Platelet Update 2019: Achievements and Insights
The Appropriate Use of Platelets work stream focuses on sustainability and compliance in platelet management. Explore the findings from the 2019 platelet audit in Wales, including key users and indications.
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Appropriate Use of Platelets update 2019 Dr. Brian Tehen Medical Director for Quality& Transformation BCUHB Brian.tehan@wales.nhs.uk Stephanie Ditcham Blood Health Advisor WBS Blood Health Blood Health National Oversight Group
Overview The Appropriate Use of Platelets work stream is 1 of the 5 key areas identified by the BHNOG To ensure sustainability of platelets long term, the balance of supply and demand needs to be addressed. To achieve this the platelet work stream aims to: Blood Health Blood Health National Oversight Group Review the current platelet supply chain Achieve 100% compliance with 2016 BSH Guideline for Platelet Transfusion Significantly reduce platelet wastage within hospitals What was achieved in 2018-2019?
Review of the Supply Chain & Compliance to BSH Guidelines: Where do Platelets go audit 2019 Snapshot Audit of Platelet Requests for a 2 week period Feb 2019 An audit proforma was completed for every platelet request during this period Data will provide a baseline of activity within Wales The audit data will provide a baseline of activity for the customer element of the supply chain and their compliance with current BSH guidelines when requesting platelets. Data will identify areas requiring focused work in the future Blood Health Blood Health National Oversight Group
Platelet Audit 2019: Audit Findings All six University Health Boards (UHBs) in Wales submitted results Blood Health Blood Health National Oversight Group 262 proformas were submitted for analysis Who are the main platelet users in Wales? 85% 85% from Medical 76% 76% of all requests originate from Haematology What is the main indication for platelet requests in Haematology? Medical areas Haematology 58 58% % requests were for Acute Acute Leukaemia Leukaemia
Platelet Audit 2019 Platelet Audit 2019 Audit findings Audit findings Management of Acute Leukaemia Young patients Elderly Patients Blood Health Blood Health National Oversight Group Intensive treatment Low dose chemotherapy Acute reversible BMF Chronic BMF BSH* indication platelet Platelets NOT Indicated as threshold 10x109/L per BSH guideline* 59% Acute Leukaemia requests in this audit 59% Acute Leukaemia requests in this audit >60 years of age >60 years of age Suggests inappropriate requesting Suggests inappropriate requesting
Platelet Audit 2019 Platelet Audit 2019 Summery of findings Majority of platelets are requested by Haematology Summery of findings Majority to support Acute Leukaemia Blood Health Blood Health National Oversight Group Lack of compliance with BSH guidelines in Chronic BMF Approximately 10% platelets from WBS are time expired
PLATELET WASTAGE PLATELET WASTAGE IN HOSPITALS IN HOSPITALS QI project within BCUHB to reduce platelet wastage by 50% by March 2019 BCUHB WAPI 40 35 WAPI Pre Review 30 25 WAPI Post Review 20 15 Linear (WAPI Pre Review) 10 5 Linear (WAPI Post Review) 0
Reducing Platelet wastage Reducing Platelet wastage Health Board wide QI project - collaborative between hospital laboratory and clinical areas plus WBS support. Task & Finish group performed the following: Process review of haematology platelet provision at Ysbyty Glan Clwyd. Improved platelet management by increased stockholding, laboratory have increased flexibility through allocation only at the point of issue. Reduced stockholding at Ysbyty Gwynedd and review of pre-emptive requesting practices Wrexham Maelor Hospital in early stages of review process 50% targeted reduction met within timeframe Project poster came 2nd in BCU QI Conference in April Blood Health Blood Health National Oversight Group
Future Work for the Platelet Future Work for the Platelet Workstream Workstream Use Where do platelets go? findings to develop strategic aims via NOGBH Use National Comparative audit template on All Wales basis to capture adherence to BSH guidelines. Blood Health Blood Health National Oversight Group Develop a T&F group to target lack of compliance with platelet guidelines initial work on use in chronic BMF Promote the Blood component apps in the clinical areas to support adherence to BSH guidelines compliance with BSH guidelines in Chronic BMF Using work at BCUHB as an exemplar of collaborative working, select Hospitals/Health Board based on high usage/wastage to approach to review working practices in a similar mechanism of PDSA cycles supported by WBS Ensure involvement in platelet demand planning including potential increase of apheresis platelets with a North Wales hub.
Thank you for listening Dr. Brian Tehen Medical Director for Quality& Transformation BCUHB Brian.tehan@wales.nhs.uk Stephanie Ditcham Blood Health Advisor WBS Blood Health Blood Health National Oversight Group
