With increased pressure to reduce the expenditure on blood products, we established a working party to investigate the problem of platelet wastage and develop strategies to address the issues. Data was collected on platelet ordering, usage and wastage. The ordering process from bedside to laboratory was mapped and the blood bank platelet inventory management was reviewed. The group changed the platelet ordering and availability forms, commenced compatible cross-grouping of platelets and improved platelet inventory management within the blood bank. Feedback to staff was provided through a monthly target chart. Over the last six months, platelet wastage has decreased by 65% to an average of 14 units/ month (down from 42), with an average projected cost saving of $200,000 per annum.

The aim of this project was to reduce platelet wastage by 50% within six months through the development of innovative and sustainable strategies.

Data collected over a 12 month period identified that discarded platelets accounted for more than 50 per cent of the total monetary figure associated with wastage of fresh blood products. Over two-thirds of the units discarded had been ordered by the Oncology Department. Ordering processes at both the ward and laboratory level contributed to this problem, with an existing culture of over-ordering driven by a "just in case they're needed" approach, without regard to cost or wastage of unused units. In addition, it was identified that platelet inventory management in the Blood Bank could be improved.

A 12 month retrospective review of platelet wastage between May 2006 and April 2007 identified that of 2667 platelet units ordered, 501 (18%) were discarded. A working party was created, which met on a fortnightly basis. The team crossed interdepartmental boundaries and comprised of nursing staff from ward areas, doctors, and scientific officers working in the Blood Bank. The team mapped current processes and analysed data collected. The blood group/CMV status of platelets issued was analysed. Issues identified included:

• problems in communicating orders
• cancellations
• platelet availability
• relevance of platelet expiration
• impact of FBC turn-around times on ordering practices
• over-ordering from Red Cross by some blood bank staff
• wastage of CMV positive and rare blood group platelets
• The practice of ordering all platelets for the weekend on Friday was highlighted as a significant factor contributing to platelet wastage.

This project contributes to the strategic direction, "Make smart choices about the costs and benefits of health services". Blood Bank provides an essential service to the entire Hospital, supporting all the medical, surgical and emergency departments. Blood products are a finite resource that must be managed judiciously. This contributes to the KPI of achieving savings through reforming backroom processes and support services, which can be reinvested in frontline clinical health services.

By making staff aware of the cost of platelets and subsequent wastage, we created increased pride, confidence and respect for the entire Blood Bank service.

Platelet ordering sheets were introduced into Oncology, where all platelet orders for the following day were to be faxed to the Blood Bank by 12 noon each day. Oncology Clinic and Camperdown Ward (the Oncology Ward at The Children's Hospital at Westmead) receive a daily fax listing the available platelets. This reduces duplicate orders and provides a means for Oncology to communicate cancellations. Unwanted units can then be reallocated to other patients before their expiry. Weekend inpatient ordering was changed to a daily ordering process to reduce unnecessary over-ordering. An ongoing education process for clinicians/nurses about the ordering process has been implemented.

Changes implemented in the Blood Bank include reorganisation of the platelet inventory board so that platelets are stored and listed by blood group, enabling staff to more easily determine which unit is nearest expiry and should be issued first. Adoption of a cross-grouping policy for platelet issuing has had a significant impact on platelet wastage. Stocking predominantly group O and A platelets and issuing them to patients of other groups has meant that platelets can be reallocated more easily, thereby reducing wastage. Similarly, stocking only CMV negative products (depending on Red Cross availability) has meant that we have products available for a wider group of patients. Training of Blood Bank staff on management of the inventory has been an active process so that all staff members can manage the platelet inventory in the best manner to reduce wastage. Feedback to staff was provided on a monthly target chart, which also served as an effective reminder to all staff.

Full blood count turnaround times were highlighted as an external factor influencing the ordering decision making process. Strategies were implemented in Haematology to give oncology patients (particularly outpatients) priority, to improve turnaround times and enable decisions to be made before critical cut-off times for ordering.

Data on platelet usage and wastage continues to be collected and collated on a monthly basis. All discarded units are entered onto a hard copy sheet, which contains patient name, date platelet was ordered, date discarded, whether the unit was 'pooled' or 'apheresed' (apheresed platelets are double the price of 'pooled' units) and the department the patient is under. This was then collated in an excel spreadsheet.

Data which was collected from May 2006 to April 2007 showed 2667 units of platelets were ordered from Red Cross and 501 units discarded. This was an average discard of 42 units per month, equalling 18.7% wastage.

For the six month period between 1 January 2008 and 30 June 2008, 1208 units of platelets were ordered by Blood Bank and only 84 units discarded. This was an average discard of 14 units per month, or 6.9% wastage. This is a reduction of 65% in platelet wastage, well below our target of 50% reduction in wastage and provides a projected cost saving of $200,000 per annum. These savings will have a significant impact on the Hospital's budget.

Platelet Discards 2007 vs 2008

By introducing a number of communication strategies, Oncology and Blood Bank have amended their ordering policies and practices to efficiently use a scarce blood product. The changes implemented have now been in place for six months and the reduction in wastage has proved to be sustainable, even when key players are unavailable. The platelet inventory management and cross-grouping policy are now standard practice in the Blood Bank. Blood Bank and the Head of Haematology continue to monitor usage and wastage of blood products. Feedback to staff continues through the production of the monthly target chart.

This activity could be applied to all other AHS Blood Services. This process could also be applied to other areas of significant wastage, such as red cell concentrates. Strategies to reduce wastage of this equally precious resource will further enhance the management of our blood budget.

Co-ordinator, Service Improvement Unit
The Children's Hospital at Westmead
Phone: 02 9845 2093