After the initial implementation of the ELP process, clinical staff were relatively quick to come on board.
75-80% of the plasma goes to operating theatres, mostly for cardiac cases, and it was the staff involved in these cases that were largely responsible for disseminating the information. The Hospital Transfusion Committee also assisted with communicating the new protocol hospital-wide.
“I don’t think the message got out to all the theatre staff initially, so we had a lot of phone calls asking about the additional swing tags attached to the thawed plasma and was does ELP mean? While the phone queries did take time to manage, I did also welcome the calls as it indicated to me that clinical staff are checking the blood products carefully and taking notice of changes! We also made copies of the endorsement that the transfusion committee provided just in case they had any queries. We have a team of registrars and haematologists where we can refer any clinical issues or questions.” – Mary, Blood Bank, Senior Scientist
Impacts - Supply
Mary believes the most significant impact the implementation of the ELP protocol has had, is the ability to provide plasma immediately to those cases that may require plasma quickly such as bleeding cardiac and trauma cases.
“Access to ELP assists in diffusing some of the stress associated with meeting the blood product requirements of bleeding patients; if you need to issue a lot of blood products and you’re worried about putting things in the water bath and you’re the only person on and it’s the evening, access to ELP allows you that little bit of breathing space to complete all the things you need to do and provide the products to the patients in a controlled manner. There is nothing worse than going to the thawer and finding that the FFP bag has split and you have to delay the issue of the FFP for another 20 mins!” Mary, Blood Bank Senior Scientist
The laboratory has a policy that ensures that group AB FFP is not given to all patients. The AB ELP inventory is ‘reserved’ for trauma use for 3 days from thawing, however the products are made available to any patients that require FFP after day 3 to ensure the AB ELP does not expire. In the situation where a patient requires FFP and the group AB ELP inventory is only a day or two old, group specific FFP is thawed for the patient.
“I think we use more AB plasma than we did previously, but we are trying to mitigate this by only using the AB ELP for our general pool of patients when the product is at least 3 days old.” – Mary, Blood Bank Senior Scientist
Impacts - Wastage
The use of ELP in the RCH has had a significant impact on wastage rates. Mary believes this is due to the ability to use the already thawed ELP for patients they would have otherwise had to thaw additional FFP for.
“In the months immediately after the decision to have 2 units of ELP readily available to support the introduction of the new MTP at the RCH (Jan-Feb 2013), we were hitting very high figures of FFP wastage – sometimes in excess of 20-30% ,which was really difficult to deal with. However after we introduced our diversion strategy, where unused Day 3 group AB ELP could be used for any other patient requiring FFP, our wastage dropped to <5% and has remained at that level.”
From “Implementation of Extended Life Plasma” Poster, Mary Comande, Sharon Yong, Helen Savoia, HAA 2013
How will ELP work for other health providers
While the process of implementation of ELP at the RCH has been a relatively simple one, Mary believes that an ELP protocol may not be suitable for all laboratories and each laboratory should consider the pros and cons of their situation. An ELP protocol may work for a laboratory provider that supports a health service where there are regular and frequent opportunities to use thawed plasma (e.g. daily cardiac surgery) other than trauma cases.
“Your lab needs to have a regular avenue to utilise your ELP product to make the process worthwhile. I don’t believe you should implement ELP for ‘just in case’ trauma situations and not have anyone else you can direct the product to. I would imagine that a small path laboratory that only has infrequent requests for FFP would not be a candidate to implement an ELP protocol as the product would be wasted. Conversely, if your lab supports a busy trauma service or a cardiac surgery unit where FFP is often requested urgently, then the ELP protocol would be useful.” – Mary, Blood Bank Senior Scientist