Blood Stocks Management Scheme · Report 2012-14 5 The Blood Stocks Management Scheme Our Mission • To improve blood inventory management across the blood supply chain, by enabling

Blood Stocks Management Scheme

Blood Stocks Management SchemeReport 2012-14

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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: [email protected] Website: www.bloodstocks.co.uk Enquiries: [email protected]

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

Report 2012-14

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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

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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

Report 2012-14

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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.

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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.

Report 2012-14

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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.

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Hospital Participation in the Scheme

Activity levels for 2013 - 2014

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

SNBTSIBTSWBSNIBTSNHSBTNHSBT 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.

Report 2012-14

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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.

NHSBT

During 2010-12, demand was steady but started to decrease in October 2012 and has continued to drop throughout the 2012-2014

period.

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.

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.

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.

NIBTS

RBC demand started to decrease in Q2 2012 and demand has continued to decrease throughout this

period as for the other blood services.

Red Cell Demand reduced over the two years, across all blood services.

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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.

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.

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.

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.

SNBTS ISI ~ n/a

Unable to calculate due to incomplete data.

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.

A cautious response to reduced demand from hospitals, caused an increase in Blood Service Issuable Stock Index.

Report 2012-14

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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.

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.

NIBTS ~ 13.5%

<13% for first two quarters 2012-13, increasing to 13.5% in early 2013-14. The demand is

no longer increasing.

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.

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.

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.

Percentage of Group ORhD negative RBC issued

O RhD Negative red cell demand varies, but remains higher, with the use of remote fridges and number of ‘hub and spoke’ sites increasing.

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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.

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%.

SNBTS RBC

Unable to calculate due to incomplete issue data.

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.

NIBTS RBC

No internal wastage data available.

IBTS RBC

IBTS wastage is less than 1% but the range varies

from 0.5 – 1.7% with the lowest being during

December 2013.

Blood service wastage is recorded as a percentage of issues (WAPI).

Report 2012-14

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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

The number of platelets issued increased by approximately

1.5% in 2013-2014 and 1.2% in 2012-2013.

SNBTS

Demand for platelets to participating SNBTS hospitals appears to have reduced over the 2 year period 2012-2014

by more than 10%.

IBTS

Platelet demand for IBTS hospitals during this period has decreased. The number of platelet issues reduced by

approx. 10%.

NIBTS

NIBTS platelet issues increased slightly (<2%) in

2012-13 from the previous year, but in 2013-14 platelet issues

decreased by 8%.

Note: WBS do not report platelet data.

NHSBT was the only blood service with continued increase in demand for platelets. NIBTS, SNBTS and IBTS all noticed a reduced demand.

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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.

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.


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.

Report 2012-14

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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.


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).

NIBTS Platelets

No internal wastage data available.

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.

Platelet wastage as percentage of issues is being reduced in the reporting blood services.

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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.

Red Cells for Adult Emergency Use: In Six Easy Steps

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.

Red cells for

emergency use

Best Practice from BSMS

Regional Roadshows


Report 2012-14

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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.

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.

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.

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.

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.

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%.

Hospitals around the UK and Ireland have experienced raised stock levels (higher ISI) during this period.

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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.

IBTS Hospitals WAPI ~ < 1%

For those hospitals who report, WAPI in Ireland

remains very low at < 1%.

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.

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%.

NIBTS Hospitals WAPI ~ 4.6%

Red cell wastage in Northern Ireland hospitals

has remained steady throughout this period

at 4.6 - 4.7%.

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%.

Report 2012-14

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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.

Hospital RBC Wastage by Category 2013 - 2014

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

IBTSNIBTSSNBTSWBSNHSBTNHSBT 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

Time-expiry is still highest reason for red cell wastage for most hospitals.

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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.

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).

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.

Report 2012-14

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Hospital Platelet Wastage by Category

Wastage by Category in %

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

IBTSNIBTSSNBTSWBSNHSBTNHSBT 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%.

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BSMS Steering Group Membership

Dr Craig TaylorChair of BSMSConsultant HaematologistRussell’s Hall HospitalDudley, DY1 2HQ

Dr Ann BentonWelsh Blood Service & hospitalsConsultant HaematologistMorriston HospitalSwansea, Wales

Mrs Teresa AllenNHSBTAssistant Director of Customer ServicesNHSBT WatfordWatford, 4QN

Dr Janet BirchallPatients Clinical Team NHSBTConsultant HaematologistNHSBT Filton CentreBristol BS34 7QH

Elaine MacRateBSMS ManagerBSMSPO Box 33910London NW9 5YH

Mr Peter BakerHospitals served by NHSBTTransfusion Laboratory ManagerRoyal Liverpool University HospitalLiverpool, L7 8XP

Mr Jonathan WattsNHSBTNational Platelet ManagerNHSBT BirminghamBirmingham, B15 2SG

Mr Adrian EbbsNHSBT served hospitalsTransfusion Laboratory ManagerQueen Elizabeth HospitalKings Lynn, PE30 4ET

Mr Paul MilneScottish National Blood Transfusion ServiceNational Logistics ManagerGlasgow, G12 0XB

Ms Rachel MossNHSBT served hospitalsTransfusion PractitionerSt Mary’s HospitalLondon W2 1NY

Mr Tom McFarlandNorthern Ireland Blood Service and associ-ated hospitalsTransfusion Laboratory ManagerDaisy Hill HospitalNewry BT35 8DR

Mrs Karen ShreeveWelsh Blood Service & hospitalsManager, Better Blood Transfusion TeamWelsh Blood ServicePencoed CF35 5LJ

Ms Jayne AddisonNHSBT Patient Blood Management Team Patient Blood Management PractitionerLiverpool, L24 8RD

Report 2012-14

23

Glossary of Terms

Activity Status

Indicates regularity of hospital data entry into VANESA; status can be ‘regular’, ‘partial’ or ‘none’.

BSMS Blood Stocks Management Scheme.

IBTS Irish Blood Transfusion Service: Blood Service supplying hospitals of Southern Ireland.

IPS Inventory Practice Survey: Annual survey distributed to BSMS hospitals; collecting information on hospital inventory practice.

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.

MISC Miscellaneous (Hospital or Blood Service wastage not covered by other wastage reason codes).

MONU Medically ordered not used (Platelet wastage reason) Platelet unit ordered for a medical patient, but not used and wasted.

NHSBT NHS Blood and Transplant Blood Service: Blood Service supplying the hospitals of England and North Wales.

NIBTS Northern Irish Blood Transfusion Service: Blood service supplying hospitals of Northern Ireland.

Nominal Stock

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.

OTCOL 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.

SNBTS Scottish National Blood Transfusion Service: Blood service supplying hospitals of Scotland.

SONU Surgically ordered not used (Platelet wastage reason) Platelet unit ordered for a surgical patient, but 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.

WAPIWastage 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.

WBS Welsh Blood Service: Blood service supplying the hospitals of South Wales.

WI Wasted import (Platelet wastage reason) Platelet unit imported 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.

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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.

Documents

Blood Stocks Management Scheme · Report 2012-14 5 The Blood Stocks Management Scheme Our Mission • To improve blood inventory management across the blood supply chain, by enabling