Questions/Answers

To obtain the access of blood requirement needed by medical patients, the process of blood distribution took a long time before 2011 (about three hours for the process of blood diagnosis). The process of blood demand and distribution was carried out by the patient’s family. They carried the blood with an inappropriate bag where the risk of blood damage was susceptible for the uncontrolled temperature, and apparatus and methods of blood distribution were not in accordance with the standard of blood service. Thus, the blood would be damaged when it arrived at the Hospital. This could be detrimental to the patient because the blood did not increase Hemoglobin levels in the patient’s body and slew the healing process and increased the treatment cost. The delay in the process of blood distribution would cause the patient fatality. Aspects of security issues and duration of the blood distribution are the main factors determining blood services. From year to year, the average number of complaints against Blood Transfusion Unit (BTU) is still in the high level. The initiative of Blood_Jek Si Pengawal Nyawa (The Savior) comes to solve the current problem. Blood_Jek is a system of blood service designed to maintain the blood quality for healing patients, supplying blood demand required by patient’s family and supporting the service system of the hospital to keep it optimal. The service system of Blood_Jek applied is “direct-request-delivery” which means the patient’s family requests blood with a form and blood sample then completes the administration process and straight back to the hospital. The request is processed immediately. Next, the blood that is ready for the transfusion process is delivered directly by the BTU officer to the patient room. This service is 24 hours free for the public of Lumajang.

Blood_Jek is a service system designed to maintain the blood quality for healing patients, easing blood demand required by patient’s family and supporting the service system of the hospital to keep it optimal. The blood distribution should maintain the blood cold chain according to the component type, using a validated temperature distribution apparatus and monitored by the authorized officer. The service system of Blood_Jek applied is “direct request-delivery” which means the patient’s family requests blood with a form and blood sample and completes the administration and straight back to the hospital. The request is processed immediately, then, the blood that is ready for the transfusion process is delivered directly by the BTU officer to the patient room. This service is 24 hours available for all hospitals in Lumajang. Blood_Jek uses a motorcycle with a large box on the back side, coolbox could be placed inside as blood storage. Each coolbox is equipped digital thermometer to control the temperature in accordance with the carried blood product type. The form of blood temperature control is always available inside coolbox as long as the trip to Hospital

This criterion of the Blood_Jek initiative categories is to reach the poorest and most vulnerable through inclusive services and partnerships. Initiative Blood_Jek certainly deals with these criteria. Blood service is the main supporting service of curative services provided by the Hospital. The availability of safe, fast and proper blood is needed in the recovery of patients at the hospital. If this does not happen then the Hospital fails to provide healing services for the patient, the likelihood of patient deaths will occur, the high expectations of the patient's family for the healing of his family do not materialize.

Initiative Blood_Jek The life guard is a concrete step in implementing the Sustainable Development Goals (SDGs) 2015-2030 in Goals 3 ensures a healthy life and encourages prosperity for all people in all ages. One of the goals of Goals 3 is to reduce Maternal Mortality Rate to below 70 per 100,000 live birth. In Lumajang the Maternal Mortality Rate is quite high because of the bleeding caused by bleeding, therefore the role of Lumajang Blood Center (LBC) IRC as the only provider of blood is very large. In addition must be able to guarantee the needs of blood quickly, safety and blood quality should also be considered. In addition to goals 3, Blood_Jek is also in line with the 17 objective of strengthening the means of implementation and revitalizing global partnerships for sustainable development with a goal of strengthening the means and implementation of sustainable development objectives. Good Manufacturing Practice (GMP) in blood preparation is a guideline in providing blood services. In 2016, LBC IRC was selected from 8 major BTU in Indonesia visited by GMP consultants from Australian Red Cross for assistance in the implementation of blood service GMP. One of the material focus in this mentoring is the blood distribution system.

BTU IRC district is the only provider of blood in Lumajang district is required to provide optimal service both quantity and quality. The emergence of a new paradigm, that blood is a drug makes BTU continue to clean up. Moreover, the speed and safety of blood closely with the pain of patients in the hospital. If the blood comes too late then the Hospital in providing curative services will be hampered and someone's life will be at stake. Even with blood safety, when blood distribution does not use standardized methods, the blood will be damaged and therapeutic effects for patients do not materialize.

The blood distribution system was carried out by patient’s family, then they should wait about 3 hours and carried it to Hospital. As a result, BTU could not maintain the blood transfused is still safe because of a uncontrolled temperature, apparatus and methods of blood distribution that were also not in accordance with the standard of blood service. “Blood_Jek” The Savior LBC of IRC comes to solve the problem. Blood_Jek is a service system designed to maintain the blood quality for healing patients, easing blood demand required by patient’s family and supporting the service system of the hospital to keep it optimal. The request is processed immediately, then, the blood that is ready for the transfusion process is delivered directly by the BTU officer to the patient room. This service is 24 hours available for all hospitals in Lumajang. Blood_Jek uses a motorcycle with a large box on the back side, coolbox could be placed inside as blood storage. Each coolbox is equipped digital thermometer to control the temperature in accordance with the carried blood product type. The form of blood temperature control is always available inside coolbox as long as the trip to Hospital.

a. The only one in Indonesia At 2011, from 212 BTU in Indonesia, LBC of IRC is the only unit which had provided Blood_Jek service. Generally, BTU Indonesia is still applying conventional steps in distributing blood by carrying blood to the Hospital without considering the temperature and the process of distributing blood. The improper steps in distributing blood could decrease the quality of the blood. b. Low budget Costs in the manufacture and operation of this initiative are low, about 20 millions, not worth the benefits. Curative services in hospitals for patient recovery can be realized with this initiative. c. Simple and much needed Initiative Blood_Jek the life guard is a very simple and much needed initiative because this initiative comes from the local wisdom of the Lumajang community using only motorcycles equipped with coolbox, controlled temperature and performed in accordance with the operational standards of blood distribution procedures by competent officers and is the main support service at Hospital. When providing services to patients, the speed and safety of blood are preferred.

Blood_Jek is the original initiative of LBC of IRC of Lumajang Regency as the answer to the problem. Initiative Blood_Jek is an initiative that was born because the condition of blood service especially blood distribution in LBC IRC that still can not guarantee its safety and limitations of transportation make this blood is not immediately accepted by the patient's family. Proven high public complaints against blood services, 83% aspect of speed and 17% of security aspects.

Sources of funding for blood services: I. Balance Blood Transfusion Unit of IRC (Indonesian Red Cross) (Replacement Cost Blood Processing) 1. Motorcycles : IDR. 12.700.000,- 2. Cooling Box : IDR. 750.000,- 3. Motorcycles Maintanance : IDR. 2.000.000,- / year 4. Fuel : IDR. 3.500.000,- / year 5. Blood_Jek Re-identification : IDR. 1.000.000,- 6. employees : IDR. 36.000.000,- / year II. Assistance from IRC Province East Java 2016 1. One Unit Blood_Jek (motorcycle) and equipment) : IDR. 23.000.000,- III. Assistance from BRI Branch of Lumajang: 1. Blood_Jek Uniform : IDR.1.950.000 Participation of all parties for the implementation of this initiative is necessary, intensive and systematic communication makes this initiative work well. This initiative is able to move other resources from other sources to support the implementation of Blood_Jek. Year 2017 UTD building Lumajang IRC renovated by the Local Government so that the building used for services more adequate and according to the requirements of blood services, especially the area of blood distribution. In addition, hospitals with nurses are required to continue to communicate with Blood_Jek officers related to blood distribution.

Yes

Some BTU in the province of East Java began to replicate Blood_Jek blood services such as BTU of IRC Blitar, Probolinggo, Banyuwangi, Ponorogo and others. This service has the same function in blood distribution. Not quite there, Blood_Jek reportedly will be replicated by 5 regions in the province of South Sulawesi

Blood_Jek blood-care system is one effective and efficient way for a cold chain of blood to materialize. The demand that blood coming out of BTU should be of high quality and has a therapeutic effect on the recovery of hospitalized patients, blood is one of the main support systems of hospitals. Therefore, ease of access and affordability of blood needs to be done. Mid-December 2017 LBC of IRC again given the opportunity to present Blood_Jek in Makassar, South Sulawesi. The event was initiated by the Ministry of Administrative Reform and Bureaucracy Reform (Menpan-RB), as a result Blood_Jek's service system reportedly will be replicated by 5 regions in South Sulawesi. At the Asia-Pacific Economic Cooperation (APEC) meeting, the APEC Quality Workshop "Changing a Blood Establishment Culture to a Culture of Change was held on 11-14 in Jakarta, several BTUs in Indonesia and representatives from countries around the world participated in the Blood_Jek presentation . Therefore, the Blood_Jek video was asked several times to air in neighboring Vietnam. Not enough here, LBC of IRC District with Indonesian Blood Transfusion Doctors Association (PDTDI) is making paper and poster for airing and oral presentation at International Society of Blood Transfusion (ISBT) in Toronto Canada on 2-6 June 2018.

This public service initiative can be replicated by all BTU in Indonesia. The task of the BTU as a provider of blood should be able to guarantee the quality of blood to the hospital, the commitment of all parties ie from the head of BTU and staff and the Hospital as a blood user to do this all. IRC Chairman of East Java Province Mr. Imam Utomo, issued a letter from IRC Headquarters East Java Number. 0316 / 02.06.00 / ADM / II / 2017 dated February 21, 2017, on the initiative of patient's blood delivery service in hospitals that can be an inspiration to be applicable in all LBC of IRC districts throughout East Java. Beginning in 2017, several BTU of IRC have replicated Blood_Jek Blood Service Initiative, such as BTU of UTD IRC Banyuwangi, Blitar, Probolinggo, and Bojonegoro and others.

Yes

a) Complaint management The complaint management is an effort to find out how successful the implementation of Blood_Jek. Implementation of complaints with this openness system, can be done every day, by phone or directly to BTU of Lumajang Regency officer. Submission of complaints is made publicly. This complaint was recorded and immediately followed up by BTU of Lumajang Regency during a management review meeting. The results of the meeting are immediately socialized to all officers and customers. b) Customer Survey The routine customer satisfaction survey is conducted by BTU of IRC (Indonesia Red Cross) of Lumajang Regency once every 6 months. The target of this survey is the authorized officer at the hospital (Nurse / Doctor).This survey contains: a. Informant consent sheet b. Respondent's data c. List of questionnaires, among others: i. Blood_Jek blood-care system ii. The physical state of blood received iii. Mistakes in blood delivery iv. A service system that can assist cyto blood demand v. Responsibilities of the blood delivery officer vi. The ability of the blood delivery officer vii. Blood_Jek Blood Service Speed viii. The courtesy and friendliness of the blood delivery officer d. Advice on services.

a) Customer satisfaction increased, as indicated by the customer satisfaction index of Blood_Jek blood service with satisfaction index of 1.94, the value of IKP after conversion was 97, so that the quality of service in category A and Blood_Jek blood service unit performance in the Good category. By using the guideline preparation of customer satisfaction index Blood Transfusion Unit of IRC (Red Cross) of Lumajang Regency. b) Meeting the needs of quality blood has been enjoyed in all elements of society by eliminating the cost of blood. c) Transfusion reaction reports from the hospital to the BTU of IRC (Red Cross) of Lumajang Regency each year significantly decrease. d) Target blood quality distribution section achieved include: blood delivery in the city according to the temperature of blood delivery and every request is delivered without waiting for further request.

a) Improvement of customer satisfaction survey results b) Percentage of blood that can be fulfilled by using Blood_Jek c) Decrease of transfuse reaction rate in hospital d) Achievement of quality distribution section target 100%

a) BTU of Indonesian Red Cross of Lumajang Regency BTU of Indonesian Red Cross as the only provider of blood tranfusion in Lumajang Regency must maitain the quality of blood. With the Blood_Jek, BTU can maintain the blood quality. b) Indonesian Red Cross of Lumajang regency and of East Java Province. BTU of Lumajang Red Cross is a Unit under the autorization of Red Cross of Lumajang Regency. Based on government’s law No. 18 dated 1980, the duty of Indonesian Red Cross is to provide blood transfusion service. The purpose of providing blood services is to maintain and improve the quality of blood services and to facilitate access to blood for healing and recovery. c) State and Private Hospital in Lumajang Regency BTU of Indonesian Red Cross provides blood for healing and recovery. If the safety and blood destribution cannot be guaranteed, then the hospital service will also be disrupted. d) Departement of Health Office as the implementer of local government in health sector In Lumajang local government, the Implementer in health is Department of Health which aims to reduce mortality rate. The level of maternal mortality indicates the suceess of local government’s development. In 2016, Lumajang regency was in the second rank of maternal mortality rate in the province of East Java. The internal bleeding contributed to the maternal mortality rate. Therefore, the quality of blood service in Lumajang Regency should be improved by implementing Blood_Jek. e) BRI Branch of Lumajang BRI tries to improve their services to the community, and to assist any institutions by providing services in the form of direct and indirect assistance. The public community service initiative in blood service such as Blood_Jek is supported by BRI by providing uniform with BRI logo.

a) During this process the blood distribution service is considered trivial but this process greatly affects the quality of blood. b) The high commitment of all BTU employees to ensure that the fast, safe and proper blood reaching the Hospital is the key to the continuity of the system and the success of this blood service. c) If any member of the sick family can affect the psychology and emotional stability of other family members. Therefore Blood_jek provides a solution to ease the burden on family members of patients. d) The more hospitals that are served will directly affect the amount of blood demand, so that the power and means of the blood is not proportional to the hospital served. e) Quality blood is a medicine and support the patient's healing, then the blood must be really qualified. by ensuring safety in every process of blood services especially blood distribution. f) Blood_Jek became one of the main topics in GELORA magazine, so on that occasion, IRC Chairman of East Java Province strongly urge all BTU districts in East Java to replicate Blood_Jek as a means of blood service that can guarantee cold chain of blood services provided to the patient.