Blood Stocks Management Scheme Annual Report 2011/12

Blood Stocks Management Scheme Annual Report 2011/12 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: MacRate E (Ed.), Taylor C, on behalf of the Blood Stocks Management Scheme (BSMS) Steering Group. The 2011 2012 Annual BSMS Report (2012). 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 publiction 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) 2012 Published 7th January 2013

Table of Contents Foreword... 4 About the Blood Stocks Management Scheme... 5 Participation in BSMS... 6 Highlights from 2011/12... 8 Headline summary... 9 Key Findings 2011/12... 11 Red Cell Blood Supply System... 14 England and North Wales (NHSBT)... 14 Northern Ireland (NIBTS)... 17 South Wales (WBS)... 20 Southern Ireland (Irish BTS)... 23 Scotland (SNBTS)... 25 Platelet Supply System... 26 England and North Wales (NHSBT)... 26 Northern Ireland (NIBTS)... 28 Southern Ireland (Irish BTS)... 30 Scotland (SNBTS)... 32 South Wales (WBS)... 32 Blood Stocks Management Scheme (BSMS) Steering Group Membership... 33 Glossary of terms... 35

Foreword This has been another busy year for the BSMS, made all the more difficult by the ongoing changes in staffing the scheme. We have said goodbye (temporarily) to Sue Cotton who has been seconded to the NHSBT Integrated Transfusion Services stock project, and welcomed Elaine MacRate, who is managing the scheme until her return. A major part of our work in 2011/12 was to survey users to see how they would like the scheme to progress. We now have agreement for the key developments; the enhancements to VANESA to collect frozen component data and the facility for participants to collect reports electronically. The automatic transfer of data has long been a goal and we continue to explore the feasibility of implementing this. We received very positive feedback from scheme users and are gratified to know that it continues to be of value. The scheme has been collecting data on stock holding and wastage across the UK for some years now and remains the only source of this data. The data is somewhat fragmented however, but we continue to work towards being able to present data across the entire supply chain, demonstrating comparative data between the different blood services across the UK and Ireland, and delivering benefits for both hospitals and the blood services. The recently launched Patient Blood Management initiative aims to drive forward transfusion safety and appropriate use agendas and has emphasised the need for data to achieve this. These initiatives are really about changing practice, utilising benchmarking and review processes. The BSMS remains ideally placed to facilitate this. The BSMS has been involved in the AIM II pilot scheme, collecting data from Patient Administration Systems on the clinical use of blood. Participation in the scheme remains high and I am pleased to say that we are beginning to see data from Scotland and the Republic of Ireland. A key aim this year has been to broaden the staff groups who access data directly, and to encourage wider utilisation. In England, the Regional Transfusion Committees have embraced the data and we have had a good response from transfusion practitioners. I would still encourage the wider Transfusion Teams, including the Hospital Transfusion Committee chairs and consultant haematologists to access and utilise the data. We have produced new high level reports that we hope will help to expand this use of the data. As always, the scheme would not be the success that it is without the hard work and participation of the members and I would like to thank you all for your continued support. I am sure that you will join me in thanking Sue Cotton and her team for their continued hard work in making the scheme a continued success. Craig Taylor Steering Group Chair, Blood Stocks Management Scheme December 2012

3. About the Blood Stocks Management Scheme The Blood Stocks Management Scheme was established in April 2001 as a partnership between hospitals and blood services to maximise the use of donated blood and platelets, by increasing understanding of the entire blood supply chain. Data from blood services and hospitals are entered into a database either automatically or by manual entry via the BSMS website. The data stored include issues, inventory, wastage and shelf life of issued red cells and platelets. A range of reports can be generated automatically by participants from real time data, allowing the use of information on a day to day basis. In addition, a number of reports are generated by the scheme analysts and distributed periodically as hard copies to participants. Blood services and hospitals from the UK and the Republic of Ireland participate in the BSMS to contribute to the depth of information related to blood supply management. The BSMS continues to strive for improvements in stock management through a number of initiatives including inventory practice surveys and reports, publications, meetings and training events.

4. Participation in BSMS The BSMS relies on regular and accurate data input from both hospitals and blood services. The scheme has a list of registered participants, most contribute data regularly, some contribute their data less consistently. BSMS monitors the activity of hospital participants periodically so that bi monthly email reminders can inform participants of missing data. Missing data can be entered retrospectively. A recent audit of the activity of NHSBT participants showed that over 80% of registered users enter their stock data on a daily basis, which was extremely reassuring. Activity by participant is defined as: Number of entries per month Red Cell Stock Red Cell Wastage Platelet wastage Regular Activity >=16 >=1 >=1 Partial Activity <16 OR 0 OR 0 None 0 0 0 Hospital activity by blood service is shown in Tables 1a to 1e and compares activity in March 2011 with March 2012. Table 1a Hospital Activity within England and North Wales (NHSBT) Blood Service Activity Status Hospital count 2011 % 2011 Hospital count 2012 % 2012 NHSBT Regular 207 80% 213 82% NHSBT Partial 45 17% 34 13% NHSBT None 6 2% 14 5% Table 1b Hospital Activity within Northern Ireland (NIBTS) Blood Service Activity Status Hospital count 2011 % 2011 Hospital count 2012 % 2012 NIBTS Regular 6 60% 9 90% NIBTS Partial 4 40% 1 10%

Table 1c Hospital Activity within Wales (WBS) Blood Service Activity Status Hospital count 2011 % 2011 Hospital count 2012 % 2012 WBS Regular 8 50% 7 44% WBS Partial 7 44% 9 56% WBS None 1 6% Table 1d Hospital Activity within Ireland (IBTS) Blood Service Activity Status Hospital count 2011 % 2011 Hospital count 2012 % 2012 Irish BTS Regular 8 21% 9 23% Irish BTS Partial 17 44% 11 28% Irish BTS None 14 36% 20 50% Table 1e Hospital Activity within Scotland (SNBTS) Blood Service Activity Status Hospital count 2011 % 2011 Hospital count 2012 % 2012 SNBTS Regular 2 33% 2 33% SNBTS Partial 3 50% 4 67% SNBTS None 1 17%

5. Highlights from 2011/12 We organised and delivered 6 regional meetings for hospital and blood service staff. 235 delegates attended from hospitals and blood services in England, Wales, Scotland, Northern Ireland and the Republic of Ireland. The aim of the meetings was to share good practice and provide tools and ideas to improve blood inventory management. Various topics were explored including blood drivers, stock sharing relationships and the challenges and limitations of stocking platelets in hospitals. We undertook a consultation with hospitals to extend the transparency of the Blood Stocks Management Scheme (BSMS) hospital data to include NHS Blood and Transplant and in Wales to include the Welsh Blood Service. Increased visibility of data between hospitals and blood services is already in place in Scotland, Northern Ireland and the Irish Republic. The benefits of increasing data transparency are to enable improvements to the blood supply chain which will benefit both hospitals and Blood Services. There was overwhelming hospital support for the proposal and the BSMS Steering group agreed that the hospital data should be made available to NHSBT and WBS. We undertook a strategy survey with hospital participants with the objectives of assessing Whether the BSMS continues to provide benefits to hospitals in terms of management of blood stocks. What services should be provided by the BSMS in the future that would be of benefit to hospitals and Blood Services. The survey provided evidence of the benefits to the management of blood stocks and informed the BSMS Steering Group in terms of the future strategy of the BSMS. We presented three posters at the BBTS meeting held in Glasgow during September 2011. How much blood is in the supply chain? A new method for calculating platelet usage categories in the BSMS Reduction in wastage in the blood supply chain by sharing stock We had three papers published in peer reviewed journals Wilding, R., Cotton, S., Chapman, J., Yates, N. (2011) Time based analysis of the aphaeresis platelet supply chain in England. Vox Sanguinis, 101 (3),247 249. Stanger, S.H.W., Yates, N., Wilding, R., Cotton, S. (2012) Blood Inventory Management: Hospital Best Practice Transfusion Medicine Reviews, 26 (2), 153 163. Stanger, S.H.W., Yates, N., Wilding, R., Cotton, S. (2012) What drives perishable inventory management performance? Lessons learnt from the UK blood supply chain. Supply Chain Management: An International Journal, 17(2), 107 123. Invited speaker at the 6 th Malaysian National Transfusion Medicine Conference in Kuala Lumpur, Malaysia.

6. Headline Summary 6.1 Red Cell Issues NHS Blood and Transplant (NHSBT): 1,835,000 adult red cells were issued in 2011/12, a 0.2% decrease when compared to 2010/11 (cf. 1,838,500). Northern Ireland BTS (NIBTS): 53,713 adult red cells issued, a 0.5% increase when compared to 2010/11 (cf. 53,450). Welsh Blood Service (WBS): 85,620 adult red cells issued, a 2.1% increase compared to the same data from 2010/11 (cf. 83,824). (1) Scottish National Blood Service (SNBTS) 188,361 adult red cells issued by SNBTS. Irish BTS (IBTS): 138,080 adult red cells issued, a 0.5% decrease when compared to 2010/11 (cf. 138,794). 6.2 Red Cell Wastage (by Blood Service) NHSBT: 19,687 units were wasted, increased from 15,931 units in 2010/11 (2). This was 1.1% of issues compared to 0.9% in 2010/11. NIBTS: Wastage data was not available this year (3) WBS: 374 units were wasted, an increase from 266 in 2010/11. This was 0.4% of issues compared to 0.3% in 2010/11. SNBTS: Wastage data is not available this year. IBTS: 1,423 units were wasted, a decrease from 1600 in 2010/11. This was 1.0% of issues compared to 1.2% in 2010/11. 6.3 Hospital Red Cell Wastage by active hospital participants NHSBT: Average wastage was 160 units, down from 172 units (2010/11). Hospital wastage is 2.1% of total issues. NIBTS: Average wastage was 256 units, unchanged from 256 units (2010/11). Hospital wastage is 4.8% of total issues. WBS: Average wastage was 137 units, up from 107 units (2010/11). Hospital wastage is 2.6% of total issues. SNBTS: Average wastage was 270 units per participant. IBTS: Average wastage was 75 units, up from 71 units (2010/11). Hospital wastage is not reported see page 24. (1) The Welsh Blood Service issued an additional 5400 units for specific patients, bringing total issues for the service is 90,959. These units should be included in future reports but are omitted from year on year comparisons in this report. (2) Increase partly due to differences in the collation of the data. (3) Due to technical issues.

6.4. Platelet Issues NHSBT: 264,800 adult platelet units issued in 2011/12, an increase of 8.3% compared to 2010/11 (cf. 244,500). NIBTS: 8,057 adult platelet units issued, an increase of 9.4% compared to 2010/11 (cf. 7,366). WBS: 9,535 adult platelet units issued (data not previously supplied). SNBTS: 25,981 adult platelet units issued, an increase of 3.9% compared to 2010/11 (cf. 25,005) IBTS: 25,666 adult platelet units were issued by IBTS an increase of 6.3% compared to 2010/11 (cf. 24,137) 6.5 Platelet wastage (by Blood Service) NHSBT: 14,422 platelet units were wasted, (down from 17,378). Wastage was 5.4% of issues in 2011/12 compared to 7.2% in 2010/2011 NIBTS: No wastage data available for this year WBS: Platelet data not collected SNBTS: No data available (1) IBTS: 2,722 platelet units were wasted (down from 3,426). Wastage was 10.6% of issues in 2011/12, compared to 14.2% in 2010/11. 6.6 Hospital Platelet Wastage per active hospital participants NHSBT: Average wastage was 49 units per participant, down from 54 units (2010/11). Hospital wastage is 4.0% of total issues. NIBTS: Average wastage was 61 units per participant, increasing from 54 units (2010/11). Hospital wastage is 7.6% of total issues. WBS: Platelet data not collected SNBTS: Average wastage was 223 units per participant. IBTS: Average wastage was 24 units per participant, unchanged from 2010/11. 6.7 O RhD Negative Red Cells as a Percentage of Total Issues NHSBT: O RhD Neg issues were 10.6%, compared to 10.3% in 2010/11. NIBTS: O RhD Neg issues were 13.8%, compared to 13.5 % in 2010/11. WBS: O RhD Neg issues were 8.9%, compared to 8.7% in 2010/11. SNBTS: No data available (1) IBTS: O RhD Neg issues were 14.0%, compared to 15.8% in 2010/11. (1) The Scottish National Blood Service was unable to provide an automatic download of data until late 2012. Data has now been supplied retrospectively, but we were unable to analyse it for this report.

7. Key Findings 2011/12 7.1 Red Cell Supply Chain Red cell issues to hospitals during 2011/12 were relatively stable across NHSBT, NIBTS and IBTS. Changes in issues were between + / 0.5%. The red cell issues in WBS appear to have risen slightly more by comparison, with an increase of 2.1%. Issuable Stock Index (ISI) is one of the datasets calculated by BSMS and is based on the number of days stock held. This varies across the blood services from around 6 days stock held in Eire, to an average of more than 10 days stock in Northern Ireland. The level of stock held by blood services also changes throughout the year. Collections (and therefore stock levels) are affected by bank holidays, holiday periods in general and other factors such as adverse weather and sickness. It should be noted that detailed demand planning is undertaken for any predictable disruptions, such as the four day holiday weekends which occurred last year during a two week period, covering Easter and the Royal Wedding. Hospitals were approached for information about their predicted activity over that period but many hospitals were unable to offer any insight about predicted activity and subsequently the blood services ensured sufficient stock was available to meet normal demand. Most hospitals, however, experienced a reduced demand for those days. As issues were reduced, stock levels therefore become higher than normal. For England and North Wales, a prolonged period between March to May 2011 of higher stock levels (and higher ISI) was seen and this resulted in NHSBT hospitals demonstrating a higher than average wastage for April and May 2011. The amount of red cell stock normally held by each of the blood services varies. The variation in stock held between the blood services is large with IBTS ranging from 5.7 to 6.8 ISI and Wales ranging from 6.0 to 15.9 this year (Table 2). Table 2 Issuable Stock Index highest and lowest months in 2011/12 NHSBT NIBTS WBS SNBTS IBTS Lowest ISI 8.4 (Mar 12) 7.8 (Jan 12) 6.0 (Oct 11) Ave ISI 5.7 (Mar 12) Highest ISI 10.7 (Sep 11) 15.2 (Mar 12) 15.9 (Mar 12) 8.2 6.8 (Jan 12)

The Irish Blood Transfusion service has the lowest Issuable Stock Index and the hospitals that report time expiry wastage from Ireland have lower TIMEX than hospitals supplied by the other services. As only 50% of hospitals served by IBTS report wastage, the overall wastage as a % of issues for all IBTS hospitals cannot be calculated. Table 3 Hospital Wastage: Time Expiry TIMEX (by Blood Service provider) Time expiry as percentage of issues NHSBT NIBTS WBS SNBTS IBTS 1.4% 3.4% 2.1% 1.0% The number of units being wasted with a fate of Out of temperature control outside the laboratory (OTCOL) has reduced slightly for hospitals served by NHSBT, NIBTS and IBTS. Table 4 All hospital wastage as a % of issues highest and lowest months in 2011/12 NHSBT NIBTS WBS SNBTS IBTS Lowest 1.8 (Feb 12) 3.7 (Dec 11) 2.0 (Apr 11) N/A N/A Highest 2.5 (Aug 11) 6.0 (May 11) 3.2 (Feb 12) N/A N/A 7.2 O RhD Negative Issues BSMS has continued to analyse usage and wastage of Group O RhD Negative red cells, as collection of sufficient numbers of this group, is one of the biggest challenges for the UK blood services. Issues have increased again, albeit slightly, for NHSBT, NIBTS and WBS. The IBTS has had the highest percentage of O RhD Negative issues previously, and has this year reduced their O RhD Negative issues by 1.8 percentage points, to 14.0% of total issues. We also report on hospital wastage of O RhD Negative units, although this has proved controversial. Some hospital laboratories transfuse these units to all group recipients to avoid wastage (mismatch), whilst others retain the units until they expire, for use for O RhD Negative patients only. Table 5 shows the differences between hospitals, by each blood service.

Table 5 Percentage of O Negative red cells wasted in hospitals Hospitals served by 2009/10 2010/11 2011/12 NHSBT 4.4% 4.3% 3.7% Northern Ireland 5.8% 5.6% 7.0% Wales 2.8% 2.5% 3.9% Irish BTS 14.0% 7.3 Platelet Supply Chain Platelet issues have increased in all countries where this data is provided. NHSBT has seen an increase of 9.2%, Northern Ireland an increase of 9.4%, whilst IBTS increased by 6.3% and SNBTS by 3.9%. Although the figures are not available, Wales has also reported an increase in platelets issued. As discussed previously, there is evidence that some platelets may be used inappropriately ( hospital.blood.co.uk/safe_use/clinical_audit/national_comparative/ NationalComparativeAuditReports/index.asp) but other potential reasons for this increase, such as supply of platelets for massive haemorrhage trauma packs, have been suggested. There has not been an associated rise in wastage. NHSBT had a higher platelet ISI this year than 2010 11. The lowest ISI was 2.1 for two months, with most months over 2.2. For Northern Ireland, ISI was generally lower than 1.5 and this was lower than 2010 11. IBTS fluctuates between 2.1 and 2.9 ISI, similar to last year. Hospital wastage varies across the blood services, but ordering platelets for specific cases and subsequently not using them, remains the largest reason for wastage. Combined wastage for MONU (medically ordered not used) and SONU (surgically ordered not used) was 67% for NHSBT, 54% for NIBTS and 73% for IBTS. Wastage for these reasons (MONU and SONU) may be influenced by factors such as age of stock at issue, but also by frequency and times of delivery, distance from the blood centre and ability of hospital to store platelets. It is too early to determine if the BSMS algorithm for hospitals, for stock holding of platelets, has influenced practice and affected wastage. The algorithm is available from the website www.bloodstocks.co.uk.

8.1 Red Cell Blood Supply: England and North Wales 8.1. England and North Wales (NHSBT) Figure 1 shows the red cell supply chain using stock and wastage data taken from NHSBT participants and NHSBT. Total hospital wastage is shown as wastage as percentage of issue (WAPI) and can be seen to mirror NHSBT stock levels. This year the hospital issuable stock index (ISI) for the Very High Usage category and the Very Low Usage category has been added. The Issuable Stock Index differs greatly between the Very High usage category, where it is much lower and more constant than hospitals in the Very Low usage category, who receive only small volumes of red cells. Figure 1 Comparison between 2010/11 and 2011/12 for: Red cell stock (ISI) held in NHSBT, the total WAPI for all BSMS NHSBT hospitals. WAPI for NHSBT in 2011/12 shown, plus 2011/12 Hospital ISI for Very High and Very Low usage category. 8.1.1 Blood Service Issuable Stock Index: NHSBT The Issuable Stock Index (ISI) is a reflection of the number of days worth of stock. The NHSBT ISI has fluctuated between a high point of 10.7 in September 2011 which was the highest stock over the last 24 months. Stocks were built up for the Easter / Royal Wedding bank holiday period and the ISI remained over 10 days for that period also. The ISI had a low point of 8.4 in March 2012.

8.1.2 Hospital Issuable Stock Index: England and North Wales The average ISI remains variable between the hospital red cell usage categories 1 (Table 6). Very High usage category hospitals hold less stock. For all usage categories, O RhD Negative ISI is higher than the total ISI, with hospitals holding approximately an extra 2 days worth of stock. This could be due to stock held as emergency units in blood fridges outside the laboratory. The levels of stock, in terms of ISI, has remained unchanged since 2010 11 in any of the hospital categories. Table 6 Average ISI by hospital category for NHSBT BSMS hospitals Very High High Moderate Low Very Low All Groups 4.8 5.4 6.2 9.0 14.2 O RhD Neg 6.9 7.3 8.4 12.5 18.1 8.1.3 Red Cell Issues: NHSBT NHSBT issued 1,835,000 red cell units, between April 2011 and March 2012, a decrease on the previous year of 0.2%(cf. 1,838,500). The median number of days to expiry at issue was 21 days. This has increased by 1 day since 2010/11. The percentage of units with at least 20 days to expiry ranged from 41% in May 2011, to 65% in January 2012, similar to previous years. O RhD Negative issues to BSMS participants as a percentage of total issues was 10.6%, 0.3 percentage points higher than in 2010/11 (10.3 %). This represents an increase of 5,000 units. 8.1.4 Blood Service Wastage: NHSBT Blood service wastage is separated into two categories TIMEX and MISC. MISC wastage is composed of any unit that is available for issue and has been discarded for a reason other than time expired. Wastage as a percentage of issue is 1.1% in 2011/12. Table Total NHSBT wastage by wastage reason since 2010/11 TIMEX MISC Total WAPI % 2011/12 15551 4136 19687 1.1% 2010/11 10341 5590 15931 0.9% 1 Red cell usage categories are defined in the glossary

8.1.5 BSMS Hospitals Wastage: England and North Wales The percentage of all issues that were recorded as wasted by hospitals has decreased slightly, and was 2.2% (compared to 2.4% 2010/11). The percentage of all O Rh D Neg units that were recorded as wasted was 3.7% compared to 4.3% 2010/11, although differences in practice for discarding O RhD Neg units has been mentioned previously. Average total wastage per participant hospital for all blood groups was 160, a decrease of 12 units from 2010/11. Once again, a reduction in time expiry wastage accounts for most of this decrease in red cell wastage (Average per BSMS participant 105). Average OTCOL wastage per hospital participant is 39 units, slightly reduced from 2010/11. Table 7 England and North Wales BSMS hospitals wastage, by wastage reason and average per participant since 2002/3 TIMEX OTCOL MISC FF Total Total 2011/12 25897 9666 3402 638 39603 Ave. per BSMS participant 2011/12 105 39 14 3 160 2010/11 114 42 13 3 172 2009/10 125 42 12 4 183 2008/9 107 35 9 3 155 2007/8 92 29 8 3 133 2006/7 97 28 10 2 138 2005/6 104 26 8 3 142 2004/5 139 25 8 3 175 2003/4 91 23 7 2 125 2002/3 103 21 *7 N/A 135 * includes fridge failure

8.2 Red Cell Blood Supply: Northern System: Northern Ireland Ireland 8.2 Northern Ireland (NIBTS) Figure 2 shows the red cell supply chain using stock and wastage data taken from NIBTS participants and NIBTS. The wastage within the blood service varies considerably during the year, which may be a reflection on the smaller numbers of both units (53,000) and hospitals (10) involved. Figure 2: Comparison between 2010/11 and 2011/12 for: NIBTS Red cell stock (ISI), Wastage as Percentage of Issue (WAPI) for all BSMS NIBTS hospitals. WAPI for 2010/11 only for NIBTS. Hospital ISI is shown for Very High and Low usage category. 8.2.1 Blood Service Issuable Stock Index: NIBTS The ISI for NIBTS is very similar year on year. Stock reduced slightly through April and May, then from an ISI of 14 in July, red cell stocks fell throughout the year to a low point in January (7.8 in January 2012). The ISI then increased sharply to a high in March of 15.2.

8.2.2 Hospital Issuable Stock Index: Northern Ireland The average ISI by hospital category remains variable between the hospital red cell categories. The lowest ISI is found in the Very High usage hospital category for all blood groups including O RhD Negative. The average ISI for O RhD Negative is increased for all categories, less than one day extra for Very High category usage, Moderate and Low category hold approximately 2 extra days. When compared to the previous year (2010/11) there is little change in the ISI in any of the hospital categories. Table 8 Average ISI by hospital usage category for Northern Ireland BSMS hospitals Very High Moderate Low All Groups 5.1 6.5 8.0 O RhD Neg 5.6 8.7 9.9 8.2.3 Red Cell Issues: NIBTS NIBTS issued 53,713 red cell units between April 2011 and March 2012, a increase of 0.5% when compared to 2010/11 (cf. 53,450). Red cell issues seem to be fairly constant for the last four years. The median number of days to expire at issue was 21 days in 2011/12; a increase of 1 day when compared to 20 days in 2010/11. The percentage of units issued with over 20 days to expiry ranged from 35% in March 2011 to 83% in January 2012 which reflects the NIBTS ISI range from 7.8 to 15 days stock. O RhD Negative issues as a percentage of total issues was 13.8%, 0.3 percentage points higher than in 2010/11 (13.5%). 8.2.4 Blood Service Wastage: NIBTS Wastage is separated into two categories TIMEX and MISC. MISC wastage is composed of any unit discarded for reasons other than time expired. NIBTS MISC includes pre and post validation wastage. NIBTS blood service wastage was not collated into the BSMS database this year, due to difficulties with the transfer of this data from the NIBTS blood service IT system. Table 9 Total NIBTS wastage by wastage reason since 2008/9 TIMEX MISC Total WAPI % 2011/12 N / A 2010/11 1196 1957 3153 5.8 2009/10 1171 2510 3681 6.8 2008/09 1157 1666 2823 5.4

8.2.5 BSMS Hospitals Wastage: Northern Ireland The percentage of all issues that were recorded as wasted was 4.8%, this is the same as last year (2010/11). Average total wastage per participant hospital for all blood groups was 256 per participant, no change from 2010/11. Wastage of O RhD Negative units was recorded as 7.0% compared to 5.6% in 2010/11, although the percentage of O RhD Negative issued from NIBTS increased. Average TIMEX wastage per participant hospital for all blood groups decreased from 191 per participant in 2010/11 to 180 per participant in 2011/12, a decrease of 11 units. Average OTCOL wastage per hospital participant has also decreased in the last year, with more units being fated under the MISC category. Table 10 NIBTS BSMS hospitals wastage by wastage reason and average per participant since 2004/5 TIMEX OTCOL MISC FF Total Total 2011/12. 1801 302 450 7 2560 Ave. per BSMS participant 2011/12 180 30 45 <1 256 2010/11 191 35 30 2 256 2009/10 165 26 18 3 212 2008/09 128 31 8 4 171 2007/08 139 34 11 1 185 2006/07 180 37 10 1 228 2005/06 210 33 9 3 255 2004/05 197 25 7 1 230

8.3 Red Cell Blood Supply: Wales 8.3 Wales (WBS) The red cell supply chain is shown below (Fig 3). Total red cell stock (ISI) held in all BSMS WBS hospitals, total stock held by WBS, and the total WAPI for all BSMS WBS hospitals and the WBS. The hospital ISI has also been added for Very High user and Very Low user categories for this year. Figure 3: Comparison between 2010/11 and 2011/12 for: Red cell stock (ISI) for WBS, the total WAPI for all BSMS WBS hospitals and for WBS. 2011/12 Hospital ISI for Very High and Very Low usage category. 8.3.1 Blood Service Issuable Stock Index: WBS For the first seven months of this year, the WBS ISI fluctuated between 5.9 and 9.0. For the following five months, ISI rose each month to a high point of 15.9 in March 2012. This was a deliberate stock build by the Welsh Blood Service, which allowed for all blood collection teams to undergo extensive training according to a pre determined schedule. 2 Red cell usage categories are defined in the glossary

8.3.2 Hospital Issuable Stock Index: WBS The average ISI remains variable between the hospital red cell usage categories 2 (Table 11) with the Very High use category having the lowest ISI. The Issuable Stock Index for O RhD Neg is higher than for all groups in all but the Very Low usage category. Table 11 Average ISI by usage category for WBS BSMS hospitals Very High High Moderate Low Very Low All Groups 6.5 6.6 7.1 10.5 13.9 O RhD Neg 13.4 8.2 10.0 14.0 13.3 8.3.3 Red Cell Issues: WBS The WBS issued 85,620 adult red cell units between April 2011 and March 2012, an increase of 2.1% when compared to 2010/11 (cf. 83,824). The median number of days to expiry at issue was 25 days in 2011/12 compared to 24 days in 2010/11; an increase of 1 day. The percentage of units issued with over 20 days to expiry ranged from 45% in March 2012 to 90% in September 2011. O RhD Negative issues as a percentage of total issues was 8.9%, 0.2 percentage points higher than in 2010/11 (8.7%). The Very High usage category hospitals appear to hold a large O RhD Negative stock (around 13 days) which may be due to holding emergency stock in outlying blood fridges. 8.3.4 Blood Service Wastage: WBS Wastage as a percentage of issue increased to 0.4% in 2010/11. An increase of 0.1 percentage points when compared to 2010/11. Table 12 Total WBS wastage by wastage reason TIMEX MISC Total WAPI % 2011/12 264 110 374 0.4 2010/11 158 108 266 0.3 2009/10 269 160 429 0.5 2008/9 1237 172 1409 1.5 2007/8 694 167 861 0.9 2006/7 546 136 682 0.7

8.3.5 BSMS Hospitals Wastage: WBS The percentage of all issues that were recorded as wasted by hospitals was 2.6% compared to 1.9% in 2010/11. The percentage of all O RhD Negative units that were recorded as wasted was 3.9% compared to 2.5% in 2010/11. Average total wastage per participant hospital for all blood groups was 137 per participant, which is a large increase (30 units) from 2010/11. This does seem to be mainly time expiry, and may be related to the stock build towards the end of the year. Average TIMEX wastage per participant hospital for all blood groups increased from 87 per participant in 2010/11 to 114 per participant in 2011/12, an increase of 27 units. Table 13 WBS BSMS hospitals wastage by wastage reason and average per participant for 2010/11 TIMEX OTCOL MISC FF TOTAL Total 2011/12 1828 317 54 0 2199 Ave. per BSMS participant 2011/12 114 20 3 0 137 2010/11 87 16 3 <1 107 2009/10 106 22 3 2 134 2008/09 79 20 7 <1 106

8.4 Red Cell Blood Supply: Eire 8.4 Eire (Irish BTS) The red cell supply chain using stock and wastage data taken from IBTS participants and IBTS is shown below. Not all IBTS hospitals submitted data during 2011/12, figures are based on 20 hospitals. The hospital WAPI has been added for High and Very Low user categories. Figure 4: Comparison between 2010/11 and 2011/12 for: Red cell stock (ISI) held in IBTS, WAPI for IBTS, plus 2011/12 Hospital ISI for High and Very Low usage category. 8.4.1 Blood Service Issuable Stock Index: IBTS The IBTS ISI is both very stable over the year compared to the other services, and is consistently lower this year compared to last, varying between a high point in January 2011 of 6.8 and a low point of 5.7 in March 2012. 8.4.2 Hospital Issuable Stock Index: IBTS The average ISI is variable between the red cell usage categories. In all but Very High usage category, the ISI for Group O RhD Neg red cells is higher than for all groups. See Table 14. Table 14 Average ISI by usage group for IBTS BSMS hospitals Very High High Moderate Low Very Low All Groups 5.9 7.1 6.4 8.8 11.4 O RhD Neg 5.9 8.2 8.6 10.4 16.0 Please note Very High ISI contains only 1 hospital that stopped participating in the scheme

8.4.3 Red Cell Issues: IBTS The IBTS issued 138,080 adult red cell units between April 2011 and March 2012. The median number of days to expiry at issue was 26 days which gives the IBTS hospitals longer to transfuse their units than the other blood services. With a steady ISI of around 6 days throughout the year, IBTS was able to issue the majority of their units with at least 20 days to expiry, the percentage ranged from 74.5% in January 2012 to 81.4% in October 2011. O RhD Negative issues as a percentage of total issues was 14.0%. This is higher than the other blood services, but reduced from last year. 8.4.4 Blood Service Wastage: IBTS Wastage as a percentage of issue was 1.0% in 2011/12 which is slightly decreased from last year (1.2%). Table 15 Total IBTS wastage by wastage reason TIMEX MISC Total WAPI % 2011/12 1339 84 1423 1.0% 2010/11 1489 111 1600 1.2% 8.4.5 BSMS Hospitals Wastage: IBTS Only 50% of IBTS hospitals are entering data for wastage, so an overall average WAPI can not be calculated. However, the average total wastage per participant hospital for all blood groups was 75 units per participant, with only 59 being due to time expiry. This compares favourably to hospitals supplied by other blood services, whose wastage per participant is over 100 units per year for time expiry. Average TIMEX wastage per participant hospital for all blood groups was 59 units Table 16 Ave. per BSMS participant 2011/12 Ave. per BSMS participant 2010/11 IBTS BSMS hospitals wastage by wastage reason and average per participant for 2010/11 TIMEX OTCOL MISC FF Total Total 2011/12 1171 130 190 15 1506 59 7 10 <1 75 55 9 7 <1 71

8.5 Red Cell Blood Supply: Scotland 8.5 Scotland (SNBTS) This year, data from Scotland has been difficult to obtain due to I.T. issues. Scotland also has a separate system for monitoring stock in their hospitals Account for Blood. There are 5 hospitals who do submit data, but as issue data for the individual hospitals is not available, full analysis was not possible. 8.5.1 Blood Service Issuable Stock Index: SNBTS The reported issuable stock index averaged for the year was 8.2 days. 8.5.2 Hospital Issuable Stock Index: SNBTS Not available 8.5.3 Red Cell Issues: SNBTS A total of 188,361 adult red cell units were issued in 2011/12 compared to 200,131 between April 2010 and March 2011. This is a decrease of 5.9%. 8.5.4 Blood Service Wastage: SNBTS The reported issuable stock index averaged for the year was 8.2 days. 8.5.5 BSMS Hospitals Wastage: SNBTS Average total wastage per SNBTS BSMS participant was 270 units (based on 5 hospitals/ centres). BSMS did not have a full set of data for the previous year, so comparison is not possible. Some detail is included in Table 17. Table 17 SNBTS BSMS hospitals wastage by wastage reason and average per participant for 2010/11 TIMEX OTCOL MISC FF TOTAL Total 2011/12 624 604 106 16 1350 Ave. per BSMS 125 121 21 3 270 participant 2011/12 Total 2010/11* 506 325 45 5 881 Ave. per BSMS participant 2010/11 101 65 9 1 176 *Total based on wastage data entered from August 2010 to March 2011

9.1 Platelet Supply: England and North Wales 9.1. England and North Wales (NHSBT) Platelets Analysis of platelet data is more complex, as not all hospitals hold stock platelets and demand planning is made more complicated by the shorter shelf life of the product. No hospital issuable stock index is available and wastage falls in to more complex categories. Figure 5: Comparison between 2010/11 and 2011/12 for: Issuable Stock Index for NHSBT and wastage (WAPI) for BSMS NHSBT hospitals. NHSBT WAPI shown for 2011/12 only. 9.1.1 Blood Service Issuable Stock Index (Platelets): NHSBT The NHSBT platelet ISI rose slightly during the year, for 5 of the last 6 months of 2011 12 platelet ISI greater than 2.4 days for NHSBT. Bacterial screening for platelets was introduced at the start of 2011, to prevent the possibility of bacterial transmission. This allowed the shelf life to be extended to 7 days, and this may be the cause of the increased ISI. 9.1.2 Platelet Issues: NHSBT NHSBT issued 264,800 units between April 2011 and March 2012, an increase of 9.2% from 2010/11. Much work is being done to understand this rise in platelet demand. 9.1.3 Blood Service Wastage (Platelets): NHSBT 14,422 platelet units were wasted by NHSBT, representing a WAPI of 5.4%. This has reduced from the previous year (7.2%) and could be attributed either to the increased shelf life or to the increased demand.

9.1.4 BSMS Hospital Wastage (Platelets): England and North Wales Platelet wastage continues to fall. The longer shelf life of platelets may be a factor, but better practice must be helping to reduce wastage in the face of increasing demand. Total hospital platelet wastage in 2011/12 was 10,704 units, a decrease of 1,125 units from 2010/11. The percentage of all issues that were recorded as wasted by hospitals was 4.0% compared to 4.8% in 2010/11. The average hospital platelet wastage per participant was 4 units lower than in 2010/11. The highest wastage occurred in the Medically Ordered Not Used category, at almost 50% of the total wastage. Table 19 Total BSMS hospitals platelet wastage by wastage reason: NHSBT STEX MISC MONU SONU WOL WI Total 2011/12 2640 472 5267 1976 318 31 10,704 2010/11 2977 352 5884 2413 195 8 11,829 2009/10 2892 642 6199 2504 254 25 12,516 Table 20 Total NHSBT BSMS hospitals platelet wastage by wastage reason STEX MISC MONU SONU WOL WI Total Total 2011/12 2977 352 5884 2413 195 8 11,829 Ave per submitting hospital 2011/12 12 2 25 9 1 <1 50 2010/11 14 2 27 11 1 <1 54 2009/10 13 3 28 11 1 <1 56 2008/09 11 2 27 10 1 <1 53

9.2 Platelet Supply: Northern Ireland 9.2. Northern Ireland (NIBTS) This graph shows the ISI for 2011/12, which showed less variation than the previous year, plus the relationship to wastage both for the blood service and hospitals. Figure 6 Comparison between 2010/11 and 2011/12 for: Issuable Stock Index for NIBTS and wastage (WAPI) for BSMS NIBTS hospitals. NIBST WAPI shown for 2010/11 only. 9.2.1 Blood Service Issuable Stock Index (Platelets): NIBTS The NIBTS platelet ISI was between 1.1 and 1.6 for year 2011 12, compared to last year when the range was wider with most months being higher, remaining above 1.5 ISI. 9.2.2 Platelet Issues: NIBTS 88,057 adult platelet units were issued by NIBTS between April 2011 and March 2012, an increase of 9.4% when compared to 2010/11 (cf. 7,366). This is similar to the rise seen in NHSBT. 9.2.3 Blood Service Wastage (Platelets): Northern Ireland Wastage data is unavailable for year 2011/2012 due to a technical issue.

9.2.4 BSMS Hospital Wastage (Platelets): Northern Ireland Total platelet wastage for 2011/12 was 612 units, an increase of 73 units from 2010/11. The percentage of all issues that were recorded as wasted by hospitals was 7.6% compared to 7.3% in 2010/11. The average hospital platelet wastage per participant was 7 units higher than in 2010/11. The highest wastage occurred in the Medically Ordered Not Used reason (47% of the reported wastage) but this was only slightly higher than Stock Time Expiry reason (42% of reported wastage). Table 21 Total NIBTS BSMS hospitals platelet wastage by wastage reason STEX MISC MONU SONU WOL WI Total 2011/12 256 15 286 51 4 0 612 2010/11 213 11 266 47 2 0 539 2009/10 157 6 239 52 2 0 456 Table 22 Total NIBTS BSMS hospitals platelet wastage by wastage reason STEX MISC MONU SONU WOL WI Total Total 2011/12 256 15 286 51 4 0 612 Ave per submitting hospital 2011/12 26 1 29 5 <1 0 61 2010/11 21 1 27 5 <1 0 54 2009/10 16 <1 24 5 <1 0 46

9.3 Platelet Supply: Eire 9.3. Eire (Irish BTS) This graph shows the ISI for 2011/12, which was very comparable to the previous year, plus the relationship to wastage both for the blood service and hospitals. The overall hospitals WAPI is not shown as only 30% of IBTS hospitals enter platelet wastage data. Figure 7: Comparison between 2010/11 and 2011/12 for: Issuable Stock Index for IBTS and IBTS WAPI shown. 9.3.1 Blood Service Issuable Stock Index (Platelets): IBTS The IBTS platelet ISI peaked in December at 2.9 and had a low in May, at 2.1 with most months being close to the equivalent month ISI in the year 2010 11. The Christmas bank holiday peak is the main variation. 9.3.2 Platelet Issues: IBTS The IBTS issued 25,666 platelet units between April 2011 and March 2012, an increase of 6.3% compared to 2010/11 (cf. 24,137). This increase is slightly less than the other blood service issues for year 2011 12, but is still a substantial increase. 9.3.3 Blood Service Wastage (Platelets): IBTS 2,722 platelet units were wasted by IBTS representing a WAPI of 10.6%, a decrease from last year which was 14.2%. The spikes in wastage around bank holiday periods in August and December were not as marked or as prolonged as last year s data indicated.

9.3.4 BSMS Hospital Wastage (Platelets): IBTS Hospital platelet wastage for 2011/12 was 481 units (12 hospitals submitting data). For total numbers the average per hospital submitting data, is very similar to last year. Looking at the hospital wastage, the highest wastage category was Surgically Ordered Not Used (SONU) category, both last year and this year. However the number of platelets discarded as STEX (stock time expiry) has reduced, and there has been a rise in the number of units ordered for medical patients and not used (MONU). The time expiry of stock platelets as a wastage category accounted for 21% of wastage reported, compared to 73% for MONU and SONU wastage categories combined. Table 23 Total IBTS BSMS hospitals platelet wastage by wastage reason STEX MISC MONU SONU WOL WI Total Total 2011/12 104 16 159 193 8 1 481 Total 2010/11 160 8 131 171 5 2 477 Ave. per submitting hospital 2011/12 (12) Ave. per submitting hospital 2010/11 (20) 8 1 13 16 <1 <1 40 8 <1 7 9 <1 <1 24

9.4 Platelet Supply: Scotland 9.4 Scotland (SNBTS) Once again the data from Scotland has been difficult to obtain due to I.T. issues. 9.4.1 Platelet Issues: SNBTS The SNBTS issued 26,467 platelet units between April 2010 and March 2011. 9.4.2 BSMS Hospital Wastage (Platelets): Scotland Total hospital platelet wastage for 2011/12 was 446 units (based on 2 hospitals submitting data). Wastage has increased for those hospitals, from 171 to 223 per submitting participant, most of this has a wastage category of Stock Time Expiry (74%). Table 24 Total SNBTS BSMS hospitals platelet wastage by wastage reason STEX MISC MONU SONU WOL WI Total Total 2011/12 330 11 39 0 66 0 446 Total 2010/11 291 2 11 0 38 0 342 Ave. per submitting hospital (2011/12) Ave. per submitting hospital (2010/11) 165 6 20 0 33 0 223 146 1 6 0 19 0 171 9.5 Platelet Supply System: Wales 9.5 Wales (WBS) Platelet data is not currently collected from hospitals supplied by WBS.

Blood Stocks Management Scheme (BSMS) Steering Group Membership Name Representing Contact details Dr Craig Taylor Chair Consultant Haematologist Russell's Hall Hospital, Pensnett Road, Dudley, West Midlands, DY1 2HQ Email: craig.taylor@dgh.nhs.uk Mr Peter Baker Dr Ann Benton Dr Janet Birchall Hospitals served by NHSBT Welsh Blood Service and associated hospitals Patients Clinical Team NHSBT Transfusion Laboratory Manager Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP Tel: 0151 706 4605 Email: peter.baker@rlbuht.nhs.uk Consultant Haematologist Morriston Hospital, Cwmrhydyceirw near Morriston, Swansea, Wales. Email: Ann.Benton@wales.nhs.uk Consultant Haematologist NHSBT Filton Centre Filton, Bristol, BS 34 7QH And North Bristol NHS Trust Bristol. Email: Janet.Birchall@nhsbt.nhs.uk Elaine MacRate BSMS Manager BSMS PO Box 33910 London NW9 5YH Tel. 0117 9217449 Email: elaine.macrate@nhsbt.nhs.uk Mr Adrian Ebbs NHSBT served hospitals Transfusion Laboratory Manager, Queen Elizabeth Hospital, Gayton Road, Kings Lynn, Norfolk, PE30 4ET Tel: 01553 613 782 Email: adrian.ebbs@qehkl.nhs.uk Mr Jonathan Watts NHSBT National Platelet Manager, NHSBT Birmingham, Vincent Dr., Edgbaston, Birmingham, B15 2SG Email: Jon.Watts@nhsbt.nhs.uk

Blood Stocks Management Scheme (BSMS) Steering Group Membership Name Representing Contact details Ms Rachel Moss NHSBT served hospitals Transfusion Practitioner, St Mary s Hospital Imperial College Healthcare NHS Trust Praed Street London W2 1NY Email: Rachel.Moss@imperial.nhs.uk Mr Paul Milne Scottish National Blood Transfusion Service National Logistics Manager Supply Chain Directorate Scottish National Blood Transfusion Service Gartnavel General Hospital Shelly Road Glasgow, G12 0XB Email: paulmilne@nhs.net Mrs Teresa Allen NHSBT Assistant Director of Customer Services NHSBT Watford, Oak House, Reeds Crescent, Watford, Hertfordshire WD24 4QN Tel: 01865 538 1013 Email: teresa.allen@nhsbt.nhs.uk Mr Tom McFarland Northern Ireland Blood Service and associated hospitals Transfusion Laboratory Manager, Daisy Hill Hospital 5 Hospital Road Newry BT35 8DR Email: Tom.McFarland@southerntrust.hscni.net Mrs Karen Shreeve Ms Jayne Addison Welsh Blood Service and associated hospitals NHSBT Better Blood Transfusion Team Manager, Better Blood Transfusion Team Welsh Blood Service Ffordd Yr Hen Gae Bocam Park Pencoed CF35 5LJ Email: Karen.Shreeve@wales.nhs.uk Transfusion Liaison Nurse North West Liverpool NHS Blood and Transplant Speke Blood Centre,14 Estuary Banks,Liverpool, L24 8RD Direct Line: 0151 268 7041 Email: jayne.addison@nhsbt.nhs.uk

Glossary of Terms Activity Status Indicates regularity of hospital data entry into VANESA; status is one of regular, partial or none. BSMS Blood Stocks Management Scheme Hospital Red Cell Usage Categories Very High > 10,001 red cell units per annum High 7,001 10,000 red cell units per annum Moderate 4,001 7,000 red cell units per annum Low 801 4,000 red cell units per annum Very Low 0 800 red cell units per annum IBTS Irish Blood Transfusion Service Blood Service supplying the hospitals on Southern Ireland IPS Inventory Practice Survey Annual survey distributed to BSMS hospitals; designed to collect information on current inventory practice in hospitals ISI 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. Issues (Gross) (Hospital) Number of Red Cell or Platelet units issued from a blood service Issues (Net) (Hospital) Gross Issues plus or minus Red Cell or Platelet stock movements to or from other hospitals/trusts. MISC Miscellaneous (Hospital wastage reason) Red Cell units that are wasted for reasons other than TIMEX, OTCOL or FRIDGE FAIL Additionally for Platelets, wasted for reasons other than MONU, SONU, WOL, WI). (Blood service wastage reason) Red Cell or Platelet units that are wasted for reasons other than TIMEX. MONU Medically ordered not used (Platelet wastage reason) Platelet unit ordered for a medical patient, but subsequently not used and wasted NHSBT NHS Blood and Transplant Blood service supplying the hospitals of England and North Wales NIBTS Northern Irish Blood Transfusion Service Blood service supplying the hospitals of Northern Ireland

Nominal Stock Approximation of a single days stock (Hospital) Mean daily number of Red cell or Platelet unit issues from a blood service, during a six month period (Centre) Mean daily number of Red cell or Platelet units issued, during a six month period OTCOL Out of temperature control outside the laboratory (Hospital wastage reason) Red cell units that are wasted Pre validation wastage Blood centre wastage that occurs prior to a unit of red cells and platelets being validated. Post validation wastage Blood centre wastage that occurs after a unit of red cells and platelets has been validated. Post validation may include pre validation wastage that was discovered post validation e.g. pack label fault. SONU Surgically ordered not used (Platelet wastage reason) Platelet unit ordered for a surgical patient, but subsequently not used and wasted STEX Stock platelet time expiry (Platelet wastage reason) Platelet unit that exceeds its natural shelf life; only applicable to hospitals that hold stock platelets. TIMEX Time Expiry (Hospital or Blood service wastage reason) Red cell or Platelet units that exceed their natural shelf life. VANESA Blood Stocks Management Scheme data management system WAPI Wastage As a Percentage of Issue (Hospital) Total number of wasted units (Red cell or Platelet) divided by the total number of units issued to the hospital (Blood Centre) Total number of wasted units (Red cell or Platelet) divided by the total number of units of donations the Blood Centre receives. WBS Welsh Blood Service Blood service supplying the hospitals of South Wales WI Wasted import (Platelet wastage reason) Platelet unit imported from another hospital, with a patient, but then not used and wasted. WOL Wasted out of the laboratory (Platelet wastage reason) Platelet unit taken from the laboratory, left on the ward and wasted.