CURRENT PRACTICE IN HOSPITALS

Transcription

1 CURRENT PRACTICE IN HOSPITALS Julie Johnson CSci FIBMS on behalf of the BSMS Steering Group

2 Survey issued January 2015 triggered by - Latest BSMS Report WAPI NHSBT 1% Hospitals 2.4% MHRA cold chain requirements Increasing use of blood tracking devices Increasing transportation between sites / fridges Who responded 124 sites completed the questionnaire (~300) participating hospitals were surveyed (NHSBT 250, NIBTS 10, WBS 15, IBTS 30) Replies from 130 ~ mostly NHSBT Not all respondents answered all the questions

3 What parts of the cold chain did the survey collect data on? Seven areas of practice were surveyed Transfer of blood from NHSBT to hospital Transfer of blood by hospital into permanent stock storage location Transfer of blood to secondary storage location Transfer of blood to temporary storage in transport box Transfer of blood to the patient Transfer of blood to external locations Return of blood

4 Wastage between centre and hospital

5 How quickly do we process blood on arrival? A fast and accurate booking in process will result in less OTCOL 80% sites take < 20 minutes to book in stock Almost 60% of sites have a pre booking in storage location How is this proven / audited in the cold chain?

6

7 Does your hospital use the Electronic Dispatch Note? Use of EDN would speed up receipt and reconciliation process reducing the likelihood of out of temperature control wastage and removing the need for a pre-booking in location

8 Transfer of blood within hospitals 91% hospitals transfer blood both internally and / or externally How are products transported? 100% 90% 80% 70% 60% < 5 mins journey Between 5-15 mins >15mins journey 50% 40% 30% 20% 10% 0% 'In someone's hand' i.e. nontemperature controlled? Transport box without temperature monitoring system? Transport box with temperature monitoring system?

9 80% of the time internal transfers of blood are under control of either the lab staff or a designated porter allowing easier training and competency assessment for the task The cold chain cannot be fully proven if we don t log the steps along the way

10

11

12 No of replies NHS Temporary storage of blood in transport boxes Why is blood stored in boxes? Home transfusions Hospice tx Haematology wards Theatres Trauma packs Air ambulance Is a temperature logger used? Visual: any excursion would be noticed Logger: checked on return to laboratory Electronic link to alarm monitor No active monitoring done

13

14 Transfer of blood from fridge to patient 88% movements are not temperature monitored 55% removed using electronic tracking, 45% paper 17% electronic tracking cumulatively adds time out of fridge

15 Transfer of blood to external locations How is blood transferred? In a transport box without temperature monitoring system? 81% In a transport box with temperature monitoring system? 12% Not applicable 7% Electronic linked to an alarm monitor What type of logger? Logger: checked on return to laboratory Visual: any excursion would be noticed 0% 2% 4% 6% 8% 10% 12% 14% 16%

16

17 Transfer to External Locations 50% 45% 40% Wastage due to "Time" Out of control Wastage due to "Temp" Out of control 35% 30% 25% 20% 15% 10% 5% 0% Never Very rarely - once in the last 3 years Occasionally - once a year Often - 2/3 times a year Frequently - monthly

18 How long would we need to extend the 30 minute rule to reduce OTCOL? NHS

19 How can we improve practice and reduce OTCOL rates? Use the Electronic Dispatch Note Improve OTCOL when storing blood in a transport box - by splitting units down into multiple boxes Record a complete cold chain logging units both out and back into storage locations Consider surface temperature stickers now licensed for adhering to pack but limited suppliers? Minimise satellite fridges and transfer locations? Regional transfer documentation but has limitations if don t standardise transport box as well Hospitals should have robust recall, quarantine and investigation procedures to allow prompt disposal or re-use of units Increase the 30 minute rule to 60 minutes?

20 Conclusions Temporary storage in blood boxes carries the highest risk of OTCOL wastage Some hospitals are not proving the cold chain adequately There is some variation on interpretation of the 30 minute rule Increasing the 30 minute rule to 60 minutes would more than half OTCOL hospital wastage We need to make more use of our Transfusion Practitioners to improve competency of those involved in the transport of blood