Founded on the past - fit for the future

Blood banking redesign

Scottish National Blood Transfusion Service Blood Banking Laboratory Redesign Group
made up of representatives from all five regional centres, including senior scientists and staff from
Quality Assurance and Regulatory Compliance, as well as training.

Aim
The aim of the Blood Banking Redesign Project is to address historical regional differences within the Blood Banking process.
Within Scottish National Blood Transfusion Service (SNBTS) Blood Banking, 80% of activity is providing blood and blood products for transfusion to patients
requiring it as part of their management of care. These products may be elective or urgent, and are usually life enhancing or life saving.
Within the complex model of regional silos, work was duplicated and processes customised locally. Activity recording varied by site, the ability to meet
unplanned demand was limited and there was little linkage between workforce plans and operational activity.
It was essential to review the existing processes with the objective of redesigning and standardising these processes to provide a more efficient, effective,
consistent and agile service.

Methods

Scope

To carry out this review, the Blood Bank Laboratory Redesign (BBLR) group
was formed in January 2013 and included members of staff with knowledge
of the processes in each region.
Five regional blood-banking process maps were evaluated
A single national map based on best practice from all sites was
developed
Processes were leaned wherever possible
Non value added tasks and paperwork were removed

1.00 - Blood Banking Scope

- 1.00
Blood banking
Group & Save +
Compatibility
Testing

Sample receipt
and
identification

At the same time, the project team reviewed National Guidelines

(British Committee for Standards in Haematology, Red book,
European Directives, etc) to ensure that any recommendations
were incorporated into the new processes. The national process
map took three months to develop and included the development
of standard national forms and standard operating procedures
(SOPs).

- 4.00
Stock
Management

Initial testing

- 6.00 Component issue

(inc H&I?)

- 5.00
Stem cell

Issue and
transport of
units

Further testing
(as needed)

Validation

Time

SNBTS Clinical Directorate

1.00 - Blood Banking Process Group and Save / Crossmatch (excludes ante-natal)
Staff

SOPs/Forms

Dene the
objective/
data
requirement

NATS CLS 041

MLA

NATP Clin 11
NAT GEN 032

15 mins 1
hour
Manual

Manual /
auto

Follow standard
process, but tests
done manually

Carry out
the plan,
begin to
analyse ways
of working

- 7.00
Cold chain

Return of
unused units &
traceability

1.01

Request form
Sample

Equipment

Location

Date/time stamp

Reception desk

Telepath (GLA)

Check sample
as per policy

Traceline (GLA)

Laboratory

Major haemorrhage
< 15 mins

45mins to
1 hour

Auto

Valid
sample?

Yes

No

Laboratory

Follow standard
process, but move
sample to cross
match early

Electronic issue,
Group specific
Saline spin (page 2)

Issue emergency
O neg

Sample
OK?

MLA
Traceline manual 1&2

MLA

Patient manual 003

Y
NATS CLS 037

Reject sample

Telephone

Reject form

MLA

2 mins
MLA

Register
sample

MLA

Centrifuge as
per testing
spec

BMS

Initial testing

BMS

Laboratory

Barcode scanners
Racks

Label sample &

form (2 labels*)

Close all screens

and ensure line
clearance

5 mins

Traceline (GLA)

1.03

MLA

Laboratory

Telepath (GLA)

1.02

Trays

Laboratory

Labels (print 2 reconcile)

Check label
against pt details
on form & sample

MLA

1 min

Outcomes/results

Materials Used

1.0x Cross reference to sub-process

P-2

DO

Analyse the
data and
decide what
phases are
needed

Receive &
time/date
sample

Decide
urgency

30-45 mins

Registration

Decide
implementation plan,
pilot and
implement

PLAN

MLA

Process Step
Receipt and identification

Page 1

STUDY

Using a Plan, Do, Study, Act cycle of improvement, a national

Change Control was submitted and the new process was
piloted for a month. At the end of the month there was a
lessons learned and a process review, at which point alterations
to SOPs, forms, etc were carried out, and a national training
programme organised.

Patient
registration

- 3.00
Red Cell
Investigation

Phase 1 process map

ACT

The process itself is complex, therefore, a systematic and

phased approach was adopted to deliver changes in a timely
manner. Three phases were agreed.

- 2.00 Blood banking

Ante-natal

Traceline
Printer

Balance tubes

Centrifuge

Bucket caps

PHASE 2

Check sample,
barcode, form.
Prioritise

Traceline interface
Printer

Prepare sample
for analyser

Laboratory

Laboratory

Laboratory

Laboratory

Cassettes/ gel cards

Saline

Log in and set

up analyser

5 mins

Phase 1 of the project went live in January 2014. The success of Phase 1 can be
measured by its achievements:
A national process has been agreed
The number of SOPs for Phase 1 has reduced from 25 to three
All forms, letters and documentation have been agreed and standardised
Training and competency have been nationalised
Equipment has been reviewed to allow forward planning and future managed
service contracts to be delivered
The process map will be used to inform the workforce plan for blood banking

BMS
Load analyser
and log off
user

Distilled water

Biorad IH1000

Reagent red cells

Ortho Innova

Laboratory

Red cell diluent

1.04

Segment openers / scissors

Laboratory

Segments (GLA)

P-2

In addition, process mapping has been completed in 23 areas of Patient Services,

including Histocompatibility, Immunogenetics and Immunology, Blood Banking,
Apheresis and Cord Blood. Work is ongoing to review and standardise processes
across the service. Phase 2 has now commenced and it is envisaged that this it will
go live in late summer, with Phase 3 hopefully following in December.

Conclusions
Benefits to date include:
Improved customer satisfaction
Increased staff satisfaction
Reduction in wastage/non value add activity
Improved efficiency facilitating the capacity to take on new projects/initiatives
Fit for the future organisation
Improvement in regulatory compliance
Reduction in work for other internal departments who support the clinical service i.e. Quality and Procurement
Reduction in SOPs/paperwork
Lean manufacturing
Ultimately the impact of this redesign will be felt across the whole organisation resulting in SNBTS being more efficient, effective and agile an organisation
fit for the future that will continue to meet the transfusion needs of patients in Scotland.
For more information, contact Susan Buchanan, Operations Manager, Patient Services: 0141 357 7700, sbuchanan@nhs.net