Action 7.10

The Stewardship Statement¹ states that health service organisations should have processes, programs and facilities in place to minimise the wastage of blood products, and ensure that inventory data are provided on a regular and timely basis to assist in supply and demand planning requirements, especially in times of national shortages.

Wastage is loss of blood or blood products resulting from carelessness, inefficiencies or even inappropriate use. Product discard is an important component of wastage. Because of the short shelf life of some products (particularly fresh blood products), health service organisations may have policies in place to ensure that enough product is available to meet clinical need, and these policies may mean that wastage cannot be completely eliminated. The goal is to minimise discard while ensuring product availability. Monitor and report all discards through BloodNet and to the local blood management governance group.

Ensure that documented processes and systems are in place to record the fate of products by type. Where possible, use electronic systems (for example, BloodNet) to record discard as part of the fate of the product. Ensure that these processes clearly outline:

• What is to be reported and how
• The format in which it is to be reported
• Who it should be reported to, including the blood management governance group.

Minimise blood wastage

Minimise blood wastage at all times. Implement strategies as part of the blood management quality improvement system to reduce the risks identified in Action 7.9. These strategies may include:

• Identifying a target for wastage, based on targets communicated at a state or national level (the level of wastage will be product-specific, and will also depend on the different services provided by the organisation)
• Identifying appropriate inventory levels that ensure that appropriate blood and blood products are available to meet clinical demand while minimising wastage
• Identifying appropriate inventory management strategies or practices (for example, first-in-first-out)
• Communicating wastage targets to the workforce, and clarifying that meeting the target is not a goal in itself – that is, if product is available but is not clinically indicated, do not encourage use of the product to reduce wastage
• Benchmarking against the current wastage level, and against other similar organisations
• Reviewing ordering practices for non-standard or unusual blood products to ensure that prescribing is based on current knowledge and evidence
• Identifying strategies to ensure that products remain within specifications so that they do not need to be disposed of, including maintaining temperature requirements, reducing unnecessary handling and storing appropriately.

The NBA has developed tools to improve inventory management practice.

States and territories have established targets for discard rates for RBCs, platelets and clinical fresh frozen plasma for the public and private sectors. Monitor and review the organisation’s wastage rates against these targets and prepare action plans for how to achieve the targets within the organisation.

The NBA has contingency and risk mitigation measures in place to ensure continuity of the supply of blood and blood-related products and services, including the National Blood Supply Contingency Plan. The response by the clinical community is a vital element of the plan. Ensure that the organisation has arrangements in place to support the clinical management of blood and blood products in a crisis, and to help clinicians effectively respond to patient requirements.

Incorporate state or territory and national arrangements into the organisation’s local contingency plans for times of blood and blood product shortage. Test these contingency plans and participate in state, territory or national simulations. If opportunities for improvement are identified, prepare strategies to respond to these, and review them through the blood management quality improvement system (refer to Action 7.2).

Follow instructions from governments during activation of the National Blood Supply Contingency Plan.

Provide orientation and training to all members of the workforce involved in minimising wastage and responding in times of shortage.

If blood management within a health service organisation is outsourced, ensure that contracts with providers include the requirements identified above and provide sufficient information to confirm the routine monitoring of blood and blood product wastage. This requires a system to monitor compliance of blood and blood product providers with these strategies.

Applicability of actions

The actions in the Blood Management Standard will not be applicable for day procedure services that do not use blood or blood products. These services should provide evidence that they do not use, receive, store, collect or transport the blood or blood products governed under this standard.

Services using blood or blood products should refer to the information provided for hospitals for blood management.

MPSs or small hospitals that use blood or blood products should:

• Regularly review the risks associated with availability of blood and blood products, including minimising wastage and responding in times of shortage, and develop policies and processes to respond to these risks
• Provide training to the workforce about ensuring blood availability
• Record wastage in a system and monitor wastage reports
• Regularly review inventory requirements, and manage blood and blood products to ensure availability
• Identify, develop and implement contingency arrangements, including planning for times of supply shortage, considering state or territory and national arrangements.

Ensure that documented processes and systems are in place to record the fate of products by type. If possible, use electronic systems (for example, BloodNet) to record discard as part of the fate of the product. Ensure that these processes clearly outline:

• What is to be reported and how
• The format in which it is to be reported
• Who it should be reported to, including the blood management governance group.

Minimise blood wastage

Minimise blood wastage at all times. Implement strategies as part of the blood management quality improvement system to reduce the risks identified in Action 7.9. These strategies may include:

• Identifying a target for wastage, based on targets communicated at a state or national level (the level of wastage will be product-specific, and will also depend on the different services provided by the organisation)
• Identifying appropriate inventory levels that ensure that appropriate blood and blood products are available to meet clinical demand while minimising wastage
• Identifying appropriate inventory management strategies or practices (for example, first-in-first-out)
• Communicating wastage targets to the workforce, and clarifying that meeting the target is not a goal in itself – that is, if product is available but is not clinically indicated, do not encourage use of the product to reduce wastage
• Benchmarking against the current wastage level, and against other similar organisations
• Reviewing ordering practices for non-standard or unusual blood products to ensure that prescribing is based on current knowledge and evidence
• Identifying strategies to ensure that products remain within specifications so that they do not need to be disposed of, including maintaining temperature requirements, reducing unnecessary handling and storing appropriately.