Waste way down at Cincinnati hospital

May 2007
Feature Story

Karen Lusky

“Waste not, want not” is a concept that The University Hospital in Cincinnati arduously applies to its blood inventory management in an effort to use every unit of blood product.

And they just about do. In 2006, the hospital discarded 0.9 percent of blood products received at a cost of $30,000, compared with five percent or $128,000 worth of blood products in 2000, the year before the hospital began to focus on reducing blood component wastage.

The hospital’s interdisciplinary transfusion committee each month identifies patterns of blood product waste and takes action to resolve them.

As one example, the committee identifies patient care units with an unusual number of red cells returned to the blood bank warm. In such cases, the nurse manager reminds staff to return blood products within 30 minutes of receiving them, which is the specified time limit, says Mary Beth Kasper, MS, MT(ASCP), SBB, a Quest Diagnostics employee and manager of the immediate response laboratory for the hospital.

The hospital prevents wastage of RBCs held at room temperature too long by teaching nurses to prepare patients for transfusion before the blood arrives on the floor. “For example,” says Patricia Carey, MD, medical director of the hospital’s transfusion service, the nurses “were sometimes starting the intravenous catheter for transfusion after they received the blood.”

To extend the shelf life of fresh frozen plasma, which expires 24 hours after thawing, the hospital takes advantage of an option that allows you to change the product and label to “plasma thawed,” which can then be stored for five days, Kasper says.

Being a level one trauma center, “we thaw a lot of FFP,” Kasper says. Before 2001, much of it was wasted. “Now when we thaw 10 units of FFP for trauma and only use five, after 24 hours we change the label on the FFP to plasma thawed and have four additional days to use it.”

The hospital also decided to store predominantly apheresis platelets (from a single donor) because they have a five-day shelf-life, unlike random-donor platelets, which expire within four hours of pooling them from multiple donors.

“In the past,” Kasper says, “if we had a trauma case and the physician wanted X number of doses of platelets available for immediate transfusion, we’d pool the platelets, and they’d expire in four hours if not used.”

Balancing the storage of random-donor platelets and apheresis platelets helps decrease wastage. Today, random-donor platelets are predominantly used for “sure-give” transfusion orders. Apheresis platelets are saved for situations where platelet usage is unknown.

“The blood bank technologists are the gatekeepers” for storing appropriate platelet products for various clinical scenarios, Kasper says. “They have a deep desire to use every blood product as wisely as possible.”

Karen Lusky is a writer in Brentwood, Tenn.