Platelet Utilization

[dlvannest]

Does anyone include lossed platelets due to expiration in their utilization report. If so what is the monthly lossed % and does your facility perform open heart surgery.

How long does it take to get blood products from you supplier.

[Deny Morlino]

I include platelet expiration in the utilization report per the request of our pathologist. We were having a problem with newer physicians failing to think about the fact that we are a small hospital that does not perform open heart procedures, do not routinely stock platelets, have potential difficulty in getting rid of unused units prior to expiration, and are an hour and a half from our supplier. The pathologist was looking for the $ of waste we were experiencing monthly to curb ordering practices (and was successful). Hope this helps.

[LIMPER55]

we receive credit for our expired plts from our ARC--MIDWEST

[Likewine99]

I used to keep track of wasted plts due to expiration on the shelf, but we changed blood suppliers. On the rare occasion we do have one expire on the shelf they give us credit.

We do open heart surgery and are a Level II trauma center. We routinely keep 2 pheresis products in our inventory.

[David Saikin]

I only order plts to transfuse but still waste about 3/year. 2.5 hrs from blood supplier. We count the expired products in our utilization reports.

[Bill]

Part of yearly report to NYS Health Dept

[Bill]

Part of yearly report to NYS Health Dept

We expire approx 4-6 per year. We are 2 hrs from supplier.

[SMW]

Expired products should be tracked as wasted products. Regardless if $ credit is provided, it is still a wasted resource. And let's face it, someone, somewhere, somehow is ultimately paying for that wasted resource.

[L106]

Expired products should be tracked as wasted products. Regardless if $ credit is provided, it is still a wasted resource. And let's face it, someone, somewhere, somehow is ultimately paying for that wasted resource.

I share SMW's view on the subject.

We are 2 hours from our blood supplier, routinely stock 4 plateletphereses, if we don't have orders to transfuse them we rotate them back to our blood supplier the day before they expire for full credit. We still get stuck with 3 or 4 plateletpheresis a year that expire on us. (Dr. changes his mind, patient expires, etc.)

We track all expired or wasted blood products in our monthly report. Makes it easy to notice trends with problems with a Nursing Unit or specific physicians. (A few years ago a particular surgeon was wasting a lot of blood products. Turns out, he was also wasting a lot of expensive Pharmacy products. He is no longer on our staff.)

[adiescast]

We also track all wasted products, including the reason. It doesn't matter if you got credit, the product still went in the trash.

[KKidd]

:boogie::boogie:

We also track them on our blood utilization report. Before we will even order the platelets we make sure that there is an order to transfuse. It takes approx. 2 hours from the time we order to get our platelets. For us, good communication is the key. When speaking directly with the physician, I explain that we cannot order the paltelts to have available. We only have a few outdate each year.

[Brenda K Hutson]

I include it but it is usually categorized as "wasted products." The reason for that is that we also have an agreement with out supplier to switch out short-dated platelets on a daily basis. So on any given morning when evaluating our inventory to place an order, we indicate how many platelets we will be returning that day (because they will outdate the following day), and how many fresh ones we want in exchange (fresh will usually mean that when we get them, they will expire 2 days later at MN; so we will return any remaining platelets the next day). The added time of receiving platelets in the computer, then turning around and shipping some of them back out the next day, only to receive more and repeat that process the following day, is not perfect; but it is certainly better than wasting platelets (and incurring that cost). Our Donor Facility is able to do this because they are the primary supplier of a large Medical Center in the area (where I worked for many years; so I know they use a LOT of platelets on a daily basis) and they can almost always use them up there.

When I worked in the Reference Lab of a Donor Center at one time, I think they also had that in their contracts with the clients.

Note: When I do calculate the wasted products, I calculate the % wastage for all products combined (though the report will also list numbers by product); not just platelets.

Brenda Hutson, CLS(ASCP)SBB

[adiescast]

I would not include the ones that you swap out before they expire. It sounds like you are having to do alot of work to manage your platelet inventory!

[Brenda K Hutson]

I do not include those (sorry if it was not clear). I was explaining why I do not use the term "loss" but rather wasted; because in our situation, it is really only in situations where the floor orders them but then wastes them in some manner, that they are actually wasted. Otherwise, our turnaround system prevents just random wastage because you ordered them but then were not able to use them all before they expired. And yes, this system of exchange does take more time, bit it is certainly better than the costly waste of just expiring a bunch of apheresis (and as someone who has donated platelets before, I would be most unhappy to know I sat on that machine for 2 hours, only to have my platelets discarded). It is a tricky thing for Donor Center to manage a product with such a short expiration time.

Brenda Hutson, CLS(ASCP)SBB

I would not include the ones that you swap out before they expire. It sounds like you are having to do alot of work to manage your platelet inventory!

[butlermom]

We too have a similar "turnaround" system, however, it doesn't work that well for us. Our supplier is local but they cannot draw enough platelets in our area so must get them flown in from another center. We have to have a platelet in house for each open heart surgery case and we get them the night before the surgeries but they usually expire at midnight on the day of surgery. They may or may not be used for the surgery so if it is not used and no one else needs it, it expires. We lose about 4-6 a month. It kills me to waste them this way but we've not found any way around it. My monthly blood utilization statistics for wasteage is almost entirely platelets.

[LIMPER55]

so you also count the outdated units of blood? We also receive credit for those.

[adiescast]

Yes. Outdating is a form of wastage that can be mitigated somewhat by practice changes. As I said earlier, it doesn't really matter if you got credit, the unit still went in the trash. The point of tracking wastage is to see if you can keep the number of unused units as low as possible.

Edited March 11, 2011 by adiescast
spelling

[Brenda K Hutson]

Not unless the units of blood are "wasted." Our return policy for those (with the Donor Center) is that if we return them with at least 7 days left before the expiration, we will receive full credit (though we can return group AB at any time). So we print a Short-Dated Report every day to track that. If monitored appropriately, we do not waste any RBCs in this way. Our "wasted" RBCs (in addition to Autologous, or partial Pediatric units; neither of which are counted on the wasted products report) are primarily due to things like unit being returned from Nursing unit > 30 mins.; or, units returned in cooler but temp. monitors are unacceptable; or, Nurse spikes bag; etc.

Wasted FFP and Cryo are primarily due to Orders to Thaw, but then not being transfused. We do try to give them to someone else before they expire (but that rarely happens with Cryo. due to the short exp. after thawing) and are fairly successful with FFP. But we still do have those occassions where we just don't get an order (at least not for that blood type), before it expires in 5 days. Those are on the wasted product report.

What is also sickening (in addition to wasting platelet apheresis) is that we receive a limited number of pre-pooled Cryo. from our Donor Facility each month. The heart surgeons in particular like/ want this product. But they have wasted them (order; but then either never pick them up; or pick them up and return then unused) numerous times. We do not pool our individual Cryos. here (first place I have ever worked that got away with that with the Physicians); so it is nice to now get some pre-pooled Cryo.

Brenda Hutson

so you also count the outdated units of blood? We also receive credit for those.

[Brenda K Hutson]

Just a thought (not sure how many Hospitals your Donor Facility contracts with): I wonder if your distributor can have some kind of a similar agreement with theirimport Distributor (that is, that if the local distributor orders X amount of Platelet Apheresis, they can turn them around the day prior to expiration)?? That way, your supplier does not have to walk that tight rope of not wanting to order unless they have orders, because they would then end up eating the cost??

Brenda Hutson

We too have a similar "turnaround" system, however, it doesn't work that well for us. Our supplier is local but they cannot draw enough platelets in our area so must get them flown in from another center. We have to have a platelet in house for each open heart surgery case and we get them the night before the surgeries but they usually expire at midnight on the day of surgery. They may or may not be used for the surgery so if it is not used and no one else needs it, it expires. We lose about 4-6 a month. It kills me to waste them this way but we've not found any way around it. My monthly blood utilization statistics for wasteage is almost entirely platelets.

[Brenda K Hutson]

Well, on a more practical level for the Hospital, my goal is to avoid wastage at my Facility (which will then translate to overall wastage for the Donor Facility). They have to continually rotate their products to ensure they are used in order of outdate, etc; as do we. But it is a "win/win" to have agreements with your Donor Facility such that you can return products to them in a timely manner so that they can hopefully find another user. But in that sense, our particular Donor Facility has an advantage that not all places would have in that they primarily support a very large Medical Center who can almost always make use of any/ all products if given at least a little bit of time to do so.

But the logistics of that (for the Donor Center, as well as their clients), does involve more work on everyone's part (rotating; exchanging; etc); but I personally have not seen or heard of a better system than that.

Brenda Hutson

Yes. Outdating is a form of wastage that can be mitigated somewhat by practice changes. As I said earlier, it doesn't really matter if you got credit, the unit still went in the trash. The point of tracking wastage is to see if you can keep the number of unused units as low as possible.

[L106]

A couple replies to some of the previous posts:

1. If we return short-dated red cells with at least 7 days of shelf-life left, and plateletpheresis with at least 2 days of shelf-life left (we receive the plts with 3 or 4 days shelf-life) to our blood supplier, we get credit. I do not include these products in my monthly report as "wasted". (Our blood supplier has two large hospitals a few blocks away and many volunteer drivers, so they are able to "shuffle" the majority of these short-dated products to where they can be transfused.)

2. We really don't mind the trouble of rotating back the platelets to our blood supplier. Often it's only 1 or 2 plateletpheres to send back; many times we use all of them and don't have any to send back.

3. A comment for Butlermom: Do you think it would work better if your blood supplier sent you decent-dated platelets (since sometimes open hearts use them & sometimes they don't) and use the short-dated platelets sent in from another center for the "definite-transfuse" cases?

4. I'm with you, Brenda....I go for the win/win situation. I try to minimize our outdating, but our staff and I will also go the extra mile if there is something that we can do to help our blood supplier minimize their outdating.

Good management of their platelet inventory has got to be one of the bigger challenges for the blood suppliers.....both in terms of donor recruitment and good utilization.

Donna