A cluster based inventory management program leading to NDH Blood Bank Service enhancement on platelet transfusion

Transcription

1 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

2 Sustaining Vicious Cycle in NDH Restricted platelet stock Short self-life of platelets (5 days) Fear of lacking platelet supply when needed Year Annual utilization no Annual expiration no Annual expired rate % 43% Deferring negotiation for increase in platelet stock from HKRCBTS Unacceptably high platelet wastage Platelets are overreserved & for relatively non-indicated patients (e.g. platelet count > 100x10e9/L)

3 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

4 Methodology Mechanism of platelets reservation in cases with platelet count > 100x109/L discussed & defined in HTC meetings 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 Aug 12 Mar 15 Aug 15 As agreed by HKRCBTS, NDH receives a single dose of Day 3 platelet stock regularly from HKRCBTS 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)

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6 Average transportation time for platelet from external parties 2012 (Jan-Feb) 2015 (Nov-Dec) Average transportation time for platelet from PWH (Single Journey: PWH NDH) Not Applicable 1:04 Average transportation time for platelet from PWH (Double Journey: NDH PWH NDH) Not Applicable 1:37 Average transportation time for platelet from HKRCBTS (Double Journey: NDH HKRCBTS NDH) 2:16 2:08 Average transportation time for platelet at PWH from RCBTS (Double Journey) : 1 hr 30 mins 6

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

8 Results & Outcome

9 Monthly Platelet Expiration Jan 2012 Nov 2016 No. of Platelet expired 120 From Aug Justification required for platelet requests with platelet 100 count > 100x10 9 /L 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) From Mar 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 No of expired platelet 0 Jan-12 Mar-12 May-12 Jul-12 Sep-12 Nov-12 Jan-13 Mar-13 May-13 Jul-13 Sep-13 Nov-13 Jan-14 Mar-14 May-14 Jul-14 Sep-14 Nov-14 Jan-15 Mar-15 May-15 Jul-15 Sep-15 Nov-15 Jan-16 Mar-16 May-16 Jul-16 Sep-16 Nov-16 9

10 Dramatic reduction in platelet wastage in NDH with no adverse impacts of platelet wastage in PWH From 25 Nov 2015: 2016 (Jan to Nov) NDH Blood bank Platelet utilization Weekday stock is increased 1387 Platelet from 4 units expiration to 8 units 58 % Expired 43% 18.50% 16.90% 6.63% 4.01% PWH Blood Bank Platelet utilization Platelet expiration % Expired 2.05% 1.63% 10

11 A higher and stable stock in NDH with reduction of monthly extra platelet transportation From 25 Nov 2015: Weekday stock is increased from 4 units to 8 units No of extra transportation 0 11

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 % 64.2% Non-OT cases % 87.8% Platelet count > 100 x10 9 /L OT cases % 25.0% Non-OT cases % 65.5% 12

13 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 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

14 A win-win outcome on both resources utilization and service provision through a collaborative cluster-based inventory management system

15 Thank you Sunset at North Point, Hong Kong taken in Jun 2016