If you read my QA labeling post you know we have an upcoming QA meeting, in addition to the specimen labeling QA we are also being asked to present data on the amount of wasted units and the reasons why they are wasted. We are looking at number of units transfused in a year to the number wasted due to thawing with out using, returned outside 30 mins and other crappy excuses as to why it left the blood bank and the floors decided not to use them. Again if you have any data that you are willing to share I would be very appreciative. Also do you use TEG testing and if you do have you noticed a decrease in your product usage. Thanks and I hope everyone is well.

What is TEG?

Sorry I should have explained it, TEG Testing or Thromboelastograph is a coag test that measures the whole clotting process and strength of the clot. By reading the graph it can tell where in the clotting process the patient is having difficulties and tell what products are indicated. We have been using TEGs for about 6 years but they have just recently come into the laboratory.

They are really cute machines

http://www.haemoscope.com/technology/index.html

Whenever we have a wasted blood product, we complete an online incident report, which the nurse manager of that unit has to respond to with a corrective action. Quality Improvement looks at this data, we also present wasted unit data at Transfusion Committee.

For 2006, 2007, 2008, our cost of wasted product has been about 1% of total blood costs.

Linda Frederick

We have a lot of wastage. In addition to the crappy reasons, we monitor locations(OR and individual floors), physicians ordering, and cost.

Does anyone have any benchmarks for what constitutes an acceptable level of waste?

I can't imagine that there could ever be a benchmark "acceptable level of waste" for blood products because there are just too many variables involved. Factors such as distance from your blood supplier, type of services provided and patient mix (ie: it's easier to use up shorted-dated blood products if you have an active Emergency Dept and GI bleeders vs a heavy Obstetrics Dept which usually does not use much blood), how much shelf-life is on the products when your supplier sends the products to you, whether you transfer blood between other local hospitals, etc.

However, it is an important quality indicator to tract (from both a resource issue to a financial loss issue.) If you have other local similar hospitals that tract their waste, that information might be helpful to you. And, it is important even just to track your own figures month-to-month. That can tell you if there is a particular department or doctor involved with most of the wastage, identify areas where you can make changes to decrease wastage, assess the financial impact of your wastage, and tract whether or not you are making improvements to minimize wastage.

Our PI director has told me that there are benchmarks out there for appropriate levels of wastage. However, I have not yet been able to find any. I may turn this over to her, since she says she has seen them before.

I'm in agreement in that this may not be appropriate or meaningful for our facility. Our blood utilization committee would like to establish an acceptable waste threshold, based on those at other facilities or national benchmarks, because they do not want to have to discuss product waste at every meeting.