Monitoring wastage

Wastage refers to any blood component or product which is discarded rather than administered to a patient. This can occur for a number of reasons and a certain level of blood product wastage is acceptable to ensure products are available when required for patients.

Laboratories and hospitals should monitor and record the wastage of blood products (both expired and discarded products). This wastage should be monitored against national benchmarks to ensure appropriate inventory levels are determined so wastage is minimised (1).

Reviewing wastage data may identify aspects of inventory management which could be improved. For example high expiry rates may indicate excess blood product stocks are being held or high discard rates may indicate inappropriate practices within hospital wards which may need to be investigated.

All blood product fate data is entered into the National Blood Authority BloodNet system, and reports can be generated to allow monitoring of wastage and comparison of a facility against their peers at a group, state and national level.

The NBA set wastage targets which the health providers can find in their BloodNet reports.

A number of laboratories and hospitals in Australia have wastage rates of less than 1%, however, this may be difficult to attain in the regional setting depending on delivery timetables, inventory holdings and logistical challenges.

Hospitals and laboratories can implement a number of strategies to reduce wastage of blood products. Below are a few suggestions.

 

We regularly receive reports of refrigeration failures resulting in the loss of entire inventories of blood products.

This not only leaves the laboratory or hospital without the ability to respond to an emergency request for blood but wastes substantial numbers of precious donations each year.

A plan should consider:

  • How alarms are monitored particularly outside normal working hours

  • Immediate actions to be taken in the event of an alarm

  • Who should be notified and when (include contact numbers)

  • How long your fridge will maintain its temperature if it fails

  • If there is an alternative refrigerator available to store blood in case of catastrophic failure

  • How blood components and plasma-derived products will be relocated.

Hospitals and laboratories with small inventories of blood components may have higher wastage rates due to time expiry, especially of precious group O RhD negative red cells.

These organisations should consider approaching larger organisations, either within their own network or geographically proximal, with a view to entering into an agreement to transfer short-dated components to the larger organisation where they may be more likely to be used before expiry.

Agreements should cover such things as storage and transport conditions and the age of components at the time of transfer.

All blood components should be maintained in a temperature-controlled storage until they are to be administered.

Handling of refrigerated components outside of refrigeration should be kept to a minimum to ensure that specified storage temperatures are not exceeded.

Red cell components must not remain out of the refrigerator for more than 30 minutes on any one occasion.

In order to allow the return of blood components that have been issued to the ward but not used, the time of issue and the time of return to the laboratory should be recorded.

If the red cells have been out of the refrigerator for less than 30 minutes they may be returned to inventory at the discretion of the transfusion service provider.

If red cells have been out of the refrigerator for longer than 30 minutes they should be discarded unless the transfusion can be completed within 4 hours from the initial issue time.(2)

The ideal inventory of blood components will balance the requirement to have sufficient numbers of the appropriate components in the correct groups to meet clinical needs, with minimising the potential to waste blood through expiry and the cost of excessive deliveries.

The ideal inventory level will vary from organisation to organisation and will depend on a number of factors, including:

  • Time to resupply in an emergency

  • Distance from the blood supplier and the frequency of deliveries

  • The predictability of use: eg, level one trauma centre vs thalassemia treatment centre

  • The number, type and complexity of activities undertaken in the hospital, eg, trauma, obstetrics, surgery

  • The number of blood components your laboratory issues.

In a number of cases, inventory levels have evolved over the years and have not been determined by any evidence based systems. Inventory levels should be evaluated yearly in response to institutional changes that may affect blood component usage.

Inventory level holdings can be discussed with your state or territory Blood Service Customer Service Scientist who is available to offer advice.

Reference
  1. Australian and New Zealand Society of Blood Transfusion Inc. Guidelines for pretransfusion laboratory practice, 5th edition. Sydney, Australia, 2007.
  2. Australian and New Zealand Society of Blood Transfusion Ltd and Royal College of Nursing Australia. Guidelines for the Administration of Blood Products, 2nd ed. Australia, 2011.