Blood Stocks Management Scheme Blood Stocks Management Scheme

Blood Stocks Management Scheme Report 2012-14

Requests for further information should be addressed to: BSMS Office, PO Box 33910, Charcot Road, London, NW9 5BG Tel: +44 (0) 208 957 2935 Fax: +44 (0) 845 607 1414 Email: elaine.macrate@nhsbt.nhs.uk Website: www.bloodstocks.co.uk Enquiries: bsms@nhsbt.nhs.uk Copyright notice. Please cite this work as: The 2012-2014 BSMS Report (2014). MacRate E B (Ed.), Taylor C, on behalf of the Blood Stocks Management Scheme (BSMS) Steering Group. This work was undertaken by BSMS. The work was funded by NHS Blood and Transplant, the Northern Ireland Blood Transfusion Service, the Scottish National Blood Transfusion Service, the Welsh Blood Service through the UK Forum, and the Irish Blood Transfusion Service. All rights reserved. No part of this publication may be reproduced, stored or transmitted in any form or by any means, without the prior written permission of BSMS, or in the case of reprographic reproduction, in accordance with the terms of licences issued by the Copyright Licensing agency in the UK (www.cla.co.uk). Enquiries concerning reproduction outside the terms stated here should be sent to BSMS Office. Making duplicate copies of the report or using the data within the report for legitimate scientific, educational or other non-commercial purposes is permitted provided that BSMS is identified as the originator of the information. Making alterations to any of the information contained in the report or using the information in any other work or publication without prior permission, will be a direct breach of copyright. The use of registered names, trademarks etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant laws and regulation and therefore free for general use. Copyright Blood Stocks Management Scheme (BSMS) 2014 Published 2014 2

Report 2012-14 Table of Contents Message from the Chair of the Steering Group 4 About the Scheme 5 Executive Summary 6 Blood Service Data: Introduction 7 Hospital Participation in the Scheme 8 Blood Service Data: Red Cell Demand 9 Red Cell Stock Levels (ISI) 10 Demand for O RhD Negative 11 Red Cell Wastage (WAPI) 12 Platelet Demand 13 Platelet Stock Levels (ISI) 14 Platelet Wastage (WAPI) 15 Hospital Data: Introduction 16 Red Cell Stock Inventory (ISI) 17 Red Cell Wastage (WAPI) 18 Red Cell Wastage by Category 19 Platelet Wastage (WAPI) 20 Platelet Wastage by Category 21 BSMS Steering Group Membership 22 Glossary of Terms 23 BSMS Recommendations 24 3

Message from the Chair Welcome to the new look BSMS report for 2014. Since the last annual report (it has been a little more than a year in all honesty), the scheme has seen turbulent times with the ongoing economic situation and discussions about reorganisation and the ultimate direction of the scheme. Despite these uncertainties the scheme has come out the other end and continues to thrive and develop. VANESA has finally undergone the long awaited face-lift and we anticipate that this will be unveiled in early January 2015. This will bring a more pleasing interface with improvements in functionality and a degree of future proofing. Perhaps most importantly, this sees the addition of frozen products to the repertoire. This has been a long time in the coming but is in direct response to the requests of users, and we hope that it will be as successful and useful as the red cell and platelet data has become. The Blood Stocks Management Scheme remains the only source of data on wastage of blood components and with the addition of frozen components, will provide data that has not been available routinely up to this point. In addition it will provide data on stock levels of non blood service supplied components another first. We are confident that these enhancements will continue to support the blood services in better stock management, and will help to support efforts to implement Patient Blood Management (PBM). The AIM II pilot, to benchmark clinical use of blood components, provided important lessons for the future around how this data can be collected and BSMS will continue to be involved in efforts to implement clinical benchmarking to support PBM, to the mutual benefit of BSMS, the stock project and PBM. It has been an objective of the Steering Group for some time to provide data on wastage across the whole supply chain, to allow better understanding of how the supply chain can be optimised. We have now achieved this, and I hope that this will provide an increasingly interesting comparison between the systems in place across the United Kingdom. I would like to take this opportunity to thank Elaine and her team for continuing to bring expertise and enthusiasm to the BSMS, and as always, all of the participants who continue to support the scheme. Finally, this report contains only a small taster of the data available and I would encourage all to explore what is available on VANESA. Thank you for your support. Craig Taylor Steering Group Chair Blood Stocks Management Scheme October 2014 4

Report 2012-14 The Blood Stocks Management Scheme Our Mission To improve blood inventory management across the blood supply chain, by enabling both hospitals and blood services to benchmark their services against their peers. Our Aims To improve standards of hospital stock management practice. To educate users on blood stock management. To provide recommendations on best practice to reduce wastage. To inform the UK Blood Services on hospital outcomes of supply chain adjustments. To monitor the entire supply chain from donor to patient. Our Objectives Collect and analyse data on blood component stocks within hospitals from all organisations in the UK and Ireland. Provide analysis of these data which is disseminated regularly. Monitor changes to the supply chains affecting hospital wastage. Identify areas where supply chain management could be improved and make recommendations through appropriate reporting channels. Provide and encourage education on blood stocks management to all personnel involved in the process. Undertake research, studies and audit in blood stocks management, and publish where appropriate. 2012-2014 Key Actions Platelet stock algorithm (2012). Red Cells for Emergency Use recommendations (2013). Inventory Practice Survey for O RhD Negative Red Cells. Electronic Reports: your reports are now stored on VANESA. BSMS for Transfusion Practitioners guidance. Bite-size information updates with operational features. Collaborated on publication: Lateral transshipments: an institutional theory Perspective Sebastian H.W. Stanger et al. International Journal of Physical Distribution & Logistics Management. 5

Executive Summary 2012-14 This report from Blood Stocks Management Scheme covers a 2 year period from April 2012 - March 2014. The report provides analysis of blood service and hospital stock levels demand and wastage, for adult red cells and platelets. Data provided by blood services are daily issues of components, by blood group to hospitals and monthly wastage data on post-validated components. Hospitals data includes a daily stock level by blood group and daily or monthly wastage data by wastage reason. Analysis is done to show trends, identify best practice and to identify correlations between hospital and blood service stocks and wastage. This report finds that demand for red cells has been reducing since October 2012 for all blood services, demand for platelets has steadied or decreased for some blood services and has risen for NHSBT. Hospital wastage for red cells remains at similar levels to those seen previously. NHSBT hospitals demonstrate a slight reduction in platelet wastage, possibly influenced by reduced blood service stocks. Blood service red cell stock inventory was not noted to be reduced to reflect the reduced demand. At periods of greater than 10 days stock availably within the blood service, hospital wastage is seen to rise. However hospitals did not react to the reduced demand by reducing hospital stock levels and therefore have a slightly higher Issuable Stock Index (days worth of stock) than two years ago, although this does not appear to have impacted wastage levels in hospital adversely. The overall hospital wastage remains around 2% in NHSBT, less in WBS, higher in NIBTS. The reduction in demand for red cells has shown that both blood services and hospitals need to be more agile in reviewing stock inventory. Despite previous recommendations to blood services to hold less stock of certain blood groups, this does not appear to have been implemented. This will become increasingly important as demand for O RhD negative red cells has not dropped (compared to other blood groups) and demand for A RhD negative platelets which are being held as stock platelets by many hospitals has increased. Limitations: Scotland data is based on only 5 reporting hospitals. IBTS less than 50% hospitals participate. Northern Ireland has been unable to provide internal blood service wastage. 6

Report 2012-14 Blood Service Data: Introduction The data submitted from the UK Forum Blood Services and the Irish Blood Transfusion Service allows the BSMS Steering Committee to analyse trends in demand, stock levels and blood service wastage and to compare performance between the blood services. When this information is used in conjunction with the hospital data, the entire blood supply chain can be viewed and best practices highlighted. There are some fundamental differences between the participating blood services. The number of hospitals supplied by each service ranges from 235 (NHSBT) to 10 (NIBTS). The units collected, manufactured and distributed ranges from approximately 1.7million (NHSBT) to 50,000 (NIBTS) for red cells and from 270,000 to 7,500 for platelets. These disparities have to be considered when drawing conclusions on performance between the blood services, but some interesting similarities are noted in the report. The balance between sufficiency of supply, to ensure patients everywhere receive timely blood components and the obligation to donors to ensure the best use of their donation is a delicate one which all participating blood services are managing with a variety of inventory management tools, but there are still lessons to be learnt in the following pages. Data for 2013/14 NHSBT WBS NIBTS IBTS SNBTS Size of Region (square miles) 50,000 8,000 5,500 33,000 30,000 Population (million) (2011 Census) 53m 3.1m 1.9m 4.6m 5.3m Red Cell Issues 1,691,868 71,410 50,148 127,171 65,003 Platelet Issues 268,344 n/a 7,552 22,204 8,484 No. of hospitals 235 15 10 ~37 ~35 No. of issuing blood sites 10 1 1 2 2 Note: Italic indicates incomplete database. 7

Hospital Participation in the Scheme Activity levels for 2013-2014 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% NHSBT NIBTS WBS IBTS SNBTS None 3% 0% 0% 54% 17% Partial 15% 0% 25% 16% 33% Regular 82% 100% 75% 30% 50% Chart 1: This chart shows the average participation (activity) levels of hospitals (by blood service) for the period 2012-2014. England and North Wales (NHSBT), Wales (WBS) and Northern Ireland (NIBTS) have sustained regular participation at high levels, with 100% of registered NIBTS hospitals submitting regularly. There has been some reduction in participation in Scotland and Ireland; of the 6 SNBTS hospitals registered, only 3 submitted regularly and 2 partially. In Ireland, of the 37 hospitals who had registered less than half are now submitting data. BSMS is aware that restructuring of pathology services within the UK, which includes formation of networks can cause some stock and wastage issues between hospitals which may not be reflected in the Blood Stocks Management Scheme (BSMS), which is based at hospital level but we value the efforts of all participants to give us full sight of the supply chain to help drive best practice both within hospitals and within the UK blood services. 8

Report 2012-14 Blood Services: Red Cell Demand After a period of stability in demand for red cells, all BSMS blood services experienced a reduced demand for red cells from their hospitals. For most of the blood services this decrease started in the second quarter of 2012-13, and this decrease has continued to the end of the 2013-14 period. No single cause has been identified for the decrease but reduction of inappropriate transfusions may be a contributing factor. Red Cell Demand reduced over the two years, across all blood services. NHSBT During 2010-12, demand was steady but started to decrease in October 2012 and has continued to drop throughout the 2012-2014 period. WBS Demand for RBC reduced from October 2012. Roughly 7000 units per month were issued during 2010-12 to <6000 per month in the latter part of 2013-14. NIBTS RBC demand started to decrease in Q2 2012 and demand has continued to decrease throughout this period as for the other blood services. SNBTS Issues to the five BSMS hospitals served by SNBTS have reduced over the period 12-14, SNBTS has experienced a downward trend since 2010. IBTS As for other services, a fall in red cell issues was noted during Q2 2012-13 and demand has continued to decrease throughout this period. 9

Blood Service: Days Stock (ISI) Red Cells The number of days stock (known as Issuable Stock Index (ISI)) that each blood service holds is important because this affects the age of the stock at issue. Higher stocks means older red cells are issued, and hospitals have less time to use them before they expire. As demand reduced, all blood services experienced a rising ISI. A cautious response to reduced demand from hospitals, caused an increase in Blood Service Issuable Stock Index. NHSBT ISI ~ 10.2 RBC stock (Issuable Stock Index) was over 10 days for an 8 month period after the demand started to reduce. The average ISI was 10.4 for 12-13 and 10.2 for 13-14. NIBTS ISI ~ 12 ISI ranged from 6.9 days stock to 16 days stock. During 2012-13, ISI <10 days and during 2013-14 the ISI was an average of 12. WBS ISI ~ 12 Ranged from >14 days, to <6 days stock, (due to training commitments of collection teams). The ISI has risen steadily through the last 6 months of the reporting period. IBTS ISI ~ 6.9 The Issuable Stock Index (number of days stock held) has remained at 6.9 days for year 2013-14. For 2012-13 it was less, at 6.1. This may reflect the reduction in demand. SNBTS ISI ~ n/a Unable to calculate due to incomplete data. 10

Report 2012-14 O RhD Negative Red Cell Demand BSMS has monitored the demand for Group ORhD negative red cells across the blood services. Whilst less than 9% of patients are Group O RhD Negative, issues are generally much higher. As red cell demand for other blood groups reduced, the number of O RhD negative red cells issued remained constant, so that as a percentage of total issues, there was an apparent increase for this group. This creates additional challenges for blood services. O RhD Negative red cell demand varies, but remains higher, with the use of remote fridges and number of hub and spoke sites increasing. Percentage of Group ORhD negative RBC issued NHSBT ~ 11.5% Pathology networking, remote issues fridges and increased use of massive haemorrhage protocols all contribute to the increase in % of O RhD neg red cells issued. WBS ~ 10% A small increase in % of O RhD Neg RBC issues over the period. The last quarter had 10% of issues which is significantly lower than NHSBT issues. SNBTS ~ 17.0% The SNBTS hospitals indicate a slight increase in O RhD Neg demand, risen from less than 16% to around 17% of issues. NIBTS ~ 13.5% <13% for first two quarters 2012-13, increasing to 13.5% in early 2013-14. The demand is no longer increasing. IBTS ~ 14.0% At 14% this percentage has increased only slightly during 2013-14. This does not reflect the upward trend seen in NHSBT and SNBTS. 11

Blood Service: Red Cell Wastage (WAPI) The data received by the BSMS continues to show very low levels of wastage within blood services. There is variation in wastage levels from month to month which can be attributed to periods where stocks were increased to cover specific events (e.g. Olympics, Flu period), especially where these may affect collections. External influences such as extreme weather conditions can lead to temporary reduction in demand which may impact on blood service wastage. Accurate demand planning is required to minimise blood service wastage. Blood service wastage is recorded as a percentage of issues (WAPI). NHSBT RBC NHSBT wastage was ~ 1% for 2012-13 but from Q2 2013-14 it has reduced by 50%, and had an average of 0.4%. WBS RBC WAPI was very low at < 0.2% WAPI from Q2 2012 to end of Q2 2013. It has increased slightly which may be due to the rise in ISI. IBTS RBC IBTS wastage is less than 1% but the range varies from 0.5 1.7% with the lowest being during December 2013. SNBTS RBC Unable to calculate due to incomplete issue data. NIBTS RBC No internal wastage data available. 12

Report 2012-14 Blood Service: Platelet Demand The change to platelet demand was not universal across the blood services. NIBTS, IBTS and SNBTS issued fewer platelets in 2013-14 than in 2012-13, after a prolonged period of increasing demand. For NHSBT, demand continued to rise over the period of the report. In the last quarter of 2013-2014 the rate of increase month on month slowed slightly, which may reflect work being done to reduce inappropriate transfusion of this component. NHSBT was the only blood service with continued increase in demand for platelets. NIBTS, SNBTS and IBTS all noticed a reduced demand. SNBTS Demand for platelets to participating SNBTS hospitals appears to have reduced over the 2 year period 2012-2014 by more than 10%. NHSBT The number of platelets issued increased by approximately 1.5% in 2013-2014 and 1.2% in 2012-2013. NIBTS NIBTS platelet issues increased slightly (<2%) in 2012-13 from the previous year, but in 2013-14 platelet issues decreased by 8%. IBTS Platelet demand for IBTS hospitals during this period has decreased. The number of platelet issues reduced by approx. 10%. Note: WBS do not report platelet data. 13

Blood Service: Days Stock (ISI) Platelets There is a difference across the blood services in platelet shelf-life, either 5 or 7 days expiry. The challenge is holding sufficient inventory to meet demand without over-stocking and increasing internal wastage. Each blood service has different ways to avoid internal wastage, which include tracking platelets and moving elsewhere if close to expiry, pushing platelets out rather than await requests and NHSBT have reduced stock levels to minimise internal wastage. Stocks of platelets held by NHSBT have decreased. NIBTS stock increased and there was no change in IBTS stocks, although demand has dropped in these two countries. NHSBT ISI ~ 2.0 Stock of platelets has reduced. At 2.4 days for the first 12 months, but decreased over that period to average of 2.0 with a low of 1.0 days. IBTS ISI ~ 3.0 IBTS stock has been running at around 3 days worth of stock for the entire period. NIBTS ISI ~ 1.9 From a stock of 1.3 for 2012-13 rising to 1.9 days during the 13-14. This could be due to the reduction in demand. SNBTS ISI ~ n/k Unable to calculate due to incomplete data. Note: WBS do not report platelet data. 14

Report 2012-14 Blood Service: Platelet Wastage (WAPI) Wastage as a percentage of issue (WAPI) is calculated for adult platelets and has always been a much higher percentage than red cells, due to the shorter shelf-life of the component. The bacterial screening of platelets within NHSBT has increased the shelf-life to 7 day and since then work has been done to reduce internal wastage levels which peaked at over 4%. Seasonal variations cause spikes in wastage after stock building for bank holiday disruptions. Due to the lack of data from the other blood services, BSMS is unable to compare performance between blood services. Platelet wastage as percentage of issues is being reduced in the reporting blood services. NHSBT Platelets Blood service wastage has been reduced from >4%. WAPI was <2% for most of 2013-14 (excluding the Christmas period which saw a 4% WAPI). IBTS Platelets Reported WAPI was > 21% in 2012-13 and has decreased slightly at < 19% in 2013-14. This data may be elevated due to platelet transfers undertaken by the blood service. SNBTS Platelets Unable to calculate due to incomplete issue data. NIBTS Platelets No internal wastage data available. Note: WBS do not report platelet data. 15

Hospital Data: Introduction The scheme relies on hospital submission of daily stock levels and reporting (either daily or monthly) of any wastage of blood components. Adult red cells and platelets only are included at this time. These data are used together with the information supplied from the blood services to allow benchmarking between hospitals of similar specialities and size. But the information also provides insight into the hospital end of the supply chain and demonstrates how hospital changes can impact on demand and how they should influence the demand planning processes for the future. Hospital participants are also involved in the Educational days run each year by the scheme. The meetings in 2013-14 focussed on one area where some atypical change in practice had been noted, that of ORhD Negative demand. With overall demand for red cells falling, demand for this blood group remains steady. The scheme wanted to understand reasons for the demand and to put together some suggestions around best practice for handling Group O RhD Negative stock. As a result, the scheme produced a leaflet Red cells for emergency use which brought together Best Practice from the Regional Roadshows. Blood Stocks Management Scheme Red Cells for Adult Emergency Use: In Six Easy Steps Red cells for emergency use Best Practice from BSMS Regional Roadshows 1. Red cells for ADULT Emergency use should be a standard specification of O RhD Negative, C-, E-. K- Other specifications are unnecessary in genuine emergencies and reduce the supply of typed blood for those who may need it. 2. Emergency red cells should be returned to general stock allowing time to transfuse appropriately. This will be dependant on hospital size. For medium and low usage category hospitals at least seven days will be required. 3. Best practice in returning emergency red cells is usually the result of good SOP s, good training and good visual aids, with clear indication about date of restock (not expiry). 4. If units are restocked in time, they can be transfused to patients who require O RhD Negative red cells. But if they aren t used, consider transfusing them to other group patients before they expire, in a time-frame determined by your hospital size. 5. Audit locations of blood fridges regularly and review through your Hospital Transfusion Committee. Removal of the emergency red cells can reduce both use and wastage. 6. Group O RhD Positive blood could be issued as part of a Massive Haemorrhage pack, dependant on age, sex and clinical condition of the patient. And finally: Though there were huge variations in practices for provision of emergency red cells, one theme was common to all delegates; that laboratories should be able to provide safe and timely blood for patients in emergencies, without compromising overall blood stocks. 16

Report 2012-14 Hospitals: Red Cell Days Stock held (ISI) As issuable stock index is calculated using hospital demand over a rolling 6 month period, the ISI increased towards the end of the reporting period for most hospitals. This suggests that hospitals did not review their inventory levels as their demand for red cells fell. There is changing practice within hospitals with more remote fridges holding stock, which may also be a factor in the rise in ISI. Hospitals around the UK and Ireland have experienced raised stock levels (higher ISI) during this period. NIBTS Hospitals ISI ~ 6.5 Increased from below 6 days stock pre 2012 to 6.1 in 12-13 (with a range of 5.9-6.3) to 6.5 days stock (ISI) during 13-14. NHSBT Hospitals ISI ~ 5.8 In 2010-12, ISI was 5.5 days stock, the ISI rose in 2012-13 to 5.6 and to 5.8 in 2013-14. This suggests hospitals have not altered their stock with reduction in demand. WBS Hospitals ISI ~ 8 After a sustained period from Q2 2012 the ISI was 6. From Q3 2012-13 the ISI has been increasing and is currently above 8%. SNBTS Hospitals ISI ~ 6.0 The days stock held was stable during 12-13 at 5.3 but through 13-14 this has increased and finished the year at 6 days stock. IBTS Hospitals ISI ~ 8.6 During 2012-13 the hospitals ISI increased and peaked at the end of the year with a hospital ISI of 9. Since then it has reduced and is now running at around 8.6. 17

Hospitals: Red Cell Wastage (WAPI) The stock levels held by hospitals depend on factors such as distance from the blood service and clinical specialities covered by the hospitals, so reducing stock to reduce wastage is not always an option. Hospital red cell wastage is known to be related to blood service stock levels. Ireland has the lowest hospital WAPI and the lowest blood service ISI. NIBTS hospitals have the highest WAPI and highest blood service ISI. Time-expiry wastage within hospitals is related to age of red cells at issue, but also partly due to number of days stock held. SNBTS Hospitals WAPI ~ 2.0% RBC Wastage reported (WAPI) remained at 1.5% for 12-13. A spike in Dec 13 of 4.9% was unusual, and WAPI has since reduced to ~ 2%. IBTS Hospitals WAPI ~ < 1% For those hospitals who report, WAPI in Ireland remains very low at < 1%. NHSBT Hospitals WAPI ~ 2.4% During August and September 2012 WAPI rose slightly to around 2.8%, possibly due to NHSBT stock build for the Olympics. WAPI has dropped again to 2.4%. WBS Hospitals WAPI ~ 2.0% The hospital wastage has been decreasing over this period an average of 2.2 WAPI 12-13 and 2.0 in 13-14. NIBTS Hospitals WAPI ~ 4.6% Red cell wastage in Northern Ireland hospitals has remained steady throughout this period at 4.6-4.7%. 18

Report 2012-14 Hospitals: RBC Wastage by Category In 2013-14 the percentage of overall RBC wastage due to time-expiry (TIMEX) was: NHSBT Hospitals - 67% WBS Hospitals - 73% NIBTS Hospitals - 75% IBTS Hospitals - 85% SNBTS Hospitals - 38% The percentage of units wasted through removal from controlled conditions (OTCOL) appears to be decreasing though this remains a significant proportion of wastage in NHSBT and Wales. This is the major cause of wastage in reporting hospitals from Scotland but IBTS hospitals report little OTCOL wastage. Time-expiry is still highest reason for red cell wastage for most hospitals. Hospital RBC Wastage by Category 2013-2014 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% NHSBT WBS SNBTS NIBTS IBTS Fridge Failure 398 8 189 28 10 Miscellaneous 2837 85 76 195 79 Out of temperature Control 9892 294 549 345 41 Time-expiry 27030 1043 492 1734 710 19

Hospitals: Platelet Wastage (WAPI) As for red cells, the stock held within the blood services (and the age of the component when issued) impacts on the wastage within hospitals. Larger hospitals are more frequently holding platelets as stock, as recommended by the BSMS algorithm produced in 2011 (1), although the majority of hospitals request platelets for specific patients. The IBTS hospitals have very low WAPI which may be related to the higher blood service WAPI seen on Page 15. Hospital platelet wastage is much more variable, especially when hospitals request for specific cases. WBS Hospitals WAPI ~ n/a (Although WBS hospitals report their wastage of platelets, we cannot provide a WAPI). SNBTS Hospitals WAPI ~ 3.2% Over the reporting period WAPI in these hospitals has reduced from 4.2% in 2012-13 to 3.2% in 2013-14. IBTS Hospitals Hospital WAPI is low and has reduced further from 1.3% 2012-13 to 0.9% in 2013-14. NHSBT Hospitals WAPI ~ 3.8% Hospital WAPI was 4% or higher for Q1 and Q2 of 2012-13. Since then it has dropped to below 4% and has been around 3.7% for most of 2013-14 with a seasonal spike at Christmas. NIBTS Hospitals WAPI ~ 5.0% There has been a significant drop in WAPI over this period from 8.3% in 2012-13 to 5.7% in 2013-14 although month to month variation is large. Note: Wastage as percentage of issues (WAPI). 20

Report 2012-14 Hospital Platelet Wastage by Category Wastage by Category in % 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% NHSBT WBS SNBTS NIBTS IBTS Medically ordered not used 49.7 26.9 20.3 48.5 34.4 Miscellaneous 3.5 0.7 3.3 2.8 3.0 Surgically ordered not used 15.9 5.5 7.4 9.8 8.6 Time expired 26.8 66.1 64.7 38.2 51.5 Wasted import 0.2 0.0 0.0 0.3 0.1 Wasted out of lab 3.9 0.9 4.2 0.5 2.4 When the scheme introduced platelet benchmarking, demand was very much related to specific patients requests. With platelet usage increasing, the categories of wastage become blurred, hospitals have reported cases where one unit of platelet may have switched between several different patients before finally time-expiring. Consequently, time-expiry is higher as a percentage of wastage in this report than previously. NHSBT hospitals still has Medically Ordered Not Used as the most common reason, as does NIBTS. SNBTS, IBTS and WBS hospitals have time-expiry as the more frequent. Wastage which is associated with ward errors or storage and transportation errors is around 4% in SNBTS and NHSBT which is an area that could be improved, with WBS and NIBTS being less than 1%. 21

BSMS Steering Group Membership Dr Craig Taylor Chair of BSMS Consultant Haematologist Russell s Hall Hospital Dudley, DY1 2HQ Mrs Teresa Allen NHSBT Assistant Director of Customer Services NHSBT Watford Watford, 4QN Elaine MacRate BSMS Manager BSMS PO Box 33910 London NW9 5YH Mr Jonathan Watts NHSBT National Platelet Manager NHSBT Birmingham Birmingham, B15 2SG Mr Paul Milne Scottish National Blood Transfusion Service National Logistics Manager Glasgow, G12 0XB Mr Tom McFarland Northern Ireland Blood Service and associated hospitals Transfusion Laboratory Manager Daisy Hill Hospital Newry BT35 8DR Ms Jayne Addison NHSBT Patient Blood Management Team Patient Blood Management Practitioner Liverpool, L24 8RD Dr Ann Benton Welsh Blood Service & hospitals Consultant Haematologist Morriston Hospital Swansea, Wales Dr Janet Birchall Patients Clinical Team NHSBT Consultant Haematologist NHSBT Filton Centre Bristol BS34 7QH Mr Peter Baker Hospitals served by NHSBT Transfusion Laboratory Manager Royal Liverpool University Hospital Liverpool, L7 8XP Mr Adrian Ebbs NHSBT served hospitals Transfusion Laboratory Manager Queen Elizabeth Hospital Kings Lynn, PE30 4ET Ms Rachel Moss NHSBT served hospitals Transfusion Practitioner St Mary s Hospital London W2 1NY Mrs Karen Shreeve Welsh Blood Service & hospitals Manager, Better Blood Transfusion Team Welsh Blood Service Pencoed CF35 5LJ 22

Report 2012-14 Glossary of Terms Activity Status BSMS IBTS IPS ISI MISC MONU NHSBT NIBTS Nominal Stock OTCOL SNBTS SONU STEX TIMEX VANESA WAPI WBS WI WOL Indicates regularity of hospital data entry into VANESA; status can be regular, partial or none. Blood Stocks Management Scheme. Irish Blood Transfusion Service: Blood Service supplying hospitals of Southern Ireland. Inventory Practice Survey: Annual survey distributed to BSMS hospitals; collecting information on hospital inventory practice. Issuable Stock Index (Hospital or Blood Service) ratio of current issuable stock to nominal stock. Used to assess relative stock levels in hospitals and/or blood centres. Miscellaneous (Hospital or Blood Service wastage not covered by other wastage reason codes). Medically ordered not used (Platelet wastage reason) Platelet unit ordered for a medical patient, but not used and wasted. NHS Blood and Transplant Blood Service: Blood Service supplying the hospitals of England and North Wales. Northern Irish Blood Transfusion Service: Blood service supplying hospitals of Northern Ireland. Approximation of a single days stock (Hospital) Mean daily number of Red cell / Platelet unit received, during a six month period (Centre) Mean daily number of Red cell or Platelet units issued, during a six month period. Out of temperature control outside the laboratory (Red cell Hospital wastage reason) units that are wasted for being outwith cold chain specifications on removal from fridge. Scottish National Blood Transfusion Service: Blood service supplying hospitals of Scotland. Surgically ordered not used (Platelet wastage reason) Platelet unit ordered for a surgical patient, but not used and wasted. Stock platelet time expiry (Platelet wastage reason) Platelet unit that exceeds its natural shelf life; only applicable to hospitals that hold stock platelets. Time Expiry (Hospital or Blood service wastage reason) Red cell or Platelet units that exceed their natural shelf life. Blood Stocks Management Scheme data management system. Wastage as a Percentage of Issue (Hospital) Number of wasted units (Red cell or Platelet) divided by the number of units issued to the hospital. (Blood Centre) Number of wasted units (Red cell or Platelet) divided by the number of units the Blood Centre receives. Welsh Blood Service: Blood service supplying the hospitals of South Wales. Wasted import (Platelet wastage reason) Platelet unit imported with a patient, but then not used and wasted. Wasted out of the laboratory (Platelet wastage reason) Platelet unit taken from the laboratory, left on the ward and wasted. 23

BSMS Recommendations 1. Reduce (where possible) the Red Cell Stock held by Blood Services Holding 10 days or more stock for red cells leads to increased wastage for hospitals. The data show that it is possible maintain adequate supply with 6 days stock. Hospitals could be encouraged to hold a larger stock, which would not increase their wastage if proper stock rotation is in place. This would give additional confidence in the supply chain to cover short periods of increased demand or any unforeseen reduction in collection processes. 2. Collection by Blood Group The reduction in blood service red cell stock should be done in parallel with a collection plan which incorporates blood groups. Whilst this may be difficult to introduce it is essential to ensure sufficient Group O RhD negative is available to meet an increasing demand. 3. Agile response to changes in demand Both blood service and hospitals need to be able to amend their stock inventory in a timely manner. This should be done as part of a controlled process to cover periods of reduced demand (e.g. when wards are closed for winter) or reduced availability. Having an agile process will avoid stock build-up and increased wastage without introducing supply failures. 4. Facilitate movement of blood components to help reduce wastage Both hospitals and blood services should consider the movement of blood components to reduce wastage. If appropriate, the blood service could facilitate the transfer of products from one site to another. 5. OTCOL wastage to be focus of 2014-15 survey and educational events As Out of Temperature Control wastage remains a significant cause of wastage, BSMS should engage the hospitals to find ways of avoiding this. Next years educational focus will be on this topic. 24