Oxford’s War on

Wastage

JRNOCChurchill

Horton

Rr

Rrr

1

2

3

4

5

1. Started monitoring wastage

2. SCBU Paedi pack reduction (3

units)

3. FFP 5 day change

4. SCBU Paedi pack reduction (1 unit)

5. Stock level reduction

6. TP daily monitoring and

reporting (clinical wastage)

6

OXFORDS WAR ON WASTAGE

The laboratory frontline

Sue Hemmatpour

• Main stock at JR hospital

• Horton Hospital

• “Hot-lab” at Churchill hospital

• 6 Remote issue fridges

• 4 Remote storage fridges

Stock Holding Areas

• Greater monitoring increased awareness

• Stricter adherence to SOP for stock rotation

• Supernumerary MLA dedicated to stock control

Small Beginnings

• February 2016 paed pack issues 3 units/baby

• June 2016 paed pack issues 1 unit/baby with 1 day reservation

• Wastage reduced by 27%

• No increase in donor exposure

Paediatric units

• 1 adult dose (4 units) pre-thawed FFP

• April 2016 post-thaw storage increased to 120hrs

• Wastage reduced by 22%

Fresh Frozen Plasma

• July 2016 review of usage from remote issue fridges

• Stock levels reduced by approximately 20%

• No significant increase in re-stocking incidents out-of-hours

• Wastage reduced by 3%

• July 2017 further reduction

Stock Levels

• Coffee club to raise awareness

• List of short-dated units kept on work bench

• Rotating stock between JR and Churchill

• Order appropriate volumes for red cell exchanges

Other Actions

• HEMS products in summer

• Non K negative red cells

• VMI orders

Challenges

OXFORDS WAR ON WASTAGE

The Clinical frontline

Edward Fraser

Produced by Dipika Solanki, Advanced Transfusion Practitioner

Wastage: Disaster TrailPre-op Hb (elective surgery) 101 g/l

Lowest intra op Hb 78 g/l

2 units remote issued

Anaesthetist change over (2nd

anaesthetist does not want to transfuse)

Unused units sent to recovery

Recovery not happy to Tx due to 30 minute breech (but was <4 hrs)

2 more units transfused

Post-op (post Tx) Hb 94 g/l

NICE QS1: iron

supplementation NICE QS 3:

Reassess after

RBC transfusions

NICE Hb

threshold: 70 g/l

(target 70-90)

Rrr

Acknowledgements:

• Julie Staves, TLM

• Marie Casey, Clinical Lead

• Alan Cook, Project

Manager

• Dipika Solanki, TP

• Gardash Bakhishli, Data

Analyst