Blood Inventory Management Best Practices for Hospital

Blood Inventory Management

Best Practices for

Hospital Transfusion Services

Inspiring and facilitating best transfusion

practice in Ontario.

BLOOD INVENTORY MANAGEMENT BEST PRACTICE FOR HOSPITAL TRANSFUSION SERVICES

Blood and blood products are necessary for the treatment of many different types of patients; however these products

are in limited supply. Although considerable efforts are put in place to ensure an adequate and sustainable supply,

external factors such as disasters, pandemics, decreased donations or manufacturing interruptions have the potential to

impact supply or demand, which can affect the availability of these products.

Good inventory management principles are essential in ensuring that the supply of blood components and products will

be sufficient to meet the transfusion needs of patients while minimizing wastage. Listed below are 10 key strategies

gathered from several referenced sources that are considered relevant to implementing and maintaining an effective

blood inventory management system. Implementing these strategies can maximize utilization, minimize wastage

(Celebrating Success) and help ensure safe and equitable access to all products for all patients.

NOTE: Implementation of some of the following may require prior consultation with the transfusion service Medical

Director and/or hospital transfusion committee.

ONE

Determine target inventory levels and maintain these levels by

using an ‘order up to’ policy. Rule of thumb is to maintain a stock

inventory equivalent to approximately 10-11 days of your average

daily use of red blood cells (RBCs) and 2 days of your average daily

use of platelets (based on averaging your annual use divided by

365). Inventory levels should be reviewed annually and if there are

any changes to blood utilization practices at your hospital, the target

numbers should be revised as needed. Additional considerations:

• A review of the pre-admission and next day’s surgical schedule

may also improve management of inventory by ensuring

sufficient blood group specific units are available.

• If you are located in an area that experiences significant seasonal

fluctuations in use, inventory levels should be adjusted up or

down as indicated by review of historical utilization patterns.

• Inventory levels for other components/products should be

reviewed and a target level defined

• Target levels should be defined as part of your hospital

emergency blood management plan

• If you report your disposition to CBS by ABO/Rh group, review of

your Inventory Index on the Canadian Blood Services (CBS) web

based reporting system can help you determine optimum inventory

levels by ABORh based on your actual use

Utilization Data Tools

• Calculating your

blood inventory

• Provincial Blood

Utilization Graphs

• PLT Inventory

Calculator

• RBC Inventory

Calculator

•

• Calculator

InventoryInventoC

akc Cal

TWO

Arrange your inventory to ensure the oldest units or vials (shortest

remaining shelf life) are at the front of the storage equipment. If

possible alert staff to units that will be outdating soon (e.g. RBC in

the next 5 days, platelets same day, plasma protein products and

frozen products in next three months) to help ensure they will be

used first. Use visual aids such as an expiring units list posted in a

visible location or place distinctive tags on the units. Ensure that a

strict ‘oldest unit first out’ policy is adhered to.

Remember to

include reserved units or phenotyped units (which may be kept in

a separate area) in this process by moving them into useable

inventory before they reach the end of their shelf life.

ATTENTION:

Product at the front of this

shelf is soon to expire.

Please use first!

Blood Inventory Management Best Practices for Hospital Transfusion Services | Dec 2017

www.transfusionontario.org

THREE

Perform an available inventory count prior to placing an order

with Canadian Blood Services (CBS). Ensure that the inventory

count includes crossmatched stock, stock that is held in remote

locations (Emergency Room or Operating Room) as well as

units that are irradiated or phenotyped. Include a regular

verification between your computer inventory count and

the physical count. Reporting inventory on CBS web based

reporting on a regular basis can help provide helpful

information to the blood supplier. This is especially important

during times of shortage.

FOUR

Implement policies to address the management of group O Rh

negative RBC to preserve these units that are often in scarce supply.

These policies should include reserving them for female patients of

child bearing potential (less than 45 years of age).

The use of O Rh

negative RBC for non O Rh negative recipients should be minimized

wherever possible. This practice should be monitored and reviewed

regularly to ensure inventory levels are kept at optimum levels to

avoid wastage and to ensure there is a sufficient supply for those

patients who really need them. When requesting phenotyped units

from Canadian Blood Services, request group specific. If your site

has the capability, and time allows, attempt to find units of the

phenotype required from group specific stock within your own

inventory. If you are frequently issuing O Rh negative units to non O

Rh negative recipients in order to avoid outdating, consider reducing

your target inventory levels for O Rh negative.

O Neg Utilization Tools

• Ontario O Rh Negative

Audit 2015 Report

• Age of Child-Bearing

Potential in Ontario

Women in 2016

• Maternal Age at

Delivery Ontario LHINs

Five Years of Data

• CBS CL#2014-14

FIVE

Limit the number of units that are held in ‘reserve’ inventory. Use

of electronic or immediate spin crossmatch techniques can aid in

reducing the length of time units remain ‘on hold’ for a patient.

Regular review of any reserved units and returning them to available

inventory as soon as possible (within 24 hours)

will also aid in

reducing the number of units being held. For surgical patients, a

review of the patient’s blood use during surgery, the most recent

post-operative hemoglobin result and the presence of any clinically

significant alloantibodies may assist with the decision.

SIX

Establish a maximum surgical blood order schedule (MSBOS)

based on a hospital’s past RBC use to serve as a guideline for

future surgical and other treatment RBC requests. A MSBOS

can guide clinicians in their ordering practice and avoid ‘just in

case’ ordering.

Note: Endorsement by a hospital’s Medical

Advisory Committee, communication of the MSBOS guidelines

to your hospital’s physicians and surgeons, and regular review

of the MSBOS guidelines are critical to the success of a

MSBOS. Crossmatch requests that exceed the MSBOS

guidelines may require consultation with the ordering

physician. An MSBOS may not be required in hospitals that

have fully implemented an electronic crossmatch. The use of

pre-printed order sets can also improve ordering practices.

MSBOS Tools

• MSBOS Development

Tool

• Order Set for

Transfusion

Example

• MSBOS Policy and

Procedure Example(SHSC)

Blood Inventory Management Best Practices for Hospital Transfusion Services | Dec 2017 www.transfusionontario.org

SEVEN

Implement redistribution to minimize outdates. Smaller hospitals

should consider an arrangement to transfer “soon to outdate” blood

components and products to a nearby larger hospital with a higher

demand. Packing procedures must ensure the blood components/

products are maintained at the appropriate conditions during

transport using a validated shipping container and that the

appropriate documentation accompanies the transfer.

Redistribution Tools

• Redistribution Toolkit

EIGHT

Train your staff. Studies show that staff training and awareness

can contribute to improved inventory management practices.

2,3

Providing clear standard operating procedures and ensuring staff

understand the importance and value of the blood components

and products can be key to minimizing wastage. Having experienced

staff performing the inventory count and ordering can minimize

variability in practice which will contribute to better overall

inventory management and control. Establishing reorder levels with

consideration of time until next routine delivery, can avoid

unnecessary STAT or ASAP delivery for stock replenishment.

Training Tools

• Transporting Blood

Products Internally

NINE

Collaborate with clinical staff. This can make a significant

difference in improving ordering practices.

Prospectively

screening orders against locally developed/endorsed evidence

based guidelines, audits, and consultation with a transfusion

medicine physician can help reduce unnecessary or inappropriate

ordering of blood. Increasing awareness of the value of blood

components and products, the timelines for their availability and

the risks involved with transfusion can also improve practice and

minimize wastage.

Audit Tools

• Bloody Easy Audits

Handbooks

• Bloody Easy 4

• Bloody Easy Coagulation-

Simplified

• Bloody Easy Blood

Administration

ver 2

• Transfusion Committee

Handbook

Guidelines/Resources

• Top 10 Hints on Safe

Transfusion

• Guidelines/Recommend

ations

• NAC Guidelines

TEN

Avoid large numbers of units expiring on the same day. When

replacing stock orders for one blood type, ask CBS to send units

with a mixture of expiry dates. Trying to manage large numbers of

components all expiring on the same day can be challenging and

may lead to higher wastage due to outdating.

Blood Inventory Management Best Practices for Hospital Transfusion Services | Dec 2017 www.transfusionontario.org

REFERENCES

Ontario Contingency Plan for Management of Blood Shortages and Toolkit. October 2016. Ministry of Health

and Long-Term Care. http://transfusionontario.org/en/download/ontario-contingency-plan-for-management-

of-blood-shortages-version-3/

Stanger SHW et al Transfusion Medicine Reviews, Vol 26 (2); April 2012: pp153-163.

Bhella S et al. Obstetric and trauma database review at a single institution finds the optimal maternal age restriction

for the transfusion of O – blood to women involved in trauma to be 45 years. Transfusion (Letters to the editor)

2012;52:2488-2489.

Chapman JF. Unlocking the essentials of effective blood inventory management. Transfusion 2007;47:190S-196S.

Managing Blood and Blood Product Inventory – Guidelines for Australian Health Providers. February 2014.

National Blood Authority Australia. www.blood.gov.au