Best Practice in Red Cell Inventory Management
facilitated by Teresa Allen, Emily Okukenu and Heather Cawley

The Workshop
The workshop was run twice during the day.  A mix of transfusion laboratory managers and blood service staff attended.  Participants were briefed by Teresa Allen before splitting into groups to discuss the following questions:

• What is an appropriate stock level?  Should I hold higher or lower stocks
• Should I change my de-reservation period to 24 hours?  Do I have a written SOP for stock ordering?  Do I have a member of staff responsible for inventory management?
• Is it appropriate to consider using some hospitals as stock holding facilities?
• Should increased sharing between hospitals be considered?  How will it be arranged?
• How should I manage red cells with respect to a major incident?
• What is an ideal shelf life for red cells at delivery?  Is this group specific?

For each question the participants were asked to consider the important issues and problems and identify possible solutions and best practice.

Outcome of discussion

Q 1  What is an appropriate stock level? Should I/we hold a higher or lower stock level?
Important issues:
Hospitals should aim for a lower stock level, however there will be a number of circumstances that will influence the decision including the size of the lab, the physical space, and the number of staff as well as patient demographics and clinical specialities.
Training and education of staff involved in the ordering of blood and inventory management is an  important aspect in the determination of the appropriate stock level. 
For clinical staff issues such as reduced reservation periods, the maximum surgical blood order schedule and the availability of alternatives e.g. cell salvage should be considered.
For laboratory staff the issues include support from laboratory based clinicians in dealing with the appropriateness of requests and assessing the need and appropriateness for satellite fridges.
Possible solutions: 
Include charging clinical directorates for wastage and unused requests, savings to be re-invested into transfusion, the education of all clinical staff and the use of remote issue.

Q 2  Should I change my de-reservation period to 24 hours? 
Do I have a written SOP for stock ordering and do I have a member of staff responsible for inventory management?
Important issues:
The presence of an MSBOS and its’ monitoring and regular updating, whether the hospital is a single site hospital or has multiple sites and the delivery schedule from the NBS. 
The delivery schedule and the possibility of a tracking system for deliveries, a later last delivery to capture late platelet orders and reduce the number of ad hocs and preferably no deliveries at lunch time due to staff constraints.
Possible solutions:
The use of electronic crossmatching including “on demand”, and further education and training of clinical staff. 

Q 3 Is it appropriate to consider using some hospitals as stock holding facilities?
Important issues:
The hospital’s understanding of the blood supply chain, a review of stock levels, the location of the hospital and the transport arrangements, cold chain management, inventory management, visibility of the age of stock, the implications of the blood safety and quality regulations and the use of technology such as RFID. 
It was suggested that hospitals could group together thereby reducing their stock holding but this may lead to other issues related to best practice; transfer triggers, documentation, traceability, and the presence of SOPs.
Possible solutions: 
A holding facility that is adequately resourced e.g. IT, special requirements, phenotyped units etc improved stock rotation/shortened reservation, 
The concept of a distribution centre could lead to problems if the holding hospital kept back stock for itself in times of shortage. 
Good cold chain management needs to be a priority to counteract the possibility of fridge failures. 
Should there be ability to blue light at the holding centre. 
Improved stock rotation/shortened reservation period. The suggestion of an ice cream style van which toured hospitals and where blood could be bought as required from the van was made.

Q4 Should increased stock sharing between hospitals be considered?  How will it be arranged?
Important issues:
The interpretation of legislation by the blood safety and quality inspectors. 
Transfers of blood from private hospitals to NHS hospitals and whether private hospitals cherry pick units i.e move units when they are very close to their expiry date to reduce their wastage. 
The additional cost, the need for good communications and the implications on wastage were also discussed.
Possible solutions: 
A regular review of the reservation period, the use of increased automation which could lead to reduced stock levels, e.g. the use of electronic and remote issue and the facility to return blood to the NBS.
An eBay for blood stocks was suggested but it was recognised that this would have many implications, not least compliance with the blood safety and quality regulations.

Q 5 How should I manage my red cells with respect to a major incident?
Important issues: 
The recall of stocks from satellite hospitals, the role of satellite hospitals, the involvement of medical staff.
Possible solutions:
Ensuring that the major incident plan is reviewed annually or when changes occur e.g. moving of a laboratory, point of care testing, the introduction of a laboratory presence in A & E to manage the interaction between blood transfusion and trauma staff. Maintenance of the traceability of blood and blood components in a major incident is important as is the necessity to maintain stock levels for cases not related to the major incident

Q 6 What is an ideal shelf life for red cells at delivery?  Is this group specific?
Important issues:
Inventory management, whether the hospital was in a stock sharing relationship with another hospital, and communication within the laboratory.
There was difficulty understanding why the NBS will not accept returned stock especially if it is because the delivery is incorrect.
Possible solutions: 
Ordering of phenotyped units on an ad hoc basis and a 15 day review of short shelf life products.