Platelet utilization and inventory management best practices
What is the challenge?
Current practices at Canadian Blood Services require that platelet units be stored no longer than five days prior to transfusion. This short storage period results in very challenging inventory management and many platelet units being discarded. In fall of 2015, the Canadian Blood Services hospital liaison specialist team surveyed 53 Canadian hospitals to gather best practices on platelet utilization. The goal was to identify ways to decrease the number of platelet units that are discarded.
We thank all hospitals that participated and are pleased to share the collected responses:
Best practice #1: Blood groups
- Give group specific and group compatible platelets. Hospitals should have a policy in place regarding ABO substitution when platelets with compatible plasma are not available (CSA Z902-15, article 10.7.7). Further, the policy may describe steps to minimize potential risks associated with the transfusion of group O platelets to a non-group O at-risk patient. Some steps implemented by hospitals surveyed include plasma volume reduction for neonatal/pediatric patients, or performance of an anti-A and anti-B titre.
- Hospitals should have a policy regarding the transfusion of Rh positive platelets to Rh negative patients, particularly for pediatric patients or women of child bearing potential. That policy may include recommendations regarding the administration of Rh Immune Globulin (AABB Standards 29th edition, article 18.104.22.168).
Best practice #2: Redistribution
- If possible, share platelet inventory that is soon-to-outdate with other hospitals.
- Canvas other hospitals for platelets prior to ordering from Canadian Blood Services (subject to available redistribution practice).
- Leverage existing resources and consider participating in any available platelet redistribution programs.
Best practice #3: Standing order / Inventory review
- Implement minimum and maximum inventory levels for platelets.
- If possible, abandon use of standing orders for platelets. Order as required to keep minimal stock.
- If standing orders are used, routinely review platelet requirements and revise standing orders.
- Adjust platelet inventory based on utilization trends.
- Educate and reinforce with transfusion medicine lab team the rationale for inventory levels and/standing orders.
Best practice #4: Clinical
- Frequently review the daily HLA-matched platelet requirements with physicians and nurses on patient care units.
- Maintain a roster of all post stem cell transplant patients and review platelet counts daily to assess current and future needs. Allow technologists to release and reassign platelets according to patient needs.
- Routinely review patient platelet counts when platelet transfusions are ordered.
- Incorporate the use of a data analytics dashboard (or other analytics system) to predict patient demand.
- Regularly perform utilization audits.
- Require a physician order to transfuse a patient before requesting product from the blood provider.
- Consider implementing a Cytomegalovirus (CMV) safe policy for all patients to avoid ordering CMV seronegative platelets (http://www.nacblood.ca/resources/guidelines/CMV.html).
- Consider transfusion medicine department representation at cardiac rounds or other medical rounds to emphasize the need for better communication between surgeons, anesthetists and the transfusion medicine lab regarding patient specific platelet requirements.
- Kaufman R.M. et al., Platelet Transfusion: A Clinical Practice Guideline from the AABB. Annals of Internal Medicine 2015; 162 (3): 205-213.
- Nahirniak S. et al., for the International Collaboration for Transfusion Medicine Guidelines (ICTMG), Guidance on platelet transfusion for patients with hypoproliferative thrombocytopenia. Transfusion Medicine Reviews 2015; 29: 3-13.
- Pavenksi K. et al., Efficacy of HLA-matched platelet transfusions for patients with hypoproliferative thrombocytopenia: a systematic review. Transfusion 2013; 53: 2230-2242.