Transportation Cooler Interventions Reduce Plasma and RBC Product Wastage

Abstract

Objectives: The rate of plasma product wastage for the United States in 2011 was approximately 1.8%. The plasma wastage rate at our institution was higher, mainly due to products returned out of temperature range from procedural areas. A process review and intervention to reduce plasma wastage was undertaken, which included modifications to our transport cooler.Methods: A new cooler system was designed, and this device was implemented alongside an updated protocol for delivering plasma while also enhancing the previous RBC cooler validation time. We audited plasma and RBC product wastage prior to these interventions, from January 2013 to February 2014, vs after the intervention from April 2014 to March 2015.Results: After the intervention, the monthly plasma wastage rate declined 60% (12.6 units/100 units transfused preintervention vs 5.0 units/100 units transfused postintervention; P < .0001). The monthly RBC wastage rate also decreased 28% (3.2 units/100 units transfused preintervention vs 2.3 units/100 units transfused postintervention; P < .01).Conclusions: Our intervention resulted in significantly decreased plasma and RBC wastage and is broadly applicable, since out-of-temperature product wastage in procedural areas is likely a significant problem at many institutions.The most recent data collected by the US Department of Health and Human Services in 2011 indicate that the percentage of plasma product wasted nationally was 1.8%. Data were not published for RBC unit wastage, but prior studies suggest RBC wastage rates may be similar but variable.2 A significant challenge in wastage is that products go out of temperature (OOT) when they are held in procedural areas to help meet the clinical need of instant blood access. Through our quarterly Transfusion Service Committee meetings, we became aware that product wastage at Stanford Healthcare (SHC) was noticeably higher than the national average. The primary driver of the increased wastage was products returned OOT from operating rooms (OOT for transport coolers: >10 C). While SHC has employed a number of strategies to provide blood emergently to procedural areas, including emergency blood order sets, close physical proximity, and a dedicated pneumatic tube system channel, there is added comfort for operating room (OR) personnel to have instant access within a room to cross-matched blood products for elective, complex surgical cases.Here we review our experience and results from process improvement initiatives to lengthen cooler validation time intervals for blood products, reduce repacking during surgical cases, validate cooler temperature range within the stricter 1 C to 6 C range instead of 1 C to 10 C, and overcome challenges with chemical temperature-sensitive adherent monitors.

Utility of temperature‐sensitive indicators for temperature monitoring of red‐blood‐cell units

“…). In line with previous studies, this study implies that as long as 10°C remains the regulation for transportation of RBC units, the 10°C rule might be more appropriate rather than the time‐based, 30‐min rule . Based on our data, the CT increased more rapidly after 30 min.…”

Patient rescue and blood utilization in the Ogasawara blood rotation system

“…Adequate temperature control reduces this waste RBC . By using the ATR700 in a hospital setting, such as for temporary storage in and transportation to the operation room or the emergency room, wastage of RBC solution as a result of inadequate temperature management can be reduced …”

How do I manage severe postpartum hemorrhage?

“…On the day of surgery, the transfusion services department sends blood products to the operating room in modified temperature‐controlled coolers (Igloo). At our institution, introduction of these modified coolers led to a 60% and 28% reduction in monthly plasma and RBC wastage across the adult hospital, respectively …”