Authors (including presenting author) :
POON ASW, AU JWY
Affiliation :
Central Nursing Division, TWGHs Wong Tai Sin Hospital
Keyword 1: :
Blood Transfusion Challenges
Keyword 2: :
Cooling Tech
Keyword 3: :
Workflow Redesign
Introduction :
Blood and blood components are delivered from KWH Blood Bank to WTSH and HKBH (the decanting ward of OLMH) via courier transport. If the patient is deemed unfit for transfusion upon delivery, the units must be promptly returned to the Blood Bank. The red cell units remain suitable for use if returned within 2 hours in a validated, temperature-controlled transport containers after removal from the standard blood bank refrigerator. However, logistical challenges often prevent timely returns, resulting in the unnecessary disposal of blood products. In 2024, six incidents were reported where blood products became unfit for reuse. The Primary causes include: (1) long transit distances between hospitals, (2) delayed courier collections, and (3) unpredictable traffic congestion. Each instance of exceeding the 2-hour window mandates disposal of otherwise viable blood products - a preventable waste of critical resources that could save lives. This wastage underscores the urgent need for enhanced transport logistics and coordination.
Objectives :
1. To extend the validated thermal transportation window for blood product between hospitals. 2. To minimize blood product wastage if the red cells unit must be returned to the Blood Bank due to unfit condition of the patient. 3. To Implement uniform workflows for packaging, courier handoffs, and nurse-led decisions on unlocking TempShell bags based on patient fitness.
Methodology :
A suitable insulator bag for blood product was searched and discussed with pathology department KWH on 15/11/2024. Procurement process finished on 7/1/2025 and Cold Chain Audit for the transportation from KWH Blood Bank to WTSH and HKBH was performed from 9/1/2025 to 22/1/2025. The validated methodology employed the transport of one red cell unit per container, using a specific packaging method, and was secured with a plastic twist-lock with a unique number to ensure integrity and an unbroken cold chain. A temperature logger was placed with the red cell units in the blood container at Blood Bank, date and time were recorded by Blood Bank and Nursing Staff. The temperature data would then be downloaded and reviewed. Results indicated that 100% of the cases fulfilled the transportation temperature requirement (2-10°C) for a duration exceeding 4 hours outside of blood fridge.
Result & Outcome :
To address blood transport challenges, we implemented an enhanced cold-chain system in Q1 2025 to extend the validated transport window beyond the standard two-hour limit. A new insulated bag (TempShell) feature six coolant layers that maintain one red cell unit at 2-10°C for up to 4 hours, provided the twist-lock seal remains intact after removal from the standard blood fridge. To ensure the implementation between hospitals, the workflow of sending Type & Screen to KWH and performing blood transfusion procedure was standardized. Clear instructions were given to nurses on the appropriate moment to unlock the insulator bag according to patient’s condition and fitness for blood transfusion. Concurrent workflow improvements included the endorsement of standardized packaging instructions for blood components and established procedures for returning insulator bags to KWH Blood Bank after transfusion. To ensure suitability for return-to-stock, the twist-lock seal must remain intact with the unique number matching KWH Blood Bank documentation, verifying the unit’s integrity for subsequent clinical use. These measures have effectively doubled the safe transportation window from two to four hours while ensuring temperature compliance and reducing blood product wastage. Since implementation in Q1 2025, no incidents of blood product wastage due to transport delays have been reported.
