Hospital Experience. Mike Herbert - Transfusion Laboratory Manager New Cross Hospital Wolverhampton

Transcription

1 Hospital Experience Mike Herbert - Transfusion Laboratory Manager New Cross Hospital Wolverhampton Blood Stocks Management Scheme 2016 Annual Road Show 8th June 2016 Birmingham

2 Ten Top Tips Understand your Inventory Provide Expert Training Set Appropriate Inventory Levels Keep Procedures Simple Build collaborative relationships Use oldest product first

3 Top Ten Tips Use oldest product first Optimise Crossmatching Procedures Maintain all equipment appropriately Have a plan to conserve inventory in times of shortage Have a patient blood management program

4 Understand your Inventory - Where do the Red Cells go? 11% 9% 5% 2% 19% 18% Surgery Haematology Medical Emergency Admissions Oncology Cardiac Critical Care Obs & Gynae Childrens 11% 12% 13% n= 33,977

5 Understand your Inventory O Rh (D) Neg transfused to non O Rh (D) Neg recipients by group 7% 4% 1% O Pos 7% A Pos B Neg 8% B Pos A Neg 73% AB Pos n =521

6 Understand your Inventory O Rh (D) Neg transfused to non O Rh (D) Neg recipients by patient category 4% 1% 17% 8% 49% Other Emergency Admissions Adult Sicklers Obstetrics Paediatric Sicklers Theatres 21%

7 Expert Training Competency Criteria The Royal Wolverhampton NHS Trust Department of Haematology Competency Criteria (B9.H040F.HAE) Objective: Cold Chain Relevant to: Blood Transfusion Haematology Immunology Competency Criteria The Royal Wolverhampton NHS Trust Department of Haematology SOPs Cold Chain SOP. (Available in Blood bank SOP file or available on Qpulse F2.BT600P.HAE) Ordering and receipt of blood and blood products SOP (Available in Blood bank SOP file or available on Qpulse F2.BT230P.HAE) Transfer of blood to other sites SOP (Available in Blood bank SOP file or available on Qpulse F2.BT300P.HAE) De-reserving blood SOP (Available in Blood bank SOP file or available on Qpulse F2.BT220P.HAE) Relevant SOPs / documents Other documents Blood bank request form BCSH guidelines - Guideline on the Administration of Blood Components (British Committee for Standards in Haematology 2009) You must be able to Receipt of blood products from NHSBT, entering into TDBBS and appropriate storage of stock (rotation) Dealing with out of date stock red cells Dealing with out of date stock platelets Dealing with out of date stock plasma products Dealing with temperature excursions ward Dealing with temperature excursions fridges Dealing with temperature excursions transport boxes Fridge maintenance alarms Fridge maintenance cleaning Fridge maintenance probe calibration Fridge maintenance temperature mapping Fridge maintenance fault reporting Competency Criteria You must know & understand Understand the process of putting blood products into stock Understand how to deal with out of date stock Understand how to deal with temperature excursions Understand how to perform fridge maintenance Understand how to transfer blood to other sites Understand the storage conditions for blood products Transfer of blood to issue fridge Transfer of blood to satellite fridges or units Storage temperature and expiry red cells Storage temperature and expiry platelets Storage temperature and expiry cryo B9.H040F.HAE Version: Date Issued: Oct 2015 Authorised by: Kevin Goodridge Page! 1 of 12! Required Training B9.H040F.HAE Version: Date Issued: Oct 2015 Authorised by: Kevin Goodridge Page 2! of 12!

8 Optimal Stock Levels Optimal Stock Levels Min Max O Rh (D) Pos O Rh (D) Neg A Rh (D) Pos A Rh (D) Neg B Rh (D) Pos B Rh (D) Neg AB Rh (D) Pos AB Rh (D) Neg O Rh (D) Pos Irradiated 4 O Rh (D) Neg Irradiated 4 A Rh (D) Pos Irradiated 4 A Rh (D) Neg Irradiated 4 Document number: F2.BT120N.HAE Page:! of! 1 1 Author: Anna Smith Review Date: May 2017 Approved: Mike Herbert Version: 3.0 This is a controlled document; all authorised printed copies must be bound, signed and have footer details printed in red. Any single sheets printed from this document must be signed by the author or approver and dated. Any copies not meeting this criteria are not valid and must be discarded.

9 Simple Stock Calculator b = Average daily use = number of units used over a one year period 365. Day s Cover = a b a = Number of available units in stock example - O Rh (D) Neg Stock Levels Optimal a= 8 b= = 3.2 a b = = 2.5 days Minimum a= 4 b= 3.2 a b = = 1.25 days Maximum a= 12 b= 3.2 a b = = 3.75 days

10 Keep Procedures Simple EDN Transport Monday - Friday Saturday Morning Round Order Deadline 09:00 hrs. 11:00hrs Morning Round Delivery Time 12:30hrs 14:00 hrs. Afternoon Round Order Deadline 13:00hrs N/A Afternoon Round Delivery Time 16:20hrs N/A

11 Build collaborative relationships Recycling of blood products with private hospitals units ( 31,097) units ( 36,960) SLA in place Allows spoke sites to increase O Rh (D) Neg units for major bleeding

12 Use oldest product first Check fridge every morning to do stock check for dates (including expired/near to expired units) and after every delivery. Use freshest blood for operations with a risk of bleeding.

13 Optimise Crossmatch Procedures 86% of all red cell issues do not require a serological crossmatch. 1-2% of all patients have antibodies/serological issues. (CD38 trial etc) Should non-transplant centres stock irradiated Hep E products?

14 Wiener classification C D E c e Wiener % R1r R1R rr R1R R2r R2R R0 r R1r 1.0

15 Maintain all equipment

16 Have a plan to conserve inventory in times of shortage DEPARTMENT OF HAEMATOLOGY NEW CROSS HOSPITAL WOLVERHAMPTON Protocol for Emergency Blood Management Arrangements for Blood Shortages at the Royal Wolverhampton Hospitals NHS Trust (E1.BT400P.HAE) Edition 6.0 Date issued: December 2014 Review interval: Biennial Authorised copy: Printed copies Jayne Parkes Author Mike Herbert Location of printed copies Blood Transfusion Number of pages including the front page 13 Document number: E1.BT400P.HAE Page: 1! of 13 Author: MH Review Date: December 2016 Approved: J Parkes Head BMS Version: 6.0 This is a controlled document; all authorised printed copies must be bound, signed and have footer details printed in red. Any single sheets printed from this document must be signed by the author or approver and dated. Any copies not meeting this criteria are not valid and must be discarded.

17 Have a patient blood management program JPAC AABB EUPBM

18 Platelets Platelets in Additive Solution and Plasma, Leucocyte Depleted Change Notification UK National Blood Services No Platelets in Additive Solution and Plasma, Leucocyte Depleted Applies to the Guidelines for the Blood Transfusion Services in the United Kingdom 8 th Edition th September Storage If any production stage involves an open system, after preparation the component should be used as soon as possible. If storage is unavoidable, the component should be stored at a core temperature of 22 ±2 C with continuous agitation and used within 6 hours. If platelet agitation is interrupted due to equipment breakdown or prolonged transportation, platelets are suitable for use provided that no single interruption lasts for more than eight hours, and the total length of all interruptions is no longer than 24 hours.

19 Fresh Frozen Plasma Change Notification UK National Blood Services No Fresh-frozen plasma, Leucocyte Depleted Applies to the Guidelines for the Blood Transfusion Services in the United Kingdom 8 th Edition th March Storage If delay is unavoidable, the component may be stored and should be used within 4 hours if maintained at 22 ±2 C or up to a maximum of 120 hours if stored at 4 ±2 C, but it should be borne in mind that extended post-thaw storage will result in a decline in the content of labile coagulation factors. Pre-thawed FFP that is out of a controlled temperature environment (4 ±2 C), can be accepted backinto temperature controlled storage if this occurs on one occasion only of less than 30 minutes. For indications other than unexpected major haemorrhage, the component should be used within 24hours of thawing.

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