The blood supply · Killed by a needless blood transfusion Judy Kenny, whose husband was the first...
Transcript of The blood supply · Killed by a needless blood transfusion Judy Kenny, whose husband was the first...
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Right Blood, Right Reason 25th January 2013
The blood supply –drivers, challenges and
future plans
Rebecca Gerrard Head of Bet ter Blood Transf usion
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Right Blood, Right Reason 25th January 2013
Blood supply in UK may not always be plent if ulNeed t o reduce waste across t he supply chain I nvolve t he pat ient and use blood appropriat ely
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Right Blood, Right Reason 25th January 2013
Manages t he nat ional volunt ar y donat ion syst em f or blood, t issues, or gans and st em cells t ur ning t hese pr ecious donat ions int o pr oduct s t hat can be used saf ely t o t he benef it of t he pat ientLast year r eceived 3,500 or gan and 4,000 t issue donat ions and banked 2,200 cor d blood unit s f r om acr oss t he UKSupply ar ound 2 million unit s of blood a year t o hospit als in England and nor t h Wales
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Right Blood, Right Reason 25th January 2013
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Right Blood, Right Reason 25th January 2013
TOTAL Blood Blood used per Transfusion
Number of Transfusions
Efficiency
Stock control
Technology
Autologous drains (hip / knee surgery)
Keyhole surgery
Trauma / Shock packs
Remote / Electronic Issue
Demographic Changes
Total Number of Patients
Disease rates
Mortality rates
Number of junior doctors
Birth rates
Transfusion trigger levels
Use of new / existing treatments
Accident rates
Policy changes (targets, regulations etc)
Iron deficiency drugs
Audits
Technology
Cell Salvage
MSBOSCell Salvage
Waste (unused blood)
Awareness / Education / Training (BBT)
Health (obesity, diet, alcoholism, etc)
Extended shelf life of products
O+
O-
A+
A-
B+
B-
AB+
AB-
Drivers that are a function of RBC usage type (see separate chart)
STOCKS
DRIVERS
Use of Pre-operative Assessments
Use of Transfusion Practitioners
MSBOS
TEG Technology
TEG Technology
Demand Drivers for red blood cells in the hospital
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Right Blood, Right Reason 25th January 2013
Demand f or blood - benchmar king I nappr opr iat e use audit dat aDH - NHSBT Commer cial Review 2011 NHSBT St r at egy Compliance wit h legislat ion / inspect ions Minimise r isk / impr ove saf et yPat ient s Reduce cost s / wast age
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Right Blood, Right Reason 25th January 2013
Red Cell Demand
1700000
1800000
1900000
2000000
2100000
2200000
2300000
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Right Blood, Right Reason 25th January 2013
Things changed in Sept ember 2007
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Right Blood, Right Reason 25th January 2013
St at us Quo r eleased t heir 28t h album I n Sear ch of t he Four t h Chor dHouse pr ices peakedGor don Br own was appoint ed Pr ime Minist erThe onset of t he f inancial cr isis - Bank of England was f or ced t o hand emer gency f unding t o Nor t her n RockSummer 2007 was t he wet t est on r ecor dDemand f or blood component s st ar t ed t o r ise
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Right Blood, Right Reason 25th January 2013
Moving Annual Total of Red Cell [Full Unit Equiv] Issues to Hospitals - 000s
1775
1800
1825
1850
1875
1900
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Right Blood, Right Reason 25th January 2013
Moving Annual Total of Platelet Issues to Hospitals - 000s
200
205
210
215
220
225
230
235
240
245
250
255
260
265
270
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Right Blood, Right Reason 25th January 2013
Moving Annual Total of Frozen Component Issues to Hospitals - 000s
350
360
370
380
390
400
410
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Right Blood, Right Reason 25th January 2013
Blood Usage in comparison with other European count ries
Red Cell Usage NHSBT r epor t ed a blood usage r at e of 34.5 unit s / 1000 populat ion. Compar es well wit h t he ot her well developed EBA member s
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Right Blood, Right Reason 25th January 2013
Platelet Usage in comparison with other European count ries
Platelet sNHSBT r epor t s a r at e of 5.0 ATDs / 1000 populat ion in 2011-12 This f ell mid-r ange in t he r epor t ed usage r at es (3.2 t o 8.0)
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Right Blood, Right Reason 25th January 2013
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Right Blood, Right Reason 25th January 2013
I s blood donat ion keeping pace wit h issue?
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Right Blood, Right Reason 25th January 2013
Long term t rend in act ive donor numbers
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Right Blood, Right Reason 25th January 2013
Demand Dr iver Par amet er s used in model Pr oj ect ions:
Contributory factor: RBC 1 year 3 years 10 years
Demographic effects 1.3% increase
4.3% increase
15.9% increase
Changes in the rate of procedures / treatment per 100,000 population
1.0% increase
3.0% increase
10.3% increase
Changes in the average red blood cell use per procedure / treatment assuming a power-law fit.
2.5% decrease
6.7% decrease
16.3% decrease
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Right Blood, Right Reason 25th January 2013
Clinical demand f or all main blood component s is expect ed t o incr ease especially f or :
O neg red cellsPlatelets Cryoprecipitate
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Right Blood, Right Reason 25th January 2013
Demand is incr easing.... Donor base is declining....
Wher e is all t hat blood going?
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Right Blood, Right Reason 25th January 2013
Red blood cell usage
RED BLOOD CELLUSAGE
Obstetric / gynaecological
6.5%
Medical61.7%
Surgical 31.0%
Obstetrics, 4.3%
Gynae non malignant, 1.2%
Orthopaedics, 7.3%
Other Surgery, 2.4%
Cardiothoracic, 4.7%
Vascular Surgery, 2.5%
Urology, 1.7%
Anaemia, 31.3%
Haematology, 18.1%
GI bleed, 11.8%
Non-Haem cancer, 9.8%
Hip replacement, 3.7%
Knee replacement, 1.2%
Road Traffic accident, 0.9%
Neonatal, 1.6%
Reduction NOF, 2.1%
GI and liver, 5.3%
Plastic surgery, 0.8%
Coronary artery bypass grafting, 2.1%
Colorectal surgery, 2.5%
Trauma, 3.8%
Other / unknown, 15.7%
Renal failure, 2.7%
Fe deficiency, 1.5%
Chronic disorders, 1.4%
Critical care, 1.4%
B12 / folate deficiency, 0.2%
Myelodysplasia, 6.0%
Lymphoma, 3.5%
Acute Leukaemia, 3.0%
Myeloma, 1.4%
Myelofibrosis, 0.8%
Acquired haemolysis, 0.6%
Other Specific cause, 2.4%
Inherited anaemia, 0.4%
Gynae oncology, 1.0%
Transplant, 1.6%
Neurosurgery / ENT, 0.9%Data from Wallis et al. audit, 2008 NOT PUBLISHED
Hospital Wastage
4%%
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Right Blood, Right Reason 25th January 2013
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Right Blood, Right Reason 25th January 2013
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Right Blood, Right Reason 25th January 2013
43% to adults, 48% to children, 62% t o inf ant s
5032186/ 248 (75%)2009FFP
19.5% of transfusions
111326/ 56 (46%) hospitals in two
regions
2008Red cell transfusion
15% of r bcs,42% of platelets, 27% of FFP
6750217/ 257 (84%)2007Upper gastrointestinal bleeding
48% patients 7465139/167 (83%)2007Red cells in hip replacement
Inappropriate useN cases audited
Number of hospitals
YearTitle
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Right Blood, Right Reason 25th January 2013
20% of cases had a possible potentially reversible anaemia. Tr ansf usion was st ar t ed above the agreed audit haemoglobin standard in 35% of pat ient s wit h anaemia and 6% of patients with blood loss. 33% of patients were t r ansf used t o >2g/ dl above the agreed audit standard. Over all, 53% of cases f ell outside the algorithm set
9126197 f r om across UK
2012Red cells in Adult Medical Patients Part 1
25% of t r ansf usions 44943/82 (52.4%) from
3 regions
2012Cryo-precipitate
27% of t r ansf usions 3296139/ 153 (91%)2011Platelets in haematology
Inappropriate useNo. cases audited
Number of hospitals
YearTitle
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Right Blood, Right Reason 25th January 2013
I n NHSBT in 11/ 12:
19,600 unit s of r bcs wast ed (1.1% of issues)
14,400 unit s of plat elet s wast ed (5.4% of issues)
I n hospitals:
39,600 unit s r bcs wast ed (2.2%)
10,700 unit s plat elet s (4%)
The highest wast age occur r ed in t he Medically Or der ed Not Used cat egor y, at almost 50% of t he t ot al wast age.
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Right Blood, Right Reason 25th January 2013
Recommendation 1Mor e wor k should be done bot h at nat ional and t r ust level t o suppor t t r ust s, in achieving and maint aining best pr act ice, t o r educe t he inappr opr iat e use of r ed cells, plat elet s and f r esh f r ozen plasma; t his would impr ove pat ient car e and r educe cost s t o t r ust s and would in t ur n r educe demand and dir ect cost s on NHSBT .
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Right Blood, Right Reason 25th January 2013
To deliver a moder n, wor ld class blood ser vice t hat pr ovides a sust ainable and dependable supply of blood component s t hat meet all saf et y, qualit y, compliance and ser vice st andar ds, as ef f ect ively as possible.
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Right Blood, Right Reason 25th January 2013
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Right Blood, Right Reason 25th January 2013
Blood t r ansf usion has a chequer ed hist or yNo clear consensus f or many aspect sCost s r ising New saf et y measur es expensiveI nspect ion and r egulat ion Blood ser vices need t o const ant ly assess new r isks
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Right Blood, Right Reason 25th January 2013
The r isk of get t ing hepat it is f r om a plat elet t r ansf usion in t he UK is about 1 in 1 million f or Hep B and 1 in 72 million f or Hep C. The chance of get t ing HI V is about 1 in 6 million.
OR......You ar e mor e likely t o die in a gas incident (f ir e, explosion or car bon monoxide poisoning) t han t o get Hep B f r om a blood t r ansf usion.
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Right Blood, Right Reason 25th January 2013
ht t p:/ / www.blood.co.uk/ about -blood/ inf or mat ion-f or -pat ient s/
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Right Blood, Right Reason 25th January 2013
Killed by a needless blood transfusionJudy Kenny, whose husband was the first to die from vCJD contracted via a blood transfusion, is campaigning for tighter controls over the procedure
'To this day I don t know why Deryck needed that transfusion Judy Kenny at home in Bournemouth, with a picture of her late husband Deryck15 Oct 2012
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Right Blood, Right Reason 25th January 2013
Logist ics / Tr anspor t including ad hocs 24/ 7 wor king Vehicle and lab machines under -ut ilisedBlood collect ion sessions Diminishing r esour cesConsolidat ion
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Right Blood, Right Reason 25th January 2013
Blood donat ion Need to attract sufficient donors to meet the future demandDigital nativesClub 96Migration
21st Century - Combining the kindness of strangers with tough economics
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Right Blood, Right Reason 25th January 2013
Reduce wast e
Opt imise invent or y levels acr oss t he supply chain
Reduced age at issue
Opt imise int r a-cent r e t r anspor t s
I mpr ove f or ecast ing
Reduce subst it ut ions
I ncr eased cust omer sat isf act ion
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Right Blood, Right Reason 25th January 2013
Need t imely dat a of t r ansf usion r ecipient s f or f ut ur e planning and t ar get ing of maj or user s f or appr opr iat e blood-saving st r at egies. Tar get ed audit s of appr opr iat e use wit h ef f ect ive act ion plans.
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Right Blood, Right Reason 25th January 2013
Reduce cost s / consolidat e / cr eat e pat hology net wor ks or hub and spoke syst emsI TS in NHSBT:
shared stock management systemsautomatic replenishment systemsintegrated transfusion laboratories
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Right Blood, Right Reason 25th January 2013
Bet t er Blood Pat ient Blood Tr ansf usion Management
Pat ient - at t he hear t of decision makingBlood conser ve pat ient s own blood, avoid t r ansf usion wher e appr opr iat eManagement or ganise and co-or dinat e
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Right Blood, Right Reason 25th January 2013
Blood supply in UK may not always be plent if ulNeed t o reduce waste across the supply chain I nvolve t he pat ient and use blood appropriat ely
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Right Blood, Right Reason 25th January 2013
Rebecca Ger r ar dHead of Bet t er Blood Tr ansf usion
r ebecca.ger r ar d@nhsbt .nhs.uk