Monitoring of Storage and Transportation Temperature Conditions in Red Blood Cell Units: A Cross-Sectional Study

Investigating the quality of hemovigilance process using the first two steps of Six Sigma model: a cross-sectional study

BACKGROUND AND PURPOSE

Hemovigilance is a set of monitoring methods that covers the blood transfusion chain, from collecting blood and blood products to monitoring the blood recipients. To this end, any error in this process can have serious and irreparable consequences for patients. The present study aimed to investigate the quality of hemovigilance process in Iran, using the first two steps of Six Sigma model.

METHODS

This was a quantitative cross-sectional study that was conducted over 6 months (from August 20, 2021, to February 20, 2022) at Afzalipour Hospital in Iran, using the first two steps of Six Sigma model. The study population comprised of all inpatients who needed blood or blood product transfusion in various departments of Afzalipour Hospital, among whom 477 patients were selected via stratified sampling in three shifts (morning, evening, and night). The datasheet was used to record errors in the three shifts. This research was conducted, using the DMAIC cycle's "define" and "measure" steps.

RESULTS

In the define step, the hemovigilance process at Afzalipour Hospital was divided into two categories of normal process and emergency process. Each of these processes consists of several sub-processes, including "phlebotomy," "requesting blood and blood products from the department," "preparation of application by the blood bank," " sending a request from the blood bank to the blood transfusion center," "transfusing blood and blood products," and "returning the blood and blood products to the blood bank and waste disposal." In the measure step, the quality of hemovigilance process was evaluated based on sub-processes and labels at morning, evening and night shifts. The sub-process of sending a request from the blood bank to the blood transfusion center had the highest error rate with a sigma level of 1.5. Also, the evening and night shifts had a sigma level of 1.875, and the clinical and registration labels had a sigma level of 1.875. The overall sigma level of hemovigilance process was calculated to be 2.

CONCLUSION

The results of this study showed that the quality of hemovigilance process at Afzalipour Hospital was poor. By employing the first two steps of Six Sigma method, we identified the existing errors in the hemovigilance process of Afzalipour hospital in order to assist hospital managers to take the necessary measures to improve this process.

Deviations in red cell blood component temperature during laboratory processing and at blood return monitored by a time-temperature indicator device

OBJECTIVES

To evaluate the performance and utility of a time-temperature indicator (TTI) to determine the cumulative exposure time (CET) of red cell components (RCC) to temperatures above 10°C occurring within and outside the transfusion laboratory.

BACKGROUND AND OBJECTIVES

Blood centres often use the '30 or 60-min rule' for accepting RCC exposed to room temperature (RT) back into inventory. Effective monitoring of these temperature deviations is however lacking.

MATERIALS AND METHODS

A Timestrip PLUS® TP153 10°C (TS + 10) TTI was attached to RCC units after preparation of the unit in the blood bank or on issue to the ward, to track the CET > 10°C during laboratory processing and outside the transfusion laboratory.

RESULTS

The mean CET of 153 RCC tracked within the laboratory was 56 min. Sixty-four (41.8%) and 34 (22.2%) of RCC had core temperature (CT) >10°C for more than 30 and 60 min, respectively. Among the 69 RCC that were returned unused, 27 (39.1%), 17 (24.6%) and 5 (7.2%) RCC units had CT >10°C for more than 30, 60 and 120 min respectively.

CONCLUSION

A large proportion of RCC have CT >10°C exceeding 30 min during handling within the transfusion laboratory, as well as when RCC are returned unused from transfusion locations. Corrective measures should be implemented to better manage the cold chain to avoid undesirable consequences to blood transfusion. A temperature sensitive device that can also indicate CET can be employed to objectively monitor the period that RCC remained at a CT that exceeds 10°C.

Blockchain technology: a troubleshooter for blood cold chains

Purpose

Blood cold chain (BCC) represents a system for preserving the blood during its journey from the donor to the ultimate transfusion site. Existing BCCs have many drawbacks related to information transparency and information security. Secured and real-time information sharing in BCC can bring several benefits. The purpose of this paper is to summarise the issues in typical BCCs and to explore the scope of blockchain in the management of BCCs.

Design/methodology/approach

Issues in the existing BCCs are identified through a narrative review. To explain the potential of blockchain in mitigating these issues, a blockchain-based traceability solution is demonstrated with respect to a particular BCC scenario. The BCC management system discussed in this study makes use of the Ethereum blockchain’s smart contract feature and internet of things (IoT) technology. The smart contract is written in the solidity programming language and tested and validated using the Remix integrated development environment.

Findings

BCCs are concerned with several issues both from technical and non-technical perspectives. Blockchain technology is capable of troubleshooting the issues in the existing BCCs. Combining blockchain and IoT technology enables real-time information sharing among the entities. The demonstration presented in this work depicts how the blockchain-based smart contract can support operations in a typical BCC.

Research limitations/implications

This paper explores the scope of blockchain in BCCs through a demonstration. To get insights into its technical and economical feasibilities, further investigations are needed.

Originality/value

Blockchain-based traceability system presented in this work can be adopted in BCCs to ensure the quality of blood or blood products. Blockchain-based smart contracts can aid the BCCs to achieve a proper balance between blood shortage and outdating.