Home

Managing Blood and Blood Product Inventory

1. E E E E N Y E D D E E E E D D E E E E E D D E E E E D E C b E E UJ pn I lt 88 82 AJ 23 ps National Blood Authority 2014 With the exception of any logos and registered trademarks and where otherwise noted all material presented in this document is provided under a Creative Common
2. 2 Cto 10 C DO NOT USE products if Autologous Blood 2 16 10 C The shipper arrives open Platelets 20 C to 24 C The product is outside the specified Manufactured products as per Product Information temperature range LOC 8 AHOLN3ANI L90dO8d G00 18 ANY GOO SNIDVNVIN E ga Y FEBRUARY 2014 NITI TUOR SARIANI MANAGING pg 62 APPENDIX 8 SHIPPER LABEL DELIVER IMMEDIATELY HUMAN BLOOD PRODUCTS FOR TRANSFUSION Do Not Refrigerate This Shipper CONTENTS c Packed Time Autologous Blood Red Cells Platelets ThawedFFP Frozen Plasma Components Clotting Factors Immunoglobulins Albumin Packed Date Despatch Date Time Signed Valid to Time Deliver To Attention to Insert Name and Position Insert name of Transfusion Laboratory Insert location building name Insert name of Hospital Insert address Insert Phone Number Insert Fax Number Delivered From Insert Name and Position Insert Hospital Name Insert Address Insert Phone Number Insert Fax Number MANAGING BLOOD AND BLOOD PRODUCT INVENTORY FEBRUARY 2014 JO E Acknowledgements The National Blood Authority would like to acknowlege the contributions of the following organisations to the development of these Guidelines Hunter Area Patholog
3. M MANAGING BLOOD AND BLOOD PRODUCT INVENTORY FEBRUARY 2014 ga CO 6 Temperature Data Loggers and Placement 6 71 Dataloggers equilibrated to required temperature e g 10 C 14 C 20 C 24 C 32 C and 52 C 6 72 Place one logger in between the red cells or dummy packs 6 73 Place one logger above the red cells or dummy packs 6 74 Attach one logger to the outside of the shipper to measure the environment temperature 6 7 5 Refer Figure 1 above 6 8 Temperature Validations 6 81 Shipper packed in accordance with Figure 1 was placed in Cool Room for as per 6 1 4 for minimum temperature validation This was repeated on three separate occasions 6 8 2 Shipper packed in accordance with Figure 1 was placed in Blood Bank Laboratory for as per 6 1 4 for ambient temperature validation This was repeated on three separate occasions 6 8 3 Shipper packed in accordance with Figure 1 was placed in Incubator 1001 set at 32 C for as per 6 1 4 and then at and at 42 C for maximum temperature validations This was repeated on three separate occasions RESULTS rad Data logger Performance Qualification Performance testing was undertaken and completed by Enter detail e g Engineering Department on Enter date Results of performance testing against a reference thermometer are outlined in the Table 1 below Table 1 Reference thermometer performance testing Temperature Recor
4. 10 TIPS HELP MANAGE YOUR BLOOD PRODUCTINVENTORY co 6 86 89 n n 11 1 Understand your inventory 99999 12 Monitoring inventory patterns 12 Inventory locations tI EI Ree ees 6 13 Checklist for inventory management best practice 14 2 Provide expert training n eee 0 5 15 3 Set appropriate inventory levels 16 Bay sicoVerd E 17 Discards as a percentage of issues DAPI 18 4 Keep procedures simple a a 20 5 Build collaborative relationships 21 6 Use oldest product 22 7 Optimise crossmatching procedures 23 8 Maintain all equipment appropriately p 9 Have a plan to conserve inventory in times of shortage 25 10 Have a patient blood management program 26 IMPBEMENTATIONESS nan 27 REREREN GES ee nanas tener nr 63 LOC 8 AYOLNAANI LONQOYd GO0 8 ANY A0018 SNIDVNVIN a Introduction The National Blood Authority Act 2003 states that the National Blood Authority NBA is to carry out national blood arrangements to ensure that there is a sufficient supply of blood products and services in all the States and covered Territories and to carry out national blood arrangements r
5. When choosing validated packing methods you may like to consider implementing existing validated shipper configurations For example an existing validated blood and blood product packing configuration and transport times is detailed in Australian Red Cross Blood Service Receipt and Use of Blood Service Shippers by External Institutions to Transport Blood and Blood Products and Transportation of blood components and fractionated products The Blood Service recommend the use of data loggers outside their validated transport times with specific packing configurations 3 3 AHOLN3ANI 109 dO8d OO 18 ANY GOO 18 SNIDVNVIA 615 UJ N pg MANAGING BLOOD AND BLOOD PRODUCT INVENTORY FEBRUARY 2014 D ga UJ CO You may wish to validate your own shipper configurations or the shippers and packing configurations used by the Blood Service for extended time frames Principles and guidelines on validation can be found in the National Association of Testing Authorities Guidelines for the validation and verification of quantitative and qualitative test methods An example of one method of shipper validation is located at Appendix 2 Validation data must be documented reproducible and available to NATA on request Consideration of the ambient temperature is important when transporting blood and blood products There are vast temperature differences across Australia that can affect transport shipper validation times and e
6. For example agree to receive the transferred blood or blood product review your current inventory and routine stock orders to account for expected transfers in inspect all packaging of received blood and blood product and do not accept the transfer unless it is intact and packed according to agreed validated shipper configuration document the time and date the product was received document evidence that manufacturer s temperature specifications have been maintained If in doubt quarantine all products until storage packing and transport conditions can be verified check temperature data logger if used visually inspect all blood and blood products received record transferred in units into your LIS complete all other documentation as required e g group check if transferred from a non laboratory setting K maintain record of product received by transfer 8 TRANSPORT LOGISTICS lt Enter transport logistics as agreed by the participating health providers gt For example The agreed packing configuration is as per the Blood Service Validated Shippers Refer to Receipt and Use of Blood Service Shippers by External Institutions to Transport Blood and Blood Products a Transport Times Transportation of blood components and fractionated products OR The agreed packing configuration is lt enter agreed validated packing configuration gt Data loggers or temperature monitoring must be used when tran
7. MANAGING BLOOD AND BLOOD PRODUCT INVENTORY FEBRUARY 2014 g 58 APPENDIX 5 BLOOD FRIDGE MAINTENANCE RECORD Blood fridge maintenance must be performed according to the schedule above Record all results on the form F idge location idenfi icascrr Davmaneuneceds EEE ERE RP PERE EEE EB BE cre Range MEL ie cnart iar Owl oT range spite Dumeniressons or sokeson eS s Cm ndge tor blood fmatcan be ietumed ki fre franz cae tei cn qui M 11 9 IHE et Maintenance checks deine period with 5 minimum e ma T aa imay temperature chart crculer Oren cower remove cid ciat Check chan for conformance dumg Change temperature chart o F c i date end sgn Dete mew chart dentiy 55125 522 5 sgn and place on recorder Ensure a E BER anie raar ad seri irte rg iria ie mn juae IT Remate Alarm in a fon and ensure vest T 55 ing ight 5 3 M MM Save ae nn Maintenance checks defne period wih a minimum requirement as aufimed in AS38654 se m 575 aye requie a manuel checking F process 6 deisied below Please refer bo the fridge manufacturers manuel on how bo dohia De By ni a Pease handle probes carefully forthe folowing checks ence compisted cere uly 2 28 22551 Batiery
8. TIMES OF SHORTAGE Where inventory levels are running low either within your organisation or more widespread you should have a plan for what to do to conserve product You should develop local policies concerning the management of contingency events These policies can cover shortages ranging from a small short term shortage of a particular product to much more widespread shortages National Blood Supply Contingency Plan Australia s Response to Blood Ji hovtages Communication You should communicate shortages in supply to clinicians ordering the product You may be able to ask them to consider the patient s immediate requirements and whether the product could be ordered at a later date when product becomes more available In times of more widespread shortage your state or territory health department will have a contingency plan that you can adapt to fit your setting and this should involve identifying key personnel to be responsible for communicating any shortages to those affected You should also be familiar with the National Blood Supply Contingency Plan found at www blood gov au 7 LOC 3 AHOLN3ANI LONGOYd GOO 18 ANY GOO 18 SNIDVNVIA ga NJ pg MANAGING BLOOD AND BLOOD PRODUCT INVENTORY FEBRUARY 2014 U g 26 HAVE A PATIENT BLOOD MANAGEMENT PROGRAM One of the best ways to conserve blood and blood products is to avoid its use Before the decision to transfuse
9. and private Outline how to ensure that acceptable temperature ranges for blood and blood products are maintained during transportation Outline how health providers can ensure blood has been stored and transported correctly before accepting a transfer Provide a uniform process for transferring blood and blood products Foster a culture throughout the blood sector that strives to transfuse all units before expiry noting that some discards are appropriate but not inevitable The term health provider in this document refers to an organisation providing health services to the Australian community and approved by the to receive blood and or blood products through the NBA supply contracts This guideline covers blood and blood products as outlined in the National Safety and Quality Health Service NSQHS Standard 7 Blood and Blood Products Standard including Fresh blood components Plasma derivatives and recombinant products blood cells albumin platelets immunoglobulins including immunoglobulin a Clinical fresh frozen plasma replacement therapy e g IVIg and Cryoprecipitate hyperimmune globulins cryodepleted plasma clotting factors 3 AHOLN3ANI LONGOYd COO 18 ANY GOO 18 SNIDVNVIA pg 31 Preparation All health providers are required to identify and develop processes that maximise the appropriate use and minimise the wastage of blood and blood product
10. backup check pO High bempersture alarm Remove probe from container insert info a smal container of mom fempersture weber Ensure slerm B echveted 5 bempersture rmes boue 3580 High Alarm actvaton check w Low bempersture slam Flemouwt probe from container Insert into 5 smal container of iced 5 5 weber Ensure ciem sctvebed se bempersture fele below LFC Low Alarm activation check BATTERY BACKUP CHECK refer iz manutecturers insbuctions Check door seas clean miemaly 3 Ge ANT e Rh a Reewdbisonby cme MANAGING BLOOD AND BLOOD PRODUCT INVENTORY FEBRUARY 2014 o 2 APPENDIX 6 BLOOD AND BLOOD PRODUCT TRANSFER FORM For facilities without BloodNet access only Comments These include any tempergture or stange nan compliance issues eg outrage the 30 minute rule problems with the blood fndge any physica damage to the unit STORAGE CONFIRMATION COMPULSORY Indicate the following checks have occurred by ticking the appropriate box Red Blood Cell Units check the Blood Fridge Register to ensure each red cell unit being transferred has been stored appropriately redcell units have not been removed from the blond fridge longer than 30 minutes at any given time OCheck the Blond Fridge Maintenance Record to ensure compliance of storage criteria blood fridge temperature has remained stable within 2 amp C degrees during the storage period that the tempera
11. benefit analysis can be undertaken to understand the workload and financial cost of transferring blood and blood products in and out versus the financial cost and loss of a valuable resource If the cost of transport outweighs the cost of the blood product s then it may not be feasible to develop regular transfer arrangements in exceptional circumstances LOC AH V13834 AHOLN3ANI LONGOYd 00078 ANY QOO SNIDVNVIN oa UJ U1 Dg MANAGING BLOOD AND BLOOD PRODUCT INVENTORY o All signatories on the MOU may invest in a transport option to reduce costs Examples of transport options include using an existing health provider courier service engaging hire cars buses or taxis investigating a courier service that specialises in cold product transfer This may be especially useful for longer distances and flights You may consider entering into a Service Level Agreement with your chosen courier company In accordance with the National Pathology Accreditation Advisory Council blood and blood products must be transported in validated shipping containers It is important to review what shipping configurations and containers if any are currently in use with each health provider participating in the MOU More information on packing and transport shippers can be found under Packing Requirements section below See for a summary of items to consider when setting up formal transfer arrangements See for an outlin
12. e e y Platelet Requests Asking clinicians to plan ahead can be particularly helpful in planning platelet inventory where the shelf life is short BUILD COLLABORATIVE RELATIONSHIPS Having good relationships with all people involved in the supply handling and use of blood and blood products can help with managing inventory You should encourage clinicians to understand the inventory and ordering process to minimise the number of unnecessary orders that could lead to product unavailability Explain to clinicians who are requesting blood and blood products the requirements and time frames needed when ordering product Clinicians often turn to laboratory staff for advice when ordering blood and blood products You should help raise awareness around patient blood management refer to tip 10 below and appropriate use by Good relationships with referring clinicians to local policies as well as those outside your facility such as other health providers and suppliers can also help when transferring or ordering product If you order for or from another health provider you should ensure they understand inventory management best practice au patientbloodmanagement national guidelines found at www blood gov LOC 34 AYOLNSANI L9ndO8d d00 18 ANY GOO 18 SNIDVNVIN oa N Dg MANAGING BLOOD AND BLOOD PRODUCT INVENTORY FEBRUARY 2014 g 22 USE OLDEST PRODUCT FIRST W
13. is made all of the alternatives risks and benefits should be considered as there may be another more appropriate product or treatment that can be used You should have an organisation wide patient blood management program This program should aim to manage and preserve the patient s own blood to reduce or avoid the need for a blood transfusion The program is a way to link clinical areas across a health provider such as medical officers transfusion nurses and laboratory staff to ensure the most appropriate use of blood and blood products Patient Blood Management Patient Blood Management ueni Guidelines Module 2 Guidelines Module 1 Critical Perioperative Bleeding Massive Transfusion Patient Blood Management Guidelines Module 3 Patient Blood Management Guidelines Module 4 Medical Critical Care The NHMRC endorsed Patient Blood Management Guidelines can be found on the website www blood gov au The iPad app is also available from the Apple App Store Available on the App Store Implementation Now that you have been provided with these 10 steps to improving inventory management practice how do you start to make any changes to improve current practice Read the modules on specific product types to get some further help with things you can do to improve inventory management and learn how to calculate recommended stock levels Talk to other health providers that you know may be pe
14. low temperature qualification period 6 3 3 Sampling was undertaken over x hours for 20 C 24 C ambient temperature qualification period 6 3 4 Sampling was undertaken over x hours for 32 C 42 C high temperature qualification period 64 Data logger Parameter Settings 6 41 Data logger delay setting set to 15 minutes to allow equilibration 6 4 2 Data logging sample rate set at x minute intervals 6 4 3 Data logger sample points set at number of readings to reach 30 hours 6 5 Participating centres amp personnel Enter Health Provider Laboratory Name s Enter Location Senior Scientist Quality Manager 66 Packing Configuration Packing configuration as outlined in Figure 1 below For each configuration you will need to determine the minimum and maximum number of packs allowed for each configuration to be validated Frozen Ballast Place temperature data logger on the outside of the shipper to measure the ambient temperature Place temperature data logger on top of red cells or dummy packs Chilled Ballast Place temperature data Liner Bag logger between the red cells or dummy packs Cardboard Separator Figure 1 adapted from the Australian Red Cross Blood Service Receipt and Use of Blood Service Shippers by External Institutions to Transport Blood and Blood Products Red Cell Configuration R1 LOC AH V18834 AHOLN3ANI L90dO8d 00078 ANY QOO SNIDVNVIN
15. of 1 C between the lowest and highest values for the minimum temperature recorded for each of the data loggers and each of the replications when determining minimum transport time PROCEDURE add delete below as required 6 1 GZ Description Background Information 611 This laboratory will be validating revalidating the enter shipper name for the transport of red blood cells or other component between the following health providers insert names 6 1 2 Routine transfer of blood components is undertaken by enter name 61 3 A review of Bureau of Meteorology for local climatic conditions indicates that minimum environment temperatures do not drop below enter minimum temperature e g 10 C 6 1 4 Validation time was set at x hours as a review of transport arrangements and non compliance reports indicate that thiswould be the worst case scenario the laboratory would experience in the transfer of components Key Variables add delete below as required 6 21 Staff will be accessing cool room during low temperature qualification period 6 2 2 Building air conditioning is switched off from enter time e g 10pm to enter time e g 6am during ambient temperature qualification period 6 3 Samples add delete below as required set temperature levels to represent your requirements 6 31 Data logging sample rate set at x minute intervals 6 3 2 Sampling was undertaken over x hours for 10 C 14 C
16. 11 Hyperlinks pdf IATA International Air Transport Association Dangerous Goods Documentation at lt http www iata org whatwedo cargo dgr Pages download aspx gt Australian Red Cross Blood Service Transportation of blood components and fractionated products 1 2013 at lt http www transfusion com au blood_products storage blood transport Australian Red Cross Blood Service Transport Times 1 2013 at http www transfusion com au blood products storage blood transport transport times National Association of Testing Laboratories Technical Note 17 June 2012 Guidelines for the validation and verification of quantitative and qualitative test methods 2012 at http www nata asn au phocadownload publications Guidance information tech notes information papers technical note 17 pdf Provincial Blood Coordinating Program Standand operating procedure for the use of log tag analysers as part of the inter hospital transfer program within the Province of Newfoundland and Labrador using the Golden Hour 24 2 shipping container Newfoundland Labrador 2012 at lt http www health gov nl ca health bloodservices pdf nl08_001_iht_ver 3 pdf gt Australian Red Cross Blood Service Blood Component Information Circular of Information Melbourne Victoria 2012 at lt http www transfusion com au sites default files BCl 2012 pdf gt Council of Europe Guide to the Preparation Use and Quality Assurance Directorate f
17. EW lt Identify the MOU review responsibilities and timeframe gt For example Review timeframe is every two years Responsibilities include a review of 7 updated accreditation documents and Australian Standards MOU participant inventory holdings and blood and blood product usage patterns inclusion of additional health providers lt list review responsibilities as agreed gt IMPLEMENTATION Roles and Responsibilities of participating health providers Responsibilities for all MOU Participants Participating health providers are responsible for following the guidance outlined in Blood and Blood Product Transfers including the following a Maintaining standards and accreditation where appropriate Meeting all necessary standards and legislation for the storage handling and transport of blood and blood products as outlined in Managing Blood and Blood Product Transfers Participating health providers will ensure that blood components are handled stored distributed and transported in a manner that prevents damage limits deterioration and meets required standards Enter additional responsibilities agreed by the participating health providers 742 Sending Health Provider The sending health provider must Identify sending site responsibilities For example Contact receiving provider for approval prior to transfer minimum timeline agreed to is enter agreed minimum time hours b
18. NDING xem 51 APPENDIX 4 TRANSFER PROCEDURE CHECKLIST 58 APPENDIX 5 BLOODFRIDGE MAINTENANCE RECORD CREER MERECE E 59 APPENDIX 6 BLOOD AND BLOOD PRODUCT TRANSFER FORM 60 APPENDIX 7 SHIPPER PACKING SLIP BLOOD CONSIGINIMENTBREGO RD 61 APPENDIX 8 SHIPPER LABEL 62 BEHNOWLEDGEMENIS ate 63 ENDORSEMENT S SS E sateen aa 63 REFERENCES cT 63 Scope This document provides guidance to health providers on better practice in transfers of blood and blood products around Australia Additionally it offers tools that health providers can use to comply with relevant standards and accreditation Introduction Under the National Blood Agreement all Governments are committed to providing an adequate safe secure and affordable supply of blood products services and promoting high quality management of blood products This module for Blood and Blood Product Transfers aims to assist health providers in meeting the requirement of the Statement on National Stewardship Expectations for the Supply of Blood and Blood Products This module will assist health providers to develop a guideline or Memorandum of Understanding MOU to facilitate blood and blood product transfer arrangements between providers The intention is for this guideline to Help identify transfer options for blood and blood products between health providers including between public
19. NTER HOSPITAL OR PATHOLOGY SERVICE FACILITY gt List names position contact List names position contact lt ENTER HOSPITAL OR PATHOLOGY SERVICE FACILITY gt List names position contact List names position contact lt ENTER HOSPITAL OR PATHOLOGY SERVICE FACILITY gt List names position contact List names position contact lt ENTER HOSPITAL OR PATHOLOGY SERVICE FACILITY gt List names position contact List names position contact lt ENTER HOSPITAL OR PATHOLOGY SERVICE FACILITY gt List names position contact List names position contact t lt ENTER HOSPITAL OR PATHOLOGY SERVICE FACILITY gt List names position contact List names position contact LOC 4 AHOLN3ANI L9dO8d G00 18 ANY QOO SNIDVNVIN TO ga Ul MANAGING BLOOD AND BLOOD PRODUCT INVENTORY FEBRUARY 2014 ga Ul E 3 PURPOSE The purpose of this Memorandum of Understanding MOU is to establish cooperation between the above signed health providers for facilitating blood and blood product transfer arrangements between identified facilities The MOU relates to the Managing Blood and Blood Product Transfers The intention for this MOU is to Assist in the reduction of blood and blood product wastage due to expiry or non use through the transfer of blood and blood products before expiry to enhance the likelihood of usability To provide a uniform process for the transfer of blood and b
20. NVIN oa N UJ pg MAINTAIN ALL EQUIPMENT APPROPRIATELY All equipment used for the storage transportation and handling of blood and blood products such as transport containers refrigerators freezers and plasma thawers AS 3864 2 20126 states should be maintained and monitored in The organisation which accordance with relevant standards and owns the medical refrigeration equipment guidelines used to store blood and blood products is These are responsible for ensuring l f f f that it is properly managed AS3864 2 2012 Medical Refrigeration Equipment in accordance with the For the storage of blood and blood products Standard and other NPAAC Requirements for Transfusion Laboratory regulatory requirements Practice ANZSBT guidelines for Pretransfusion Laboratory Practice You should have a back up plan for refrigerator failure and be able to provide documented procedures to other hospital staff as to the correct storage and handling procedures for blood and blood products in these circumstances Any remote refrigerators such as those at remote sites emergency areas and other associated off site facilities should also be maintained appropriately Discarding product due to equipment failure can be avoided by following proper maintenance schedules and being prepared for unforeseen failures MANAGING BLOOD AND BLOOD PRODUCT INVENTORY FEBRUARY 2014 g 24 U HAVE A PLAN TO CONSERVE INVENTORY IN
21. The variation of minimum temperature across the three validations for each of the data loggers is 0 8 C within the allowable 1 C acceptance criteria The results show that the shipper stored at 10 C 14 C for x hours did not exceed 10 C until x hours The maximum temperature variation across the three validations for each of the data loggers is enter variation e g 1 1 C and is within the allowable 1 C acceptance criteria Discuss ambient temperature validation Discuss maximum temperature validation It is recommended that Shipper Enter name is suitable for the transport of red cells as inter hospital laboratory for up to x hours If the transport is expected to exceed x hours or if non contracted transport such as a taxi is required then consignments should include a data logger as part of the packing configuration to be positioned next to the red cell packs LOC 4 AHOLN3ANI L90dO8d G00 18 ANY QOO SNIDVNVIN E MANAGING BLOOD AND BLOOD PRODUCT INVENTORY FEBRUARY 2014 D oO 9 APPENDICES Attachment 1 Raw data download of data logger for minimum temperature validations Attachment 2 Cool Room Temperature Map Attachment 3 other documents as required 10 APPROVALS Name Signature Date Report prepared by Quality Manager Approval End of document Repeat the process below for each configuration product and possible temperature
22. This can be described as a health provider holding a stock of 180 units having about 6 day s cover LOC AH V18H834 AHOLN3ANI L90dO8d G00 18 ANY QOO 18 SNIDVNVIN ga a MANAGING BLOOD AND BLOOD PRODUCT INVENTORY FEBRUARY 2014 60 The ideal inventory level in terms of day s cover may differ for each product type and type of health provider However a good inventory manager will base the levels on experience and will allow for small changes over time to adapt to any practice changes at your facility Day s cover can also be referred to as the Issuable Stock Index or ISI a term used internationally If you use BloodNet you can calculate your day s cover for each fresh blood product using the Fresh Blood Orders and Issues Reports found in the Inventory Report section You may like to set a minimum trigger level to alert you when product is getting low and have well documented actions to take in these circumstances DISCARDS AS A PERCENTAGE OF ISSUES DAPI Discard as a Percentage of Issues DAPI is a good way to make your discard data comparable with other health providers You should use the FATEOO7 Fresh Component Health Provider Discards Report in BloodNet to compare your facility to those of a similar size nationally in the group category and against those in your state This will allow you to benchmark your discards against others which is now occuring on a jurisdictional and national level A certain level of di
23. ansport times when using their shippers Great distance does not mean a transfer arrangement is not possible A number of local health networks have transfer or hub and spoke arrangements between a large metropolitan laboratory and smaller regional and remote sites Examples include Hunter Area Pathology Service in NSW BloodMove South Australia and Pathology Queensland For more information see the website at www blood gov au case studies Transfer arrangement between public and private health providers Transfer arrangements can work with health providers from different organisations local health networks pathology organisations and across the public and private health sectors BloodMove in South Australia is an example where there is a formal arrangement to transfer blood and blood product between public and private health providers Public health providers who work with a devolved blood budget may wish to discuss the impact of a transfer agreement with the relevant manager of blood budgets within their jurisdiction Suitable options could include exchange of supply with short for long expiry and using existing courier networks Any issues that may arise with these or any other proposed options should be considered agreed and documented by all parties Transfers between National Association of Testing Authorities NATA accredited health providers with blood fridges that are compliant with AS3864 Medical refrigeration eq
24. bility is Supply patterns product received from suppliers relatively low then you or other health providers You should consider all will not need to hold as product entering your inventory Product may be much received either from the supplier or transferred from another health provider The pattern of this may be consistent or may vary and this can have an effect on your ordering patterns Distance from supplier leadtime You may need to consider how far away your hospital or blood bank is from the Australian Red Cross Blood Service Blood Service or other supplier depot as this will have an effect on how quickly you will be able to re stock once you reach your minimum level If you are a long way from the Blood Service or other supplier depot you may like to set a higher minimum level Refer to the BloodNet user manual for definitions of different order types and priorities User manuals and tip sheets can be found at www blood gov au bloodnet Frequency of deliveries Hospitals or laboratories that get few deliveries may need to set higher target levels than those that are restocked more frequently Transfer patterns Hospitals and laboratories that transfer product back and forth need to carefully examine the effects this has on inventory For example product may be able to be transferred to another health provider to enable it to be used before expiry but should be transferred with sufficient expiry to ensure it is used Arrange
25. ciated with ordering storing handling and issuing of blood and blood products to optimise efficiency Planning of inventory levels held timing of deliveries and order volume and Physical and process control of product in your facility to ensure efficient and effective handling to maintain availability and minimise wastage Inventory management procedures records and systems may vary significantly from one health provider to the next depending on the size and nature of the services provided There is no single set of activities that will suit all health providers so you should examine which activities might work VIN JNIDVN 10014 jnagosd doo 18 ANY C AYOLNAANI L pg 9 MANAGING BLOOD AND BLOOD PRODUCT INVENTORY FEBRUARY 2014 to improve inventory management for you An effective inventory manager understands how to make use of the data available in order to determine how each part of the supply chain affects their facility and how it could be improved on WHY IS INVENTORY MANAGEMENT IMPORTANT Good inventory management is vital for health providers holding blood and blood products to ensure appropriate utilisation of a precious resource Not holding enough inventory can potentially put patients at risk or disrupt routine services However having too much inventory can deplete products held by the supplier to insufficient levels increase the age of product at transfusion and incr
26. dard 7 Blood and Blood Products requires health service organisations to have systems to receive store transport and monitor wastage of blood and blood products safely and efficiently Many of the risks associated with receipt storage collection and transport of blood and blood products can be reduced Systems and processes can be designed to address these risks Systems for cold chain integrity sample collection cross matching product collection and inventory management including storage handling and transport should be monitored to identify and address weak spots These guidelines provide better practice processes that can be used by health providers to ensure these risks are mitigated and improvement opportunities are identified and implemented WHAT BLOOD AND BLOOD PRODUCTS ARE COVERED These guidelines are intended to cover the following products Fresh blood components and products Red blood cells Platelets Clinical fresh frozen plasma Cryoprecipitate Cryodepleted plasma Whole blood and other products such as autologous serum eye drops Plasma amp recombinant products Albumin Immunoglobulins including immunoglobulin replacement therapy e g IVIg Hyperimmune globulins Clotting factors Inventory Management Basics Managing blood and blood product inventory is made up of two key factors Good inventory management encompasses all the activities asso
27. ded Temp C Ref Thermometer Difference C Data Logger Recorded Temp C 1111 23 6 235 01 TLD2 23 6 23 6 0 0 TLDS 23 6 2595 01 Note Reference Thermometer Enter Serial No records can be obtained from Enter Engineering Department 7 2 Minimum Temperature Validation 724 Raw data of data logger download is included in Attachment 7 2 2 Summary of results of data logger mapping is in Table 2 below Table 2 Data logger mapping results Position Date Data Logger Minimum Maximum Position 1 Enter date TDL1 4 9 C 6 8 C Position 1 Enter date BAC 7 9 C Position 1 Enter date TDL Z 2 C Enter other tables as required 8 DISCUSSION AND RECOMMENDATIONS The performance testing of the four data loggers was undertaken and completed bv Enter name e g Engineering Department an ISO9000 accredited facility on enter date The results against a reference thermometer showed that no data logger had a variance greater than enter variation e g 0 1 C The minimum temperature validation occurred on three separate occasions over a 7 day period from enter date to enter date Cool room CROO1 decommissioned for maintenance was recommissioned and set to 10 C 14 C for this validation study The packing configuration and data logger placement is outlined in Figure 1 The results show that the shipper stored at 10 C 14 C for x hours did not drop below x C for the validation period
28. e of a possible shipper configuration and validation process Implementation REQUIREMENTS FOR PACKING AND TRANSPORT Health providers should agree to a validated method for packing and transporting blood and blood products and document in an MOU HANDLING OF BLOOD AND BLOOD PRODUCT Care must be taken when handling blood and blood products In particular the following steps should be completed minimal physical handling of all blood and blood products must be practiced to ensure those products are kept within their recommended temperature ranges ensure that when you are handling any red blood cell product that it is not exposed to temperatures outside refrigeration specifications for longer than 30 minutes ensure that when you are handling any frozen blood products outside storage conditions that it is kept on dry ice or frozen ballast within a container to prevent temperature changes the blood and blood product bag and or packaging integrity must be inspected before sending to another health provider management of out of specification consignments to be included in the MOU PACKING REQUIREMENTS Blood and blood products must be packed for transport in accordance with the validated specifications agreed to between participating health providers If packing materials such as dry ice are used it is recommended that relevant policies and procedures are developed and appropriate training is provided for staff
29. e of shipping health provider and receiving health provider identification of components products shipped donor numbers and description of component product and total number of units transferred date and time transfer entered into BloodNet where applicable date and time packed a identification of person who packed the shipment inspection of product appearance attended transfer procedure checklist see Appendix 4 shipper Packing Slip for sites without BloodNet example available in Appendix 7 The above documentation can be recorded on the printout from the BloodNet transfer episode or on the Blood and Blood Product Transfer Form available in Appendix 6 of this document LOC AHOLN3ANI L90dO08d G00 18 ANY QOO SNIDVNVIN pg 41 MANAGING BLOOD AND BLOOD PRODUCT INVENTORY FEBRUARY 2014 N LABELLING OF TRANSPORT SHIPPERS It is important to label blood and blood product transport shippers appropriately See Appendix 8 Shipper Label for an example Consider including the following details as a minimum name and phone number of contact person at the receiving site name and address of intended receiving site dispatch time and date dispatching health provider staff member name and contact details clear and precise instructions to the courier contractor RECEIVING BLOOD AND BLOOD PRODUCT When receiving blood and blood product transferred from another h
30. ealth provider consider the following Review your current inventory and routine stock orders to account for expected transfers into your facility This may require you to reduce your routine order For example if you know you are receiving 20 units of red blood cells reduce your order by 20 units unless you know that more is required that day Document the time and date the transferred blood and blood product was received on Appendix 6 Blood and Blood Product Transfer Form and whether temperature specifications have been met This will ensure you have completed records for accreditation purposes It is the responsibility of the receiving facility to ensure the blood and blood product has been maintained within the manufacturer s required temperature range before accepting it into your inventory If in doubt the product must be quarantined until storage and transport conditions have been verified Please refer to the Australian amp New Zealand Society of Blood Transfusion Guidelines for pretransfusion laboratory practice It is good practice to inspect the shipper and blood product upon receipt as per Appendix 6 Blood and Blood Product Transfer Form This ensures the integrity of each unit and that patient safety is maintained Enter the acceptance or non acceptance of product into your laboratory information system as required To ensure traceability it is important that all laboratories with access to BloodNet must enter their tra
31. ease wastage through increased expiry By managing inventory efficiently health providers will be aware of their usage patterns and can order blood and blood products accordingly he National Stewardship Statement of Expectations states that health providers play an important part in minimising wastage The statement also requires that health providers have an ordering and receipting verification process such as BloodNet in order to provide adequate financial accountability as required by governments These processes are also required by healthcare organisations under NSQHS Standard 7 Blood and Blood Products SUPPLY CHAIN AND LOGISTICS The term supply chain and logistics describes the activities for supply and management of blood and blood products Health providers can be involved in influencing many parts of the supply chain This can be achieved through planning implementing and controlling activities concerning e Orders deliveries and storage of products e Stock movement and handling and issue of blood and blood products to end users including clinicians and patients Inventory management improvement activities can involve addressing the size location and number of deliveries whether health providers supply to other health providers hub and spoke type arrangements as well as on site storage arrangements and conditions for different products It also involves addressing relationship issue
32. efore arrival of transfer Ensure blood and blood products must have the minimum agreed specified time to expiry as per Section 5 Definitions unless explicit agreement is acknowledged from receiving site a Enter transfer into BloodNet where applicable Enter transfer into your Laboratory Information System LIS where applicable or manually log where no laboratory is onsite Ag vndg34 AHOLN3ANI 1 COO 18 ANY GOO 18 SNIDVNVIA UO UI 1 a MANAGING BLOOD AND BLOOD PRODUCT INVENTORY FEBRUARY 2014 Un o Z3 Visually inspect all products prior to transferring Comply with agreed packing and shipping configuration specifically lt enter agreed validated packing configuration gt Include the Transfer Checklist with either the transfer receipt from BloodNet OR the Blood and Blood Product Transfer Form Appendix 6 For sites without a laboratory include the following documentation as agreed completed Blood Fridge Maintenance Record form OR completed paperwork outlining the daily storage temperature checks of the blood fridge or storage area AND a photocopy of the objective graph recorder from the blood fridge OR information from the health provider responsible for maintain the blood fridge with temperature records maintenance records or signed declaration Receiving Health Provider The receiving health provider must Identify receiving site responsibilities
33. elating to safety measures quality measures contingency measures and risk mitigation measures for the supply of blood products and services The National Blood Agreement requires that all parties identify opportunities to develop and implement strategies for the Australian blood sector to e promote optimal safety and quality in the supply management and use of products including through uniform national standards and e make best use of available resources to give financial and performance accountability by all entities involved in the Australian blood sector Australian Health Ministers have issued the Statement on National Stewardship Expectations for the Supply of Blood and Blood Products which states that health providers should have processes programs and facilities in place that minimise wastage of blood and blood products and that national planning management and governance are supported by e health providers having an ordering and receipt verification process in place which provides adequate financial accountability as required by governments and LOC AH 18834 AHOLN3ANI L90dO8d 000 18 ANY OO SNIDVNVIN pg 7 MANAGING BLOOD AND BLOOD PRODUCT INVENTORY FEBRUARY 2014 pg 8 e inventory data is provided on a regular and timely basis to assist in supply and demand planning requirements especially in times of national shortages The National Safety and Quality Health Service NSQHS Stan
34. elp identify those areas for improvement More information on discards and strategies for reducing wastage can be found at www blood gov au wastage LOC AH V13834 AHOLN3ANI L90dO8d G00 18 ANY QOO SNIDVNVIN UO ga X a MANAGING BLOOD AND BLOOD PRODUCT INVENTORY FEBRUARY 2014 N O KEEP PROCEDURES SIMPLE Making procedures too complicated can discourage people from performing them properly Hospital and laboratory staff are usually very busy therefore simple procedures and or checklists work best for maintaining effective inventory management One example of where a simple procedure might help is the laboratory stock count procedures Sometimes performing a physical count of stock may give a more accurate picture of inventory levels if electronic records are organised in a complicated manner Setting trigger ordering levels can prevent staff from placing unnecessary orders and therefore having excess inventory Simple planning may also help with inventory management If possible ask clinicians to provide you with details of product requirements in advance Provide them with a simple procedure for informing the lab of requirements You may like to order your product requirements in line with these requests plus only a small amount for unforeseen usage 70379 RED CELLS in SAG M 620 guret 20 fo 66 Volume 240 ml Al RIR C Rh D POSITIVE ct e K ecg Y
35. exposure range for example 0 C to 4 C 4 C to 24 C 24 C to 40 C 40 C to 52 C APPENDIX 3 EXAMPLE MEMORANDUM OF UNDERSTANDING MOU MEMORANDUM OF UNDERSTANDING for the Transfer of blood and blood products between the below listed health providers lt ENTER HOSPITAL OR PATHOLOGY SERVICE PROVIDER gt lt ENTER HOSPITAL OR PATHOLOGY SERVICE PROVIDER gt lt ENTER HOSPITAL OR PATHOLOGY SERVICE PROVIDER gt lt ENTER HOSPITAL OR PATHOLOGY SERVICE PROVIDER gt lt ENTER HOSPITAL OR PATHOLOGY SERVICE PROVIDER gt lt ENTER HOSPITAL OR PATHOLOGY SERVICE PROVIDER gt lt ENTER HOSPITAL OR PATHOLOGY SERVICE PROVIDER gt AHOLN3ANI LONGOYd COO 18 ANY GOO 18 SNIDVNVIA ca Dg 1 PARTICIPATING HOSPITALS OR PATHOLOGY SERVICES The Memorandum of Understanding MOU is endorsed by the e g Senior Haematologist Senior Scientist Laboratory Manager from each participating facility The signatories agree to abide by the contents of this MOU Enter Hospital or Pathology Service Facility Enter Hospital or Pathology Service Facility gt Enter Hospital or Pathology Service Facility gt Enter Hospital or Pathology Service Facility gt MANAGING BLOOD AND BLOOD PRODUCT INVENTORY FEBRUARY 2014 g 52 U 2 CONTACTS lt ENTER HOSPITAL OR PATHOLOGY SERVICE FACILITY gt List names position contact List names position contact lt E
36. factor products are ordered and delivered You may need to determine what you think is a safe level of stock for each type of product i e inventory levels should be sufficient to ensure blood components are available to maintain expected daily patient needs but not so high that results in high rates of discard due to expiry You should also have an understanding of how these inventory levels will work in periods of short supply Monitoring the number of blood products ordered transfused transferred and discarded can provide information regarding your inventory management and can provide a basis for planning ahead You can use a variety of resources available to perform this monitoring such as reports available in BloodNet at www blood gov au reports available from suppliers reports you generate yourself from your Laboratory Information System and associated databases INVENTORY LOCATIONS Managing blood and blood product inventory is made up of two key factors 1 Product Availability Planning of inventory levels held timing of deliveries and order volume and 2 Product Integrity Physical and process control of product in your facility to ensure efficient and effective handling to maintain availability and minimise wastage Inventory management procedures records and systems may vary significantly from one health provider to the next depending on the size and nature of the services provided There is
37. here appropriate when products are received they should be sorted to allow them to be used on an oldest product first out basis This is particularly important for those products with a short shelf life such as platelets or thawed FFP or when receiving products that may have been transferred to you from another health provider If you believe product may be stored for an extended period of time with a lower likelihood of being used for example reserve emergency stock in a remote location within your facility it may be better to choose fresher product but rotate it more regularly back into general inventory to enable it to be used before expiry Product should have adequate shelf life left before expiry when moved from reserved or remote locations back to general inventory You should have documented arrangements for ensuring this occurs on a regular basis There are some special clinical circumstances where it may not be appropriate to use the oldest blood first e g Neonatal exchange transfusions Hospitals should have a policy that describes the limited clinical situations where use of the oldest blood first may not be appropriate Options to consider if product is getting close to expiry might include transferring to another hospital or laboratory rotating segregated inventories where possible and highlighting to others that product is soon to expire One example may be to make up a sign for the fridge that clearly identifies s
38. ing facilities to utilise blood and blood products before expiry The recommendations below are given to ensure the receiving site has the highest likelihood to use the product before expiry 7 14 days before expiry for red blood cells gt 5 days before expiry of supplier irradiated blood cells 24 hours or as short as agreed to with the receiving site before expiry for platelets 1 3months before expiry for manufactured products You may wish to introduce a system to improve utilisation of short expiry products For example the sending laboratory should phone the receiving laboratory to see if they can use the product prior to expiry m Ea a Ls MANAGING BLOOD AND BLOOD PRODUCT INVENTORY g 40 U The receiving health provider should be notified of an impending delivery within a time frame agreed between sites in the MOU e g 24 hours notice This notification will allow sufficient time for receiving facilities to adjust their own inventory orders from the supplier If relevant outline in your MOU multiple hub and spoke arrangements to ensure that if one health provider is unable to accept a transfer another arrangement is in place Details of blood and blood product transfers should be recorded in BloodNet prior to transport for facilities with access to BloodNet The BloodNet transfer receipt form or equivalent should then be printed and added to the shipper for transportation
39. intenance Record a photocopy of the objective graph recorder from the blood fridge demonstrating the temperature range of the place of storage or information from the health provider responsible for maintaining the blood fridge for example temperature graphs maintenance records You may be satisfied with a declaration from the sending health provider For remote sites without a blood fridge consider how blood and blood products are stored while onsite and include specific storage methods in your MOU Examples of inclusions include but are not limited to the product must remain in a sealed shipper until used the product must be accompanied by a data logger or temperature indicator transfer of patient specific product only for immediate use For remote sites without a blood fridge storage and transport requirements and documentation must be detailed in the MOU Staff at the remote site should undertake the BloodSafe eLearning Transporting Blood module The receiving laboratory could also consider undertaking additional training for ward nursing staff at the remote site LOC AHOLN3ANI L90dO8d G00 18 ANY OO 18 SNIDVNVIN E UJ APPENDIX 1 TRANSFER ESTABLISHMENT AND REVIEW CHECKLIST PROCEDURE SRI Identify sites you could transfer to from a Review what blood and blood product you could transfer in out Review courier or transport possibilities Contact potential partici
40. lines It is also recognised that the implementation of a blood and blood product transfer agreement between users could assist laboratories to enhance the availability of blood and blood products Yours sincerely A vito Fa Andrew Griffin caus msc cse DEPUTY SECTOR MANAGER LIFE SCIENCES 7 Leeds Street Rhodes NSW 2138 PO Box 7507 Silverwater NSW 2128 Tel 02 9736 8222 628 Ipswich Road evel Unit 1 Business Centre 675 Victoria Street Annerley QLD 4103 13 King William Road i Suite amp MANAGING BLOOD AND BLOOD PRODUCT INVENTORY FEBRUARY 2014 Abbotsford VIC 3067 PO Box 1122 Unley SA 5061 Tel 03 9274 8200 Archerfield BC Qjd 4108 Tel 08 8179 3400 NEW SOUTH WALES amp ACT VICTORIA amp TASMANIA QUEENSLAND SOUTH AUSTRALIA amp NT x WESTERN AUSTRALIA 2A Brodie Hall Drive Bentley WA 6102 Tek 07 3721 7300 Tel 08 9486 2800 UO e Free call 1800 621 666 National Association of Testing Authorities Australia is a company limited by guarantee ABN 59004379 748 www _nata com au Managing Blood and E Product inventory INTRODUCTION ee 7 What blood and blood products are covered 8 INVENTORY MANAGEMENT BASICS 9 What is inventory 5 Why is inventory management important 10 Supply chain and logistics 10
41. lood products between the participating facilities To ensure that acceptable temperature ranges for blood and blood products are maintained and are demonstrable during storage and transportation That AS3864 compliant blood refrigerators are used for the storage of blood To provide a uniform process for tracking transferred blood and blood products 4 COORDINATION The original document and technical and administrative coordination of this MOU will reside with enter facility name and contact details The coordinator will be responsible for the MOU and will communicate with all participating health providers on the activities conducted and information related to the MOU 5 DEFINITIONS Sending Health Provider the health provider that is transferring blood and blood product out of their site Receiving Health Provider the health provider that has agreed to receive the blood and blood product transfers into their site Blood product approaching expiry any product shipped should not have less than the following remaining of the shelf life unless specifically agreed to by participating health providers in this MOU or in special situations 7 14 days for red blood cells gt 5 days before expiry for irradiated blood cells 24 hours or as short as agreed to with the receiving site before expiry for platelets 1 3 months before expiry for manufactured blood products 6 MEMORANDUM UNDERSTANDING REVI
42. ments should be in place with these laboratories to ensure this process is appropriate Your discards as a percentage of issues DAPI If your discard rates are high you may need to consider whether holding less stock is appropriate DAY S COVER Day s Cover is the number of days of available stock that is held in inventory for a particular product It can be calculated by dividing the number of available product units in inventory by the number of product units used on average per day over a given time period It is generally recommended that you look at a time period that will be representative of current practice to determine this For example if your hospital has added a new surgical unit you may want to look at the time period since the unit was set up to determine the usage Each health provider should consider whether the level of inventory holdings will balance costs in relation to the level of discards and the number of deliveries Day s Cover a b Where a Number of available units in stock b Average daily use number of units used over a one year period 365 or you may like to use a different denominator if your facility doesn t use blood and blood products every day of the week This can be done for each type of product individually For example 11 000 units of red cells ordered over a 12 month period 11000 365 30 units per day Number of available units in stock 180 Days cover 180 30 6
43. mperature coolant packs conditioned at 20 to 24 C for 24hrs prior to use 33 Chilled coolant packs conditioned at 2 to 6 C for 24hrs prior to use 3 4 Frozen coolant packs conditioned at approximately 19 C for 24hrs prior to use 3 5 Tamper evident labels 36 Cardboard dividers 3 7 Expired red cells with defaced label Research Only or empty dummy packs filled with 275ml saline 4 EQUIPMENT Temperature Data Loggers TDL Enter Company Name Enter Model No Temperature Data Logger Serial Number Asset Number TDL TDL2 AHOLN3ANI LONGOYd A0018 ANY GOO 18 SNIDVNVIA UO U MANAGING BLOOD AND BLOOD PRODUCT INVENTORY FEBRUARY 2014 D E Note Performance Qualifications for the data loggers have been included in Attachment X Cool Room Enter name e g Incubator Enter name e g CROO1 Note Records for Cool Room CROO1 and Incubator 1001 are located in Enter location e g Engineering Department 5 ACCEPTANCE CRITERIA 5j Temperature maximum does not exceed 10 C 5 2 Temperature minimum does not fall below 2 C 5 3 There should not be a temperature range difference of 1 C between the lowest and highest values for the maximum temperature recorded for each of the data loggers and each of the replications when determining maximum transport time 5 4 There should not be a temperature range difference
44. no single set of activities that will suit all health providers so you should examine which activities might work to improve inventory management for them An effective inventory manager understands how to make use of the data available in order to determine how each part of the supply chain affects them and how it could be improved on Some BloodNet reports that might help monitor your inventory include Issues INVOO2 Inventory INV001 006 007 amp 008 Discard Fate 001 002 8007 Transfers Fate 003 8 004 Fresh Blood Orders amp Issues FULO10e LOC AHOLN3ANI L90dO8d G00 18 ANY OO 18 SNIDVNVIN UO aa zx UJ a MANAGING BLOOD AND BLOOD PRODUCT INVENTORY FEBRUARY 2014 CHECKLIST FOR INVENTORY MANAGEMENT BEST PRACTICE ww Do vou have a set time for placing orders lt Do you do an inventory count before placing orders Do you return unused reserved product to inventory before counting Do you receipt product into BloodNet LIS within one hour of receipt Do you maintain and monitor blood product refrigerators according to guidelines Do you have Standard Operating Procedures that cover inventory management Do you have a training protocol that covers inventory management Do you have policies that cover movement of product between facilities Do you have policies that cover movement of product to ward areas Do you monitor and report on your discard rates to a governing b
45. nsfers and discards You should maintain a record of transferred products for auditing and accreditation purposes This can be completed through BloodNet or manually if the transferring and or receiving site does not have access to BloodNet This will allow you to review the transfer arrangements and track if transferred products are utilised if discards rates of expired product decrease and so on REMOTE SITES WITHOUT A LABORATORY OR BLOOD FRIDGE For non laboratory remote sites with a blood fridge consider who is responsible for maintaining the fridge The receipting site is responsible for ensuring that all product received has been kept within manufacturer s temperature specifications and will need to include access to temperature records in the MOU You may also want to consider including any maintenance records Alternatively you may choose to opt for a signed declaration that all blood and blood product has been maintained within manufacturer s temperature specifications by the transferring out site For remote sites or facilities without a laboratory you may like to include the following additional documentation with the transferred blood and blood products as an assurance for the receiving facility that blood and blood product have been stored according to manufacturers temperature requirements completed paperwork outlining the daily storage temperature checks of the blood fridge or storage area see Appendix 5 Blood Fridge Ma
46. nsuring blood and blood products remain within manufacturer s temperature specifications It is important to consider all temperature conditions and length of time that may be experienced by the blood or blood product you are packing and transporting Think about where your blood or blood product is being transferred to and all the environments the shipper may experience The validation process must be repeated for all possible temperatures the blood and blood product may be exposed to during its transport Some examples of items to consider when transferring blood and blood product include If the product is going by plane the cargo hold might not be heated resulting in very low temperatures the items might be held in air conditioned storage before or after the flight the items might be left on the tarmac for some time in extreme hot or cold temperatures If the product is travelling by road it may travel long distances on a truck that could experience extremes of hot or cold temperatures it might be left on a loading dock for an extended period of time before arriving at the storage site Consider conducting initial and ongoing seasonal courier temperature audits and ad hoc quality assurance audits as required If you are transporting blood or blood product outside of a validated timeframe or condition you must ensure manufacturers temperature specifications are met Where a validated shipper has a minimum n
47. ody Do you monitor and report on your usage rates to a governing body Do you monitor and report on your transfer rates to a governing body Do you maintain up to date and accurate records Do you regularly review your inventory requirements Are your procedures simple enough for everyone involved to understand Do you regularly communicate with others outside your area who are involved in supply handling and use of blood and blood products Are you able to inform others above of better practice processes Do you use Electronic Crossmatching where possible Do you utilise a Group and Screen or Maximum Blood Ordering Schedule where possible Do you have short reservation periods where possible Do you sort your inventory to allow oldest product to be used first Do you have contingency plans Are your contingency plans linked to your state or territory health emergency plan EH E EEEE NE BHENENENENENNEE E Do you have a patient blood management program PROVIDE EXPERT TRAINING Research has shown that having staff that are well trained can have an overall positive effect on inventory management and reducing wastage You should ensure that all staff involved in the handling of blood and blood products participate in a well designed training program Staff should learn the importance of inventory management and be instructed on how their decisions impact the supply chain The National Blood Autho
48. or the Quality of Medicines amp HealthCare of the Council of Europe EDQM Strasbourg France 2011 at lt http www centronazionalesangue it sites default files guida edqm 16 edizione pdf LOC AH 18834 AHOLN3ANI L90dO8d 000 18 ANY QOO SNIDVNVIN UD ga o NATIONAL BLOOD AUTHORITY AUSTRALIA
49. pating sites to gauge interest Set up initial meeting with managers and scientists in charge to discuss transferring options Go through the MOU to make it specific for your situation Agree to storage transport package documentation and training requirements Outline acceptable days until expiry that units should be identified for transfer Sign off on agreed MOU Educate staff on arrangements Set start date for transfer arrangement to commence Set date to meet and review transfer arrangement E E NH BH E Review MOU arrangement to ensure working for all health providers involved MANAGING BLOOD AND BLOOD PRODUCT INVENTORY FEBRUARY 2014 g 44 APPENDIX 2 VALIDATION PLAN 1 PURPOSE SCOPE This document describes the validation of Shipper enter shipper name for the use in the inter hospital laboratory transport of Enter components as required Responsibilities Position Responsibility Senior Scientist Design validation analyse results prepare the report per form the validation compile results Quality Manager Authorise validation and approve for implementation 2 REFERENCES A reference you may like to review is the Council of Europe s Guide to the Preparation Use and Quality Assurance of Blood Components 16th edition List references you outline in this document 3 MATERIEL add delete below as required 31 3x Shipper enter shipper name 3 2 Room te
50. ralia Australian Standard 2012 AS 3864 2 2012 Medical refrigeration equipment For the storage of blood and blood products User related requirements for care maintenance performance verification and calibration at lt http infostore saiglobal com store Details aspx productID 1600491 gt re National Pathology Accreditation Advisory Council NPAAC 2008 Requirements for Transfusion Laboratory Practice First Edition Department of Health and Ageing Commonwealth of Australia Canberra Australia at http www health gov au internet main publishing nsf Content health npaac docs transfusion htm gt National Blood Authority Australian Health Ministers Conference National Blood Supply Contingency Plan 88 2008 National Blood Authority Patient Blood Management Guidelines Development at http www nba gov au guidelines review html Australian Red Cross Blood Service Receipt and Use of Blood Service Shippers by External Institutions to Transport Blood and Blood Products ARCBS DIS L5 011 1 14 2011 at http www transfusion com au sites default files Receipt and Use of Blood Service Shippers pdf gt Australian amp New Zealand Society of Blood Transfusion Guidelines for pretransfusion laboratory practice The Australian amp New Zealand Society of Blood Transfusion Ltd Sydney Australia 2007 at http www anzsbt org au publications documents ANZSBT Guidelines Administration Blood Products 2ndEd Dec 20
51. rforming well and have reduced their wastage rates as they may be able to share some other better practice ideas with you Establish champion networks to promote good inventory management practice Tools to help implement better practice inventory management are being developed by the National Blood Authority and will be found at www blood gov au when available Contact the NBA for advice on support blood gov au or call 13 000 BLOOD 13 000 25663 LOC AH V13834 AHOLN3ANI L90dO8d G00 18 ANY QOO 18 SNIDVNVIN U ga NJ 1 00 N LOC 8 LONQOYd dO0 18 ANY A0018 SNIDVNVIN a NATIONAL BLOOD AUTHORITY B E AUSTRALIA Module1 Contents SCOPE TT 31 INTRODUCTIONS S nan mn EIU 31 PREPARATION 32 IMPBEMENTATIONE 5 5 37 APPENDIX 1 TRANSFER ESTABLISHMENT AND REVIEWS Si 44 APPENDIX 2 45 APPENDIX 3 EXAMPLE MEMORANDUM OF UNDERSTA
52. rity is developing some tools to assist in designing your training and will make them available on www blood gov au Performing procedures in a consistent manner is important along with having training protocols and procedures that ensure that only experienced personnel provide direction to new starters Standard Operating Procedures SOPs should be easy to follow and clearly outline required tasks and processes to minimise inconsistencies amongst staff Staff should be aware of the impact of inadequate storage and handling as well as the implications of wasting blood You can avoid putting patients at risk by assuring product integrity Wasted product not only has financial implications but can also mean less product is available where required potentially resulting in an adverse clinical outcome Training should be provided not only for laboratory staff but for all staff in the organisation that order or use blood and blood products The organisation s Medical Officer induction program should include a session on blood use including prescribing ordering and use of blood and blood products This has been shown to bring about a significant reduction in the stock required to be held on site pg LOC AH V18834 AYOLNSANI L90dO8d G00 18 ANY 000718 SNIDVNVIN ga Ul MANAGING BLOOD AND BLOOD PRODUCT INVENTORY FEBRUARY 2014 SET APPROPRIATE INVENTORY LEVELS Each health provider is responsible for set
53. s Attribution 3 0 Australia http creativecommons org licenses by 3 0 au licence The details of the relevant licence conditions are available on the Creative Commons website accessible using the links provided as is the full legal code for the CC BY 3 0 AU license http creativecommons org licenses by 3 0 au legalcode The content obtained from this document or derivative of this work must be attributed as the Managing Blood and Blood Product Inventory Guidelines for Australian Health Providers ISBN 978 0 9873687 7 5 Print Edition ISBN 978 0 9873687 6 8 Electronic Edition This publication is available online at www blood gov au inv mgt guideline For more information Inventory Management National Blood Authority Locked Bag 8430 Canberra ACT 2601 Phone 13 000 BLOOD 13 000 25663 Email support blood gov au www blood gov au Q NATIONAL BLOOD AUTHORITY AUSTRALIA National Association of Testing Authorities Australia NATA W 7 February 2014 Ms J Cameron Manager Health Provider Engagement National Blood Authority Australia Level 2 243 Northbourne Ave LYNEHAM ACT 2602 Dear Jo NATA recognises that the National Blood Authority s Managing Blood and Blood Product Inventory guidelines is an important initiative which may help in ensuring a reduction in unnecessary wastage of blood and blood products NATA supports the National Blood Authority s initiative in producing these guide
54. s among suppliers distributors and end users e g clinicians This requires creating strong channels of communication with suppliers distributors and end users so that important information gets through 10 Tips to Help Manage Your Blood Product Inventory Blood products are a valuable of these practices however you should use perishable resource sometimes these guidelines to assess whether there is any room for improvement in your facility in scarce despite efforts to ensure any of the areas mentioned More specific a sustainable supply Being able information around particular products to use blood and blood products including advice on how to set inventory 1 levels is given in the modules relating to before they expire is desirable those products to maintain cost efficiency Therefore it makes sense to maintain an inventory of product that is at a level sufficient to meet requirements Balancing this level with having sufficient product to meet clinical demand is often a challenge for health providers Blood and blood product inventory management is a trade off between shortage and wastage Practice has shown that there is a strong relationship between blood and blood product inventory levels and wastage Reducing the level of inventory usually results in less wastage so understanding how to appropriately and efficiently manage your inventory is important These guidelines aim to provide health providers wi
55. s in line with the statement on National Stewardship Expectations for the Supply of Blood and Blood Products issued by the Australian Health Ministers Implementing a blood and blood product transfer agreement can assist laboratories to enhance the availability of blood and blood product manage a limited resource reduce unnecessary wastage by transferring blood and blood product to a health provider where it is more likely to be used appropriately a MANAGING BLOOD AND BLOOD PRODUCT INVENTORY W N WHAT DO YOU NEED TO CONSIDER IDENTIFY POSSIBLE PARTICIPATING TRANSFER HEALTH PROVIDERS Consider the following factors Other health providers with whom you could set up a transfer arrangement This could include the following health providers you currently have informal arrangements with health providers located in your local area that you can approach to set up a transfer arrangement health providers within your organisation located in other suburbs or health networks A larger laboratory or health provider that you could transfer your product to to enhance the possibility of its use before expiry Larger health providers service a varied patient group and are more likely to utilise a range of products before expiry If you are a large laboratory or health provider consider receiving transfers from smaller facilities to enhance the possibility product is used before expiry As a large laboratory or health pro
56. scards of blood and blood products particularly fresh products with short expiry dates is both inevitable and appropriate to ensure that products are available where and when they are clinically necessary However there is a proportion of discards of blood and blood products that is neither inevitable nor appropriate and is this is termed wastage Total discards are reported in BloodNet DAPI is calculated by taking the amount of blood and blood product units discarded in a given time period and dividing this by the total amount of blood and blood product units received by your facility in the same time period and multiplying this figure by 100 to give a percentage value DAPI x y x 100 Where x Number of units discarded For example 50 Albumin units wasted over 12 months and 5 000 Albumin units issued to your facility over 12 months DAPI 50 500 x 100 1 If you are comparing your results with international data DAPI is frequently referred to as Wastage as a Percentage of Issues WAPI internationally y Number of units issued to you If you use BloodNet you can examine your discard patterns using BloodNet reports Not all health providers will be able to limit discards to the same level You should examine your own practice for each product and assess whether there is any room for improvement Recording the reason for discard of a product is important for monitoring purposes Monitoring trends of wastage will h
57. sport is outside validated shipper times a The agreed transport method is Enter agreement for courier transport method Enter agreement for courier transport cost LOC 8 AHOLN3ANI L90dO8d G00 18 ANY QOO SNIDVNVIN D ga Ul M APPENDIX 4 TRANSFER PROCEDURE CHECKLIST PROCEDURE lx 1 Routine check for products close to expiry 2 Identify and contact possible receiving health provider s to negotiate transfer of close to expiry product 3 Record blood or blood product transfer in BloodNet Print transfer record and include with the product E EG 4 Record transfer information on Blood and Blood Product Transfer Form only if BloodNet is not available 5 Record blood or blood product transfer in the Laboratory Informa B tion System LIS your LIS is interfaced with BloodNet then record entry is not required in BloodNet 6 Inspection of blood and blood product for abnormal appearance package integrity leakage and expiry date 7 Check blood or blood product is packed according to MOU agreement include date and time packed on transfer form 8 Copy of the Blood Fridge Maintenance Record form or temperature graph included as per MOU to be sent when required requested 9 Transport shipper labelled EH E NE E 10 Notify recipient health provider by telephone or email of impending delivery Checklist completed by Date and Time
58. th 10 simple tips for better practices in inventory management that can be applied to all blood and blood products Some health providers will find that it is not possible to adopt all LOC 8 AYOLNSANI L9ndO8d d00 18 ANY QOO 18 SNIDVNVIN ga MANAGING BLOOD AND BLOOD PRODUCT INVENTORY FEBRUARY 2014 N UNDERSTAND YOUR INVENTORY Expert inventory managers understand and regularly monitor their inventory This means they know and review patterns of inventory holdings where inventory is held trigger levels delivery patterns wastage rates and usage rates Understanding the patterns of all of these items will help plan requirements for improving the inventory management practices involved MONITORING INVENTORY PATTERNS You should examine your current inventory practices to determine their efficiency This involves looking at what your current inventory holdings are as well as your usage and discard patterns in conjunction with delivery and transport schedules Ordering and delivery patterns should be examined to determine the best schedule to suit workflow requirements while maintaining cost effectiveness The patterns may be reliant on the capacity to store products the level of staffing and the shelf life of product and demand patterns For example your facility may have a large haemophilia clinic once per week and this may determine when the bulk of the clotting
59. ting their own inventory levels and ensuring these are appropriate There is a strong relationship between inventory levels and wastage Hospitals and laboratories that hold more blood and blood products relative to their average daily use often have high wastage rates The key to good inventory management is balancing sufficient inventory to meet clinical need while keeping wastage rates at a minimum Specific advice and guidance on how to set inventory levels for each different product ie red cells platelets plasma and manufactured and recombinant products will be found in the specific modules relating to those products The following are important factors that may influence decisions on inventory levels Type of health provider Hospitals and blood banks that have an emergency or obstetrics department can sometimes need a large volume of product available in a short time If your hospital has this type of service you may like to set a higher minimum or trigger level of product as restocking during an emergency may not always be possible It can be helpful to look Daily usage rates You can examine your average at the degree of variability daily use by using the Fresh Blood Orders and Issues by blood type or product report found in the Inventory Report section in If the variability is high BloodNet You should also examine your Days Cover then you may consider relative to your usage see below holding more inventory If the varia
60. tock with short expiry enabling it to be the first selected for issue ATTENTION Product at the front of this shelf is soon to expire Please use first OPTIMISE CROSSMATCHING PROCEDURES You should avoid reserving product by crossmatch or otherwise for a specific patient where the likelihood of use is uncertain Each time blood and blood products are reserved for a patient this product is effectively removed from available inventory This can create an artificial shortage and can cause unnecessary replacement orders Where possible your laboratory should consider Electronic Crossmatching procedures These procedures work well with Group and Screen policies helping to maximise product in available inventory Laboratories should encourage using Group and Screen or Maximum Blood Order Schedule MBOS policies for red cell orders in patients without clinically significant red cell antibodies Ideally a MBOS should be developed specifically for your hospital to give clinicians an idea of what the appropriate ordering patterns for blood and blood products are One example of a Maximum Surgical Blood Order Schedule MSBOS can be found in Frank et al 2013 Where blood and blood products have been reserved for specific patients consider short reservation periods to enable product to be moved back to general inventory if not used LOC AYVNYESS AHOLN3ANI LONdOYd G00 18 ANY QOO 18 SNIDV
61. ture recorded is complete with no missing data Other Blood Products check that other blood and blood product have been stored as per manufacturer s temperature specifications Ifthere are amy problems with handling and storage of any of these blood or blood products these MUST be documented in the above comments section next to the appropriate blood or blood product contact the laboratory and inform them of the details declare to the best of my knowledge the above information regarding the handling and storage of the blood and blood product feted above is correct Name Signature RECEIVING LABORATORY USE ONLY APPENDIX 7 SHIPPER lt Insert logo or Consign PACKING SLIP BLOOD es mer here gt Number CONSIGNMENT RECORD SENDER TO COMPLETE No of Shippers Blood Product Patient Name Packed Date Time Sent via YOUR Lab courier O Taxi O Bus O Airline O Other Courier O Details Other Courier Company Name have packed this consignmentin accordance with the packing configuration Signature Dispatched Date Time RECIPIENT TO COMPLETE Please return completed form to Sender No of shippers received Shipment received unopened and undamaged yes O NO D For products listed below Isthe temperature within the acceptable range yes O NO D If product is outside specified temperature range contact sender immediately for advice Received A ACCEPTABLE TEMPERATURE RANGE WARNING Red cells
62. uipment For the storage of blood and blood products are relatively easy to set up and should provide assurance that blood and blood products are maintained within manufacturer s temperature specifications ACCREDITATION Participating health providers are responsible for maintaining the necessary accreditation standards and legislation for example as outlined by NATA or Standard 7 This should provide assurance to receiving health providers that any transferred blood and blood products they receive have been stored appropriately Include a point in your MOU outlining responsibilities of all parties if accreditation requirements are not met REVIEW INVENTORY MANAGEMENT PRACTICE AT PARTICIPATING PROVIDERS It is recommended that health providers review the current inventory management practice with each product at each laboratory or site participating in the MOU 10 Tips to Help Manage Your Blood Product Inventory located within Managing Blood and Blood Product Inventory can provide practical advice to appropriately manage blood and blood product inventory REVIEW TRANSPORT OPTIONS AND PRACTICES AT PARTICIPATING HEALTH PROVIDERS Review existing blood courier system Determine if there is an existing courier service you could utilise If so investigate the cost to use this service If not investigate courier or taxi options and discuss with management to determine the division of costs When taking transport into consideration a cost
63. umber of packs specified ballast must be used to ensure minimum numbers are maintained TRANSPORT REQUIREMENTS Blood and blood products must be transported at the temperature range specified in Table 1 Table 1 Transport temperature manufacturer s requirements Product Transport temperature Comments range Red blood cells 2 10 C All blood refrigerators includ ing theatre and other holding refrigerators must comply with current AS3864 Fresh frozen plasma cryo At or below 25 C Plasma freezers must comply precipitate cryodepleted with current AS3864 plasma Platelets 20 226 Discontinuation of agitation of platelets during transportation should not exceed 24 hours Manufactured Products See relevant manufacturer s Product Information eaflet Adapted from the Australian Red Cross Blood Service 2012 Blood Component Information circular of information It is recommended that a temperature data logger or other temperature monitoring device is utilised in the transport of all blood and blood products Various temperature monitoring devices are available on the market Ag vndg34 AHOLN3ANI LONGOYd COO 18 ANY GOO 18 SNIDVNVIA UJ There are a number of elements to consider when transferring or receiving blood and blood product Below are suggestions you may wish to include in your MOU TRANSFERRING OUT BLOOD AND BLOOD PRODUCT It is important to allow sufficient time for receiv
64. vider you are more likely to utilise a product before expiry You could consider reducing your usual order depending on the amount of product you are aware will be transferred in You will need to continually consider the impact on your inventory levels and whether or not you can use the transferred product If you are a smaller laboratory consider reviewing your current inventory if frequent transfers are required If you have an established hub and spoke arrangement consider including other health providers outside these arrangements or your organisation For example a public local health network hub and spoke could include smaller private health providers in the local area Alternatively you could consider becoming a hub if you are a large laboratory with a high blood and blood product turnover This will allow you to manage your own inventory and that of smaller regional facilities with a low turnover In turn smaller sites can operate with a lower inventory and still maximise blood use before expiry The proximity of the other health providers to your site LOC AH V18H834 AHOLN3ANI L90dO8d G00 18 ANY OO SNIDVNVIN D UJ UJ MANAGING BLOOD AND BLOOD PRODUCT INVENTORY FEBRUARY 2014 D UJ E a Proximity will factor into transport or courier costs and have an effect on validated shipper configuration requirements Data loggers are currently recommended for all shipments beyond the Blood Service validated tr
65. with packing date time and signature of packer Health providers without access to BloodNet should complete the transfer form in Appendix 6 to accompany their shipment It is important to inspect all blood and blood products for prior to packing You should consider documentation of the inspection in your MOU A checklist to check blood and blood products is available for receiving sites in Appendix 6 Your MOU should include the agreed shipping configurations and container specifications for the varied climates your locations will face This should assure all participating health providers in the MOU that blood and blood products are maintained within the recommended manufacturer s temperature specifications A record of the storage temperature of the products must be available on request at the facility that shipped the product NATA accredited health providers may need to provide this documentation during their accreditation process This documentation will assure all participating health providers are storing blood and blood products within the current AS3864 Medical refrigeration equipment For the storage of blood and blood products It will also provide assurance that blood and blood products are maintained within manufacturer s temperature specifications and prevent discards due to unknown storage conditions Consider what documentation will be required with transfers in the MOU Recommended documentation and information is nam
66. y Service New South Wales National Association of Testing Authorities NATA South Australian Department of Health BloodMove Program Tasmanian Department of Health Tasmanian Blood Product Network Therapeutic Goods Administration TGA Endorsements Australian amp New Zealand Society of Blood Transfusion Ltd ANZSBT The Royal College of Pathologists of Australia RCPA References 1 The Australian Health Ministers Conference Australian Health Ministers Conference Statement on National Stewardship Expectations for the Supply of Blood and Blood Products National Blood Authority 2010 2 Australian Commission on Safety and Quality in Healthcare Safety and Quality Improvement Guide Standard 7 Blood and Blood Products ACSQHC 2012 at lt http www safetyandquality gov au wp content uploads 2012 10 Standard7 Oct 2012 WEB pdf gt 3 Perera G Hyam C Taylor C amp Chapman J F Hospital blood inventory practice the factors affecting stock level and wastage Transfusion medicine Oxford England 19 99 104 2009 4 Stanger S H W Yates N Wilding R Cotton S Blood inventory management hospital best practice Transfusion medicine reviews 26 153 63 2012 5 Frank S Rothschild J Masear C Rivers R Merritt W Savage W and Ness P Optimizing preoperative blood ordering with data aquired from an anesthesia information management system Anesthesiology 118 6 2013 6 Standards Aust

Managing Blood and Blood Product Inventory

Contents

Download Pdf Manuals

Related Search

Related Contents