A cluster based inventory management program leading to NDH Blood Bank Service

enhancement on platelet transfusion

Dr Rosalina Ka Ling Ip Presentation F8.2

Ip RKL(1)(2), Lui YK (1), Fung KFP (2), Wan SK (2), Ng MHL (1)(3)

(1)Blood Bank, Department of Anatomical & Cellular Pathology, Prince of Wales Hospital, (2)Blood Bank, Department of Pathology, North District Hospital,

(3)Division of Haematology, Department of Anatomical & Cellular Pathology, The Chinese University of Hong Kong

Sustaining Vicious Cycle in NDH

Fear of lacking platelet supply when needed

Platelets are over-reserved & for relatively non-indicated patients (e.g. platelet count >

100x10e9/L)

Unacceptably high platelet wastage

Deferring negotiation for

increase in platelet stock from HKRCBTS

Restricted platelet stock

Short self-life of platelets (5 days)

Year 2009-2011 2012

Annual utilization no

2082 1443

Annual expiration no

985 623

Annual expired rate

47% 43%

Objectives

1. To reduce the platelet wastage in NDH 2. To maintain a stable platelet stock in terms of quantity and functional life with timely supply 3. To break the above vicious cycle by addressing the worries of clinical teams and hence promote a better working partnership from bench to bedside

Methodology

Mechanism of platelets reservation

in cases with platelet count >

100x109/L discussed & defined

in HTC meetings

As agreed by HKRCBTS, NDH

receives a single dose of Day 3 platelet stock regularly from

HKRCBTS

Platelets (Day 4/5) pending expiration & not used up in NDH would be

transferred to PWH by routine cluster transport on weekdays and by taxi on weekends and public

holiday

To facilitate urgent platelet transfusion, PWH also backs up the platelet stock support by direct one-way delivery

(PWH to NDH) instead of two-way

delivery (NDH to PWH to NDH)

Mar 15 Aug 12 Aug 15

6

Average transportation time for platelet from external parties

2012 (Jan-Feb) 2015 (Nov-Dec)

Average transportation time for platelet from PWH (Single Journey: PWHNDH) Not Applicable 1:04

Average transportation time for platelet from PWH (Double Journey: NDHPWHNDH) Not Applicable 1:37

Average transportation time for platelet from HKRCBTS (Double Journey: NDHHKRCBTSNDH) 2:16 2:08

Average transportation time for platelet at PWH from RCBTS (Double Journey) : 1 hr 30 mins

Re-direction & circulation of temperature monitored platelet units within NTEC

Results & Outcome

9

Monthly Platelet Expiration Jan 2012 – Nov 2016

0

20

40

60

80

100

120

Jan-

12

Mar

-12

May

-12

Jul-1

2

Sep-

12

Nov

-12

Jan-

13

Mar

-13

May

-13

Jul-1

3

Sep-

13

Nov

-13

Jan-

14

Mar

-14

May

-14

Jul-1

4

Sep-

14

Nov

-14

Jan-

15

Mar

-15

May

-15

Jul-1

5

Sep-

15

Nov

-15

Jan-

16

Mar

-16

May

-16

Jul-1

6

Sep-

16

Nov

-16

No. of Platelet expired

No of expiredplatelet

From Aug 2012 -Justification required for platelet requests with platelet count > 100x109/L

From Mar 2015 -In weekdays, HKRCBTS delivers day 3 platelet to NDH -NDH transfers day 4 & day 5 platelets to PWH (by Routine cluster Transportation)

From 25 Nov 2015: -Weekday stock is increased from 4 units to 8 units

From 24 Aug 2015: -Further arrangements: Day 5 platelets are transferred to PWH in return for day 4 platelets on SAT/SUN/PH (by Taxi)

Dramatic reduction in platelet wastage in NDH with no adverse impacts of platelet wastage in PWH

10

2012 2013 2014 2015 2016

(Jan to Nov) NDH Blood

bank Platelet

utilization 1443 1388 1642 1633 1387 Platelet

expiration 623 315 334 116 58

% Expired 43% 18.50% 16.90% 6.63% 4.01%

PWH Blood Bank

Platelet utilization 19533 17079

Platelet expiration 413 284

% Expired 2.05% 1.63%

From 25 Nov 2015: Weekday stock is increased from 4 units to 8 units

11

A higher and stable stock in NDH with reduction of monthly extra platelet transportation

0

5

10

15

20

25

30

No of extratransportation

From 25 Nov 2015: Weekday stock is increased from 4 units to 8 units.

12

Improvement in Utilization Indicator (Ratio between ordering and transfusion)

Less just-in-case reservation is recorded

Cases requested

(Jan 2016 to Nov 2016)

Cases transfused

(Jan 2016 to Nov 2016)

% transfused

(Jan 2016 to Nov 2016)

% transfused (2015)

Overall OT cases 60 41 68.3% 64.2%

Non-OT cases 364 303 83.2% 87.8%

Platelet count > 100 x109/L

OT cases 16 7 43.7% 25.0%

Non-OT cases 45 30 66.7% 65.5%

Summary 1. To reduce the platelet wastage in NDH

: Program has dramatically reduced the platelet wastage in NDH from historical record of >40% (>600 units per year) to 4% (58 units) in 2016

2. To maintain a stable platelet stock in terms of quantity and functional life with timely supply

: A higher level of platelets stock (2 doses of day 3 platelets) have been approved from HKRCBTS since November 2015 : Reduction of monthly extra platelet transportation from PWH or HKRCBTS from 15 to 7 times on average

3. To break the vicious cycle and promote a better working partnership from bench to bedside

: This timely supply also addresses the worries of clinical teams with alleviation of tension amongst clinical and laboratory frontlines : Less just-in-case reservation is recorded

A win-win outcome on both resources utilization and service provision

through a collaborative cluster-based inventory management system

Thank you

Sunset at North Point, Hong Kong taken in Jun 2016