NATIONALBLOODANDBLOOD

PRODUCTWASTAGEREDUCTION
STRATEGY20132017

WorkingsmartertominimiseBloodandBloodProduct
wastage

LockedBag8430

CanberraACT2601

Phone:13000BLOOD(1300025663)

Email:inventory.management@blood.gov.au

www.blood.gov.au/wastage
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Foreword
BloodandbloodproductsareusedinhospitalsacrossAustraliaeverydaytosavelives.Theavailability
ofbloodandbloodproductsisfacilitatedbythegenerosityofvoluntaryblooddonorsandfundedby
Australiangovernmentswhoinvestover$1.1billionperannumincollection,processing,procuring
anddistributingtheseproductsthroughtheAustralianRedCrossBloodService(BloodService)and
othersupplierstohealthproviders.

Assuch,allpartsofthesupplychainforbloodandbloodproductshavearesponsibilitytoensurethat
allaspectsofthesupplychainincludingtransport,storageandinventorymanagementminimise
unnecessarywastage.

Acertainlevelofdiscardsofbloodandbloodproducts,particularlyfreshproductswithshortexpiry
datesisbothinevitableandappropriatetoensurethatproductsareavailablewhereandwhenthey
areclinicallynecessary.However,thereisaproportionofdiscardsofbloodandbloodproductsthatis
neitherinevitablenorappropriate.ThisStrategyisfocusedoneliminatingthisproportionofavoidable
discards,knownaswastage.

InNovember2010,AustralianHealthMinistersendorsedtheStatementofNationalStewardship
ExpectationsfortheSupplyofBloodandBloodProducts.AsoutlinedintheStatement,Health
Ministersexpecthealthproviderstocontributetothesustainabilityofthebloodsupply,includingthe
minimisationofcostandwastage.ThisisconsistentwiththeNationalSafetyandQualityHealth
Service(NSQHS)Standard7,BloodandBloodProductswhichrequireshealthserviceorganisations
tominimisewastageofbloodandbloodproducts.

TheStrategyseekstoreduceunnecessarywastageofbloodandbloodproductsthroughtwostreams
ofwork:

1. SupplyChainEfficienciesfromthepointofcollectiontothepointofissueofbloodandblood
productstohealthprovidersfromsuppliersanddistributors;and
2. ImprovingHealthProviderInventorymanagementfromthepointofreceiptofbloodandblood
productstothetransfusionoftheseunitstopatients.

ThisworkwillcomplementotherworkcurrentlyunderwaybyAustraliangovernments,theNational
BloodAuthorityandhealthprovidersinrelationtoimprovingtheappropriateuseofbloodandblood
products.

RegularupdatesonprogressagainstitemsidentifiedinthisStrategywillbeavailableonlineat
www.blood.gov.au/wastage.WewillreviewthisStrategyonaregularbasistoensureitsongoing
effectivenessinthecampaigntoeliminateunnecessarywastage.

Currentposition
Historically,thevoluntaryprovisionofdataondiscardsofbloodandbloodproductshasbeenhighly
variable,withlimitedtakeupoftheexistingreportingmechanismsandreportingusuallylimitedto
freshbloodproducts(RedBloodCells,PlateletsandClinicalFreshFrozenPlasma).Thesefactorshave
inhibitedthebaselinedatathatcanbeprovidedandmakeitdifficultinsomecases,toidentifythe
proportionofdiscardswhichcouldreasonablyhavebeenavoided.

GovernmentsareaddressingthisdeficiencywiththedevelopmentandimplementationoftheFate
moduleinBloodNet(thenationalonlineorderingandinventorymanagementsystemoperatedbythe
NationalBloodAuthority).TheFatemoduleenableslaboratorystafftoeasilyreportdiscardsforall
bloodandbloodproducts.ImplementationoftheFatemoduleinBloodNetasatmidFebruary2013
currentlycoversapproximately80%ofnationalissues,withfurtherimprovementoccurringeachweek.

Datafrom201112ismorecompleteforfreshbloodproducts(suchasRedBloodCells,Plateletsand
ClinicalFreshFrozenPlasma)withmorethan80%coverageinmostproducts.Duringthisperiodhealth
providerswereissued1.1millionunits,valuedatover$386million.Ofthese1.1millionunits,63,413
unitswerereportedasdiscardedbyhealthproviders,valuedat$23,040,286asoutlinedinthetable
below.

Product IssuedtoHealthProviders DiscardedbyHealthProviders

Volume
Cost Volume(units) Cost
(units)
RedBloodCells 809,588 $281,285,614 27,362 $9,506,733
Platelets 136,786 $58,392,076 22,618 $9,655,315
ClinicalFreshFrozenPlasma 160,547 $46,351,478 13,433 $3,878,238
TOTAL 1,106,921 $386,029,168 63,413 $23,040,286
*Pleasenotethatthevolumereportedfordiscardsisonlyfromthosefacilitiesreportingdiscardsin20112012.

Duetothelimitationsofdatacollectionstodate,itisnotpossibletoidentifytheproportionoftotal
discardsthatcouldhavebeenreasonablyavoided(wastage).

Supplychainefficiencies
TheNationalBloodAuthoritywillcontinuetoworkcollaborativelywithallAustraliangovernmentsand
supplierstoimprovetheefficiencyofthesupplychain.Tworecentexamplesofinnovationinthisarea
thathavereducedunnecessarywastageinclude:

1. TheBloodComponentEfficiencyprojectundertakenbytheBloodServicewhichidentifiedthe
pointsintheirsupplychainprocesseswherecollectionsorproductswerediscarded.Methods
wereimplementedtoreducetheseoccurrences.Asadirectresult,theBloodServiceachievedan
increaseintheredbloodcellyieldof7%,whichequatestoapproximately70,000donationsper
annum.

2. Recentchangesintheprocurementarrangementsforsomemanufacturedbatchproducts(suchas
NovoSevenRT)meantheycanbestoredatroomtemperature,largelyeliminatingtheneedto
discardtheseproductsduetofailuresincoldchainequipmentinthedistributionandhealth
providerspheres.

KEY ACTIVITIES
REDUCEREDBLOODCELLINVENTORYLEVELS
WorkwiththeBloodServiceandAustraliangovernmentstoimplementaoneoffreductionofnational
redbloodcellinventoryheldbytheBloodServicenationallybytwodays,thusreducingwastageinthe
systemandincreasingtheproportionoffresherbloodinthenationalinventory.

INCREASEREDBLOODCELLYIELD
Includearequirementinthe201314to201516StatementofExpectationsfromtheStandingCouncil
onHealthtotheBloodServicetomaintainorimproveredbloodcellyieldfromthecurrentlevelof
86%.

KeyActivities 2013 2014 2015 2016 2017

Reductionofnationalredbloodcellinventorylevels
Increaseredbloodcellyield

Improvinghealthproviderinventory
management
Reducingunnecessarywastageofbloodandbloodproductsbyhealthproviderswillbeachieved
throughamultifacetedapproach,including:

improvingthecollection,analysisanddistributionofdatarelatingtobloodandbloodproduct
discardstohealthprovidersandAustralianGovernments;
undertakinganalysisofkeycontributoryfactorstowastageanddevelopingproposalsto
addresstheseissues,notingthatthefactorsmaybedifferentacrosshealthprovidersand
producttypes;
developingandimplementingtargetsforbloodandbloodproductwastage;
developingandpromotingbetterpracticeinventorymanagement,includingbetterpractice
tools,buildingonexistingpracticesinarangeofhealthproviders;
developinganeducationandtrainingframeworktoembedbetterinventorymanagement
principlesandpracticesintocorecompetenciesforrelevanthealthproviderstaff;
enhancingawarenessofunitprices;
establishingarangeofmechanismstoenhancecollaborationacrossthesector;
supportingtheuseofevidencebasedpracticesintheestablishmentofproductmovementand
storagepolicies;and
conductingtargetedpromotionalcampaigns.

TheNationalBloodAuthoritysroleinassistingjurisdictionsandhealthproviderstoaddress
unnecessarywastagewillbeoneofcoordinationandenablement.TheNationalBloodAuthoritys
approachwillbetodeveloparangeofdata,toolsandcollaborationmechanismstoenablehealth
providerstoexaminetheirownpracticeandchoosefromthesuiteoftoolsforlocalcustomisation,
brandingandadoptionwhereappropriate.

RecognisingtheexistingstrongrelationshipsbetweenpublichealthprovidersandtheStateand
Territorygovernments,StateandTerritorygovernmentswilltaketheleadincoordinationand
communicationwithpublichealthproviderswiththeNationalBloodAuthorityactinginasupporting
capacity.TheNationalBloodAuthoritywillassumeagreaterrolewithpublichealthprovidersin
specificinstanceswhererequestedbytherelevantStateorTerritorygovernment.

Governmentsrecognisethedifferentrelationshipsandlargelynationalapproachofthemajorityof
privatehealthproviders.TheNationalBloodAuthoritywilltaketheleadincoordinationand
communicationwithprivatehealthprovidersatanationalandlocallevel.

KEY ACTIVITIES
COLLECTION,ANALYSISANDDISTRIBUTIONOFDATA
Expandingthecurrentvoluntarycollectionofdiscarddatatocoverallbloodandbloodproduct
discardsbyallhealthproviders.Thiswillbeachievedthroughcompletingthenationalimplementation
oftheBloodNetFatemodule.Thiswillprovideacompletedatasettoanalyseandidentifytrendsand
thecausesofdiscards.Inaddition,itwillinformthedevelopmentoftargetsfordiscardsofbloodand
bloodproductsbyhealthproviders.Analysisofdatarelatingtodiscardsofnonfreshbloodproducts
willoccurin2015followingthecollectionofdatarelatingtotheseproductscommencingin2013.

ReportingfromBloodNetwillbeenhancedtoprovideasuiteofreportsrelatingtoinventorylevels,
unitdiscardsandassociatedcosts,atthelevelsofhealthproviderandorganisationalunit(e.g.aLocal
HealthDistrictorPathologyService).Comparativepeerleveldatawillbemadeavailabletobetter
informgovernmentsandhealthprovidersaboutthelevelandcausesofunnecessarywastage.These
reportswillbemadeavailableondemandtohealthprovidersandtheirusewithinexistinggovernance
frameworksinhealthprovidersandStatesandTerritorieswillbestronglyencouraged.

PublicreleasethroughtheNBAwebsiteofhighlevelsummarydiscarddatabyhealthproviderwill
enhancetransparencyandpublicaccountability.Itwillalsoenhancetheawarenessofthisissuebyall
healthsectorworkersandshouldassisthealthproviderstofurtherpromotestrategiestoreduce
unnecessarywastage.Thedatareleasedwilldifferentiatebetweenunitsissuedtoahealthprovider
anddiscardedbythesamehealthproviderandunitsissuedtoahealthprovider,butdiscardedbya
differenthealthprovidersoasnottodiscouragethemovementofunitsbetweenhealthprovidersthat
doesleadtowastagereductions.

TheperformancedatawillhelptargetwastereductioninitiativesandisconsistentwiththeNational
SafetyandQualityHealthService(NSQHS)Standard7,BloodandBloodProductswhichrequires
healthserviceorganisationstohavesystemstomonitorwastageofbloodandbloodproducts.

ESTABLISHTARGETSFORDISCARDRATES
Workwithalljurisdictionstoestablishtargetsfordiscardratesforredbloodcells,plateletsandclinical
freshfrozenplasmaforthepublicandprivatesectors.Shadowtargetswillbeutilisedin201314to
facilitatetheimplementationofagreedtargetsfrom201415onwards.

Onceestablished,nationallyconsistentregularreportsagainstthetargetswillbeabletobeprovided
athealthprovider,organisationalunit(e.g.aLocalHealthDistrictorPathologyService),State/Territory
andnationallevels.

BETTERPRACTICEINVENTORYMANAGEMENT
Existinginventorymanagementprojects,includingtheNationalInventoryManagementFramework
(NIMF)collaborativeprojectwiththeBloodServiceandtheNationalBloodAuthoritywillenablebetter
practiceinventorymanagementacrossthesector.


Documentingandpromotingexistingbetterpracticeininventorymanagementthroughthe
developmentanddisseminationofcasestudiesfromarangeofhealthproviderswillenablehealth
providerstoidentifyhowtheycouldimprovetheirownpracticesutilisingtechniquesandtoolsused
anddevelopedbytheirpeers.

ThedevelopmentoftheevidencebasedManagingBloodProductInventory:GuidelinesforAustralian
HealthProviders,supportedbyatoolkitofbetterpracticetoolsthatcanbemodified,brandedand
adoptedbyhealthproviderswillfurthersupporthealthprovidersandwillprovideasuitable
benchmarkforthoseaccreditinghealthprovidersandpathologylaboratories.

ThedevelopmentofasetoftoolstosupporttheManagingBloodProductInventory:Guidelinesfor
AustralianHealthProviderswillassisthealthproviderstoestablishthemostappropriateminimumand
maximumbandsfortheirinventoryholdingsbasedonasafetystockcalculationandhistoricaltrend
dataondemandandissues.

EDUCATIONANDTRAINING
Developcoretrainingandassessmentrequirementsforstaffmanagingbloodandbloodproduct
inventoriesalongwithtrainingresourcestoenablestafftomeetthoserequirements.

ImprovinginventorymanagementwillbelistedasakeypriorityintheBloodSectorEducationand
TrainingStrategythatiscurrentlyunderdevelopment.TheNationalBloodAuthoritywillworkwithkey
stakeholdersinthisareatofeaturetrainingininventorymanagementinexistingtrainingprogramsand
courses.

ENHANCEDAWARENESSOFUNITPRICES
Increasehealthproviderstaffandpatientawarenessofthecostsofbloodandbloodproductsthrough:
incorporationofindividualunitpricesinallBloodNetreports;
additionofapricelabelonallfreshbloodproducts(notingthatconsultationonthisisalready
underwaywiththeBloodServiceandTherapeuticGoodsAdministration);and
publicationontheNationalBloodAuthorityswebsiteofanationalproductcatalogue.

Itisanticipatedthatthisincreasedawarenesswillleadtoanappreciationthatwhilstdonationsare
voluntary,thecollection,processing,testinganddistributionfunctionsforbloodandbloodproducts
incursignificantcosts.Thisinturnmayleadtoareductioninusagewhenanappropriatealternate
productisavailable.

ENHANCEDCOLLABORATION
Furtherdevelopingexistingcollaborativenetworksacrossthebloodsectorwillbekeytoensuringthe
widespreadadoptionandsuccessfulimplementationofwastagereductionmeasures.TheNational
BloodAuthoritywillutiliseexistingconsultativearrangementsandnetworksincludingthenew
BloodChat(onlinediscussionforum),systemusergroups(suchastheBloodNetUserReferenceGroup)


toengagewithhealthproviderstaffinbothformalandinformalmeanstofurtherdiscussandadvance
wastagereduction.

Targetedengagementwiththeprivatesector(bothhealthprovidersandpathologyorganisations)will
beimplementedasapriority,giventhat28%offreshbloodproductissuesnationallyarecurrently
issuedbysupplierstotheprivatesector.Thisengagementwillinclude:
oneononemeetingswithseniorstaff;
participationinprivatehospitalsandpathologyorganisationassociationmeetings;and
anannualforumforseniorprivatesectorstakeholderstoengagenationallywiththeNational
BloodAuthorityinrelationtothenationalbloodarrangements.

Establishchampionnetworksofkeyclinicalandscientificofficerswithinhealthproviders,withthe
NationalBloodAuthorityprovidingonlineresourcesandinformationforthesechampionsto
implementwastagereductionstrategiesintheirhospitals.

Developabiannualnationalawardsprogramthatwillacknowledgeexcellenceinthemanagementof
bloodandbloodproductsintheareaofinventorymanagementandwastagereduction.Thefirst
awardsceremonywillbescheduledforlate2013andwillenablethesectortosharebetterpracticein
inventorymanagementandencouragehealthproviderstostriveforgreaterwastagereduction.The
awardsprogramwillbestructuredtoensurethatitencompassestherangeofvariables(suchas
proceduresperformed,remotenessetc)thathealthprovidersmayencounter.

ConsiderconductinganAustralasianconferencetopromotebetterpracticeinbothinventory
managementandappropriateuse.

ADDRESSINGSYSTEMICISSUES
Identifyingkeycontributoryfactorstounnecessarywastagewillbeahighpriority,withspecific
proposalstobedevelopedtoaddress(wherepossible),systemicissues.

Keyissuesidentifiedforearlyconsiderationincludeproducttransferarrangementsbetweenhealth
providers(withaviewtomaximisingthepotentialforproducttransferthusminimisingwastage)ofall
types,theuseofthawedclinicalfreshfrozenplasmaandissuesrelatingtoclinicalfreshfrozenplasma
bagsbeingdamagedduringhandlingandsplittinguponthawingforuse.

PROMOTIONALCAMPAIGNS
Developspecificpromotionalcampaigns,targetedatspecificgroupsofhealthproviderswhere
necessarytoimplementtheabovestrategies.Akeycampaignthatwillbeundertakeninearly2013
willbethepromotionwithintheprivatesectorofthisstrategyandtheestablishmentofaprivate
sectorbloodwastageforum.

Suchcampaignswillbeperformedinahighlytargetedandlimitedmanner,andwillatmost,usually
involveelectronicorpapercommunicationwithkeystakeholders,thesubmissionofarticlesto


relevantjournalsandprovisionofinformationonlinethroughtheNationalBloodAuthorityswebsite
orsystems.Thesecampaignswillbeundertakeninconjunctionwithjurisdictionswhererelevant,
notingthattheStatesandTerritorieswillnormallyleadcommunicationcampaignsthattargetpublic
healthprovidersintheirjurisdiction.

Activity 2013 2014 2015 2016 2017

Collection,AnalysisandDistributionofData
BloodNetFatemodulenationalimplementation
Furtherdetaileddiscardanalysis
EnhancedBloodNetreporting
Publicationofhighleveldiscarddata
EstablishTargetsforDiscardRates
Shadowtargetsforredbloodcells,plateletsandCFFP
Targetsforredbloodcells,plateletsandCFFP
Shadowtargetsfornonfreshproducts
Targetsfornonfreshproducts
BetterPracticeInventoryManagement
NationalInventoryManagementFramework(NIMF)Project
Developmentanddisseminationofcasestudies
ManagingBloodProductInventory:GuidelinesforAustralian

HealthProviders
ToolstosetminimumandmaximumbandsforAHPinventory
EducationandTraining
Coretrainingandassessmentrequirementsforinventory

managementstaffdefined
Incorporatecoretraininginexistingtrainingprograms
EnhancedAwarenessofUnitPrices
EnhanceBloodNetreportingtoalwayslistunitprices
Pricelabelsonfreshbloodproducts
NationalProductCataloguewithpricingpublished
EnhancedCollaboration
Privatesectorengagement,includingannualforums
Developmentofchampionnetworks
Biannualnationalawardsprogram
Australasianconference

Activity 2013 2014 2015 2016 2017

AddressingSystemicIssues
Identificationofsystemicissues
Reviewandimproveproducttransferarrangements
Useofthawedclinicalfreshfrozenplasma
Examinationofalternativestocurrentpackagingarrangements

forclinicalfreshfrozenplasma
Reviewsupplychainmattersaffectingthelengthofexpiryof

Plateletsonissueofunitstohealthproviders
PromotionalCampaigns
Privatesectorwastagecampaign

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