1. Platelet inventory management
CSTM Education Day
Kathryn Webert
Medical Director, Utilization
Canadian Blood Services
September, 2016

2. Platelet outdates and rates—National
Background
Platelet outdates and rates—National
Last year, 22.6% of all donated platelets expired without being transfused
Last year, 22.6% of all donated platelets expired without being transfused
Check these numbers…why not the same as the previous graph

3. Platelet wastage 26,328 platelet doses!
Background
Platelet wastage
Within the Canadian blood system (excluding the province of Quebec), the rate of platelet outdates in the most recent fiscal year was:
Apheresis platelet units: 16.7% (1.8% at CBS, 14.9% at hospitals)
Whole blood-derived platelet doses: % (4.2% at CBS, 17.3% at hospitals)
Overall, 20.1% of all platelets that were collected were wasted
26,328 platelet doses!

4. Background
Platelet wastage
The cost to the healthcare system is high
Apheresis platelets:
6674 units X $502/unit = $3,350,340
Pooled platelets:
19645 doses X $197/dose = $3,870,065
Total cost to the healthcare system was over $7.2 million

5. What have we done about it?

6. Work done so far Surveys: Hospital CBS distribution sites
What have we done about it?
Work done so far
Surveys:
Hospital
CBS distribution sites
Hospital customer letter (best practices)

7. Surveys To gain insights:
What have we done about it?
Surveys
To gain insights:
Identification of factors that may contribute to the outdating of platelet units within the blood system
Share best practices that have been implemented to avoid or decrease platelet discards

8. What have we done about it?
A System View
Management of platelet inventory is a complicated topic, but working together within the blood system, we may be able to identify ways to decrease the number of platelet units that are collected but are ultimately wasted.

9. Hospitals and Canadian Blood Services
What have we done about it? Surveys
Hospitals and Canadian Blood Services
53 hospitals (top 50 per number of platelet in-date and outdate discards, plus 3 additional hospitals)
9 distribution sites (Vancouver, Calgary, Edmonton, Regina, Winnipeg, Brampton, Ottawa, Dartmouth, St. John’s)
Two distinct surveys with 100% participation and response rate

10. Hospital survey: results
What have we done about it? Surveys
Hospital survey: results
Hospitals were extremely helpful in their responses provided to CBS.
Many things were learned
We are still looking at responses
Here is a preliminary look at some of the interesting responses…

11. 14. What are your impressions of reasons why platelets outdate at your hospital?
Demand
Distance from CBS
Shelf life
‘Just in case’ inventory
Clinical policy /Order
Unpredictable
Distance and time for delivery
Short
Oncology
No policy to give ABO incompatible without MD approval
Routinely get platelets that are 3-4 days old
MTP requirements
No policy to give Rh Pos and automatically issue WinRhO with unit
Taking short-dated platelets from CBS
MD requests platelets be on hand for procedure
Order for platelets canceled or procedure cancelled, patient doesn’t require platelets
Standard daily inventory level
Redistribution not an option
Emergency stock
Poor transportation routes or lack of funding for redistribution
Geographic trauma centre
Contingency plan to support potential clinical procedures

12. 15. Please describe any “best practices” to avoid or decrease the frequency of platelet outdates that you have implemented or that could be implemented.
Blood Groups
Redistribution
Standing Order / Inventory Review
Clinical
Give oldest first over ABO compatible
Share inventory with other hospitals
Implement a min/max inventory
Constant follow-up with MDs/nursing units to review daily HLA matched requirements/utilization
Stock only O and A and give to all patients
Canvas other hospitals for product before ordering from CBS
Abandoned standing order of platelets to decrease expiry rate; order as required to keep a minimal stock
Keep a roster of all SCT patients. Platelet counts reviewed daily to assess current and future needs. MLT able to release and reassign platelets according to patient needs.
Use O with titre less then 1:100
Use Provincial Platelet Web Application
Routinely review data and revise standing orders
Review patient platelet counts (to predict need)
Group compatible platelets are issued and RHIG is given to Rh Neg who receive Rh Pos platelets
Adjust inventory based on utilization trend
Dashboard used to predict patient demand
Audit utilization by patient group
Increase irradiated stock
Require MD to order transfusion before requesting platelet product from CBS
Educate and reinforce with staff
Implement CMV-safe policy for all patients except neonates
Attend cardiac rounds to emphasize the need for better communication between surgeon, anesthetists and TM Lab

13. 16. Is there anything that Canadian Blood Services or the Provincial Blood Offices (if your province has one) could do to help to decrease the frequency of platelet outdates?
Shelf Life
Transportation/
Redistribution
Communication / Support
Collection/
Production
Extend >5 days
Fund improvements for routes
Greater feedback to hospitals on expected production numbers
Evenly spread out collection (address outdates at first of week)
Release platelets to hospitals sooner
Increase routine delivery options (weigh against cost of outdating)
Use better inventory management tools
Produce more group AB platelets
Faster response time for stat orders
Hold consensus meeting (CBS & hospitals) to deep dive issue
Redistribute platelets using CBS drivers
Locate distribution site closer to hospitals
BPCO could expand use of platelet inventory web app.

14. What have we done about it?
Hospital customer letter: Platelet utilization and inventory management best practices

16. Ongoing and future initiatives

17. Ongoing and Future initiatives
Still much work to do:
Working groups with CBS Medical and Supply Chain to look at
Areas for improvement highlighted within customer survey
Best practices identified within CBS sites
Identification of customer best practices, helping with dissemination
Engagement of hospital/PBCO colleagues to develop novel solutions

18. Ongoing and future initiatives
7 day platelets

19. Proposal: Buffy coat platelets
Ongoing and future initiatives: 7 day platelets
Proposal: Buffy coat platelets
Delay sampling to ≥ 36 hours post-collection, with a ≥ 6 hour post-inoculation hold
net gain: 30 hours
Increase sampling volume to 20 ml
Inoculate 1 aerobic and 1 anaerobic bottle
Slide from Dr. Mindy Goldman

20. Proposal: Apheresis platelets
Ongoing and future initiatives: 7 day platelets
Proposal: Apheresis platelets
Delay sampling to ≥ 36 hours post-collection, with a ≥ 6 hour post-inoculation hold
For a single apheresis collection, increase sampling volume to 20 ml, and inoculate 1 aerobic and 1 anaerobic bottle
For a double apheresis collection, increase sampling volume to 40 ml, and inoculate 3 aerobic and 1 anaerobic bottle
This would enhance the sensitivity of detection for double apheresis collections, but reduce the probability of machine false positives which are most common with anaerobic bottle
Slide from Dr. Mindy Goldman

21. CSB proposal More to come on this!!!
Ongoing and future initiatives: 7 day platelets
CSB proposal
This is in the proposal stage only
Requires submission to Health Canada
If approved, the project targets to go live by Spring or Summer 2017
More to come on this!!!