North West Regional Transfusion Committee Audit of Platelet Use and Wastage

Transcription

1 North West Regional Transfusion Committee Audit of Platelet Use and Wastage Facts & Figures demand and wastage Demand increased by 13% over the past three years North West demand in March 2014 is up 3.2% ytd against previous year Demand up 1.4% ytd across the rest of England and North Wales as a whole WAPI NW 6.4% 211 units (December 2013) NW second highest region of 10 for wasting platelets (December) Purpose of NW Audit To determine that the demand for platelets in the North West is driven by demand and not inappropriate use To understand why sometimes platelets are wasted To demonstrate that recommendations of The 2010 National Comparative Audit of Platelet Use are being fulfilled Methodology Online questionnaire design/paper version provided SurveyMonkey Governance (agree to participate) Data collection commenced Monday 16th September and submitted by Friday 4th October Requested to audit a specific number of consecutive transfusions according to BSMS platelet category: Very High 40 High 30 Moderate 20 Low 15 Very Low 10

2 Results Total: 452 cases submitted. Data submitted from: 20/47 hospitals (43%), 16/28 Trusts (57%) No non-nhs sites submitted data Baseline information Does the Transfusion Laboratory stock platelets? Total number of prophylactic transfusions in this dataset Yes 10 (50%) No 10 (50%) 345 (76%) Recommendation A platelet count is required prior to prophylactic platelet transfusion. As a minimum this should be within 24 hours for in-patients and within 48 hours for out-patients Total number of prophylactic transfusions with pre transfusion platelet count Total number of pre transfusion platelet counts performed overall 332/345 (96%) 434/452 (96%) Recommendation Double dose prophylactic transfusions should not be used routinely Total number of prophylactic transfusions that received more than one dose 49/345 (14%) (5 received a triple dose)

3 Recommendation If platelets are necessary pre-procedure:- - Allow time for a post transfusion platelet count to be taken to assess response Total number of platelet transfusion episodes required pre procedure Total number of post transfusion platelet counts obtained 77/452 (17%) 62/77 (81%) Total number that had a pre procedure platelet count 75/77 (97%) Appropriate Use The reason for the platelet transfusion according to the NBTC April 2013 Indication Codes for transfusion is documented on the request form or if the indication is guided by Thromboelastography Total number of documented indications (reason) on the request form Total number of platelet transfusions guided by Thromboelastography 309/452 (68%) 17/452 (4%) In 2 hospitals Appropriate Use The platelet count corresponds to the documented reason for the transfusion according to the NBTC April 2013 Indication Codes Total number of platelet counts consistent with the indication for the request 350/452 (77%) Total number of other reason given for not being documented eg telephone request 13/96 (14%)

4 Stock Total number ordered from NHSBT for a named patient Total number taken from unallocated stock 285/452 (63%) 134/452 (30%) Wastage Reason for wastage according to BSMS categories Total number of platelets wasted during audit period Medically Ordered, Not Used (MONU) 32/452 (7%) 17 Total number previously ordered or issued to another patient 20/452 (4%) Surgically Ordered, Not Used (SONU) Stock Timed Expired (STEX) 10 3 Time Expired (TIMEX) of the 285 (57%) platelets that were ordered from NHSBT for a named patient were from platelet stock holding sites Wasted out of Laboratory (WOL) Wasted Import (WI) Misc Wasted 0 0 2

5 Key Findings - Regional 96% of prophylactic transfusions had a pre transfusion platelet count 14% of prophylactic transfusions received more than 1 dose 77% had a platelet count that was consistent with the indication for the request Key Findings 68% of transfusions had a indication for the request present on the request form 82% of pre-procedure transfusions had a post transfusion platelet count prior to their invasive procedure 7% of platelets wasted during audit period Next Steps Regional Next Steps Investigate the reasons why 14% of prophylactic transfusions received more than one dose Continue to raise awareness that double dose prophylactic transfusions should not be used routinely Regional audit of double dose platelets October 2015

6 Follow up Proforma double dose Proforma sent to all hospitals showing more than one dose given for prophylactic transfusions excluding those given pre-procedure Requested: pre and post platelet count HLA selected? HLA antibodies? Platelet function disorder? Reason for transfusion Number of units given Total number of prophylactic transfusions that received more than one dose 49/345 (14%) 2010 NCA of Platelets in Haematology Number of hospitals that had at least one episode of more than one dose given Number of hospitals responded to follow up proforma Number of episodes requested of more than one dose 220/2277 (10%) 14/20 (70%) 8/14 (57%) 24/49 (49%)

7 Results double dose The review revealed that only 14 of all the episodes returned related to prophylactic transfusions Several related to bleeding, ECMO, or required pre-procedure to reach a specific threshold Pre platelet count - range Post platelet count - range Number of platelets that were HLA selected Number of patients with HLA antibodies Number of patients with a platelet function disorder Number of units given - range x 10/l x 10/l 0/14 (0%) 0/14 (0%) 1/14 (7%) 2

8 Reasons given for transfusion TEG guided (1) Post chemo (1) - clinician documented rationale Prostate cancer (bone mets) (2) Clinician documented rationale Neutropenic sepsis (1) Sepsis (1) Emergency surgery, on anti-platelet medications (1) AML (1) Low platelets in haematology patients (6) Key Finding Total number of prophylactic platelet transfusions receiving more than one dose - 14/345 (4%)