1. Platelet outdates Kathryn Webert
Medical Director, Utilization, Canadian Blood Services
NAC Meeting, October 15, 2015

2. Summary of Presentation
Trend in platelet outdates within Canadian (excluding Quebec) blood system
International platelet outdate rates
What can we do?
Hospital customer survey
CBS distribution/production site survey
Other suggestions…

3. Platelet outdates within Canadian* blood system
*excluding Quebec

4. Platelet inventory challenges at CBS and hospitals
Platelet outdates within Canadian blood system
Platelet inventory challenges at CBS and hospitals
Due to 5 day shelf-life, shortages may occur, particularly on 30-day weekends, holidays, winter storms and uneven collections/production
Increased collection and production to avoid shortages
Geographically remote hospitals
There has been a slight yet steady decline in Canadian demand for blood products as health-care systems adopt more efficient approaches to utilization, and blood conservation and surgical techniques.
At the same time, we must keep pace with emerging expectations about how blood products are selected and deployed – for example, the increased demand from hospitals for platelets that have undergone HLA (human leukocyte antigen) typing.
The diminishing need for many fresh blood components is in contrast to the growing demand for specialized plasma products. We have seen an average annual increase of 6.5 per cent in use of the latter over the past several years, despite new utilization measures introduced by some provincial health ministries. Of particular concern is the growing off-label use of these expensive products, sometimes in the absence of compelling medical evidence that they support effective treatment. The resulting pressure on our traditional sources of supply has obliged us to begin evaluating alternatives
Present US/UK numbers:

5. Platelet inventory challenges at CBS
Platelet outdates within Canadian blood system
Platelet inventory challenges at CBS
Within the Canadian blood system (excluding the province of Quebec), the rate of platelet outdates in the most recent fiscal year (14/15) were:
Apheresis platelet units: 24% (7% at CBS, 17% at hospitals)
Whole blood-derived platelet doses: 34% (13% at CBS, 21% at hospitals)
Financial costs:
In the most recent fiscal year, platelet outdates accounted for an approximate cost of $9.8 million to the Canadian healthcare system
There has been a slight yet steady decline in Canadian demand for blood products as health-care systems adopt more efficient approaches to utilization, and blood conservation and surgical techniques.
At the same time, we must keep pace with emerging expectations about how blood products are selected and deployed – for example, the increased demand from hospitals for platelets that have undergone HLA (human leukocyte antigen) typing.
The diminishing need for many fresh blood components is in contrast to the growing demand for specialized plasma products. We have seen an average annual increase of 6.5 per cent in use of the latter over the past several years, despite new utilization measures introduced by some provincial health ministries. Of particular concern is the growing off-label use of these expensive products, sometimes in the absence of compelling medical evidence that they support effective treatment. The resulting pressure on our traditional sources of supply has obliged us to begin evaluating alternatives
Present US/UK numbers:

6. International platelet outdate rates

7. Benchmarking with other countries
International platelet outdate rates
Benchmarking with other countries
Canada’s platelet outdate rate is higher than many other international blood systems.
Other countries (with similar challenges) have chosen to focus on it and have significantly lower rates of platelet outdate
Example: Comparative country
System outdate rates
buffy coat platelets: 14%
apheresis platelets: 2.3%
There has been a slight yet steady decline in Canadian demand for blood products as health-care systems adopt more efficient approaches to utilization, and blood conservation and surgical techniques.
At the same time, we must keep pace with emerging expectations about how blood products are selected and deployed – for example, the increased demand from hospitals for platelets that have undergone HLA (human leukocyte antigen) typing.
The diminishing need for many fresh blood components is in contrast to the growing demand for specialized plasma products. We have seen an average annual increase of 6.5 per cent in use of the latter over the past several years, despite new utilization measures introduced by some provincial health ministries. Of particular concern is the growing off-label use of these expensive products, sometimes in the absence of compelling medical evidence that they support effective treatment. The resulting pressure on our traditional sources of supply has obliged us to begin evaluating alternatives
Present US/UK numbers:

8. What can we do?

9. What can we do?
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 ultimately wasted.
Effective stewardship of the blood supply includes utilization management. Utilization management of blood and blood components refers to the promotion of the safe and best use of blood components and associated resources. A broad definition of utilization management would refer to all blood and blood components, including plasma protein products, throughout the supply chain. For example, utilization management includes, among others, appropriate inventory management, the monitoring of wastage of blood products due to outdating or mishandling, and ensuring that blood products are used for appropriate indications at the correct dose.
You could also argue that appropriate utilization of blood products also includes patient blood management.

10. Survey of Hospital Customers
What can we do?
Survey of Hospital Customers
Looking for hospitals’ valuable insights:
Identification of factors that may contribute to the outdating of platelet units within the Canadian blood system (in the hospital and throughout the system including CBS production and distribution sites)
Sharing of hospital best practices that have been implemented to avoid or decrease the platelet outdate rate
Targeted the top 50 hospitals (by platelet volume)
HLS contacted hospital blood bank and collected information by interview in most cases

11. Survey of Hospital Customers
What can we do?
Survey of Hospital Customers
Information gathered included:
Delivery information
Policies for ordering/stocking platelets
Redistribution programs
Policies for transfusing of platelets (e.g., group specific, trauma packs, neonates, etc.)
Impressions of reasons why platelets outdate
Best practices used to prevent outdating
Suggestions for improvement (CBS, provincial blood offices, etc.)

12. Survey of Hospital Customers
What can we do?
Survey of Hospital Customers
Once we have collected this information, it will be shared with all hospital customers
Best practices
Will be used to inform future initiatives

13. Survey of CBS Production and Distribution Sites
What can we do?
Survey of CBS Production and Distribution Sites
We are also conducting and internal survey to better understand how the process of platelet procurement and distribution is undertaken nationally and regionally
Is there variability in what CBS does in each region?
Are there areas for improvement?
Survey developed by Ahmed Coovadia, being administered to CBS Regional Production Managers

14. Survey of CBS Production and Distribution Sites
What can we do?
Survey of CBS Production and Distribution Sites
Information being collected:
Platelet collection (whole blood and apheresis)
What process is in place to meet hospital demand for platelets?
Production
What is the process to determine platelet product to meet hospital needs
Distribution
How are hospital requests met?
Redistribution between sites
Other
Processes in place to minimize wastage

15. Conclusions and Discussion

16. Conclusions
Conclusions
Platelet outdates are a significant problem within the Canadian blood system
Due to the nature of the product (short shelf-life) and Canadian geography, outdates are not completely avoidable; however, it is thought that Canada’s numbers could be lower
This would result in cost-savings to the healthcare system
What else can be done?
Suggestions/input on how to proceed welcome…
Working group?