treatment and care experiences (email: [email protected]).

Things to remember

• Timely first aid (Rest, Ice, Compression and Elevation) can be as crucial as timely clotting factor administration.
• Regular reviews with your haematologist are vital to ensure your records are up to date and will assist in timely delivery and ongoing care in the event of an emergency.
• Report all bleeds to the HTC (no matter how minor) or enter them yourself into MyABDR. This will assist with treatment decisions in both emergency and non-emergency situations.

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