By Elissa Fuchs, AABB Staff Writer
When All Children’s Hospital in St. Petersburg, Fla., opened up its new inpatient facility across the street from the blood bank, the administration knew that moving transfusion products to the operating rooms would add time. Plus, the hospital was growing increasingly uncomfortable using a refrigerator that did not control user access. A way to safely and quickly store and transport blood over longer distances was necessary, said Dee McMichael, MT(ASCP), a blood bank supervisor at All Children’s.
Enter the blood bank vending machine. This device — which All Children’s placed near the operating room and in the cardiovascular ICU — allows qualified personnel to retrieve blood bags for transfusion patients. Similar in design to vending machines that stock chocolate bars or soda cans, this machine is a refrigerator that has 10 lockable shelves storing up to 150 bags of blood. Instead of inserting change or dollar bills into the machine, trained users scan both their own and the patient’s identification information, and the right cross-matched product will be dispensed — eliminating the chance of human error. It literally speaks to its “customers,” guiding them through the process of accessing the product. Even if the vending machine is placed far away from the laboratory, individuals can view the inventory on a computer screen in the blood bank. It also lets them know if there is a problem with the controlled temperature.
“The refrigerator delivers compatible blood for the exact patient. Specific steps are required, and if one step is performed incorrectly, the refrigerator will say, ‘I’m sorry, you’ve scanned the wrong number,’” McMichael said. “The nurse doesn’t even have a choice.” She said that the vending machine, which has been at All Children’s since January, has been popular among both blood bank and clinical staff.
“When the machine first came to the cardiac ICU, the nursing staff was a bit leery. But when they saw how quick it was for them to access blood, they really bought into the system,” she said. “And it makes the blood bank more efficient. The machine can electronically cross-match and label the bags.”
Of course its speed cannot be beat. “It takes nurses who don’t use it often 80 seconds to access blood from the [cross-matching] vending machine, 55 or 60 for people who use it all the time,” McMichael said. “Our pneumatic tube delivery process takes seven minutes.”
The fast pace of the vending machine also impressed Julie Staves, FIBMS, blood bank manager at Oxford Radcliffe Hospitals in the U.K. Six units, she said, can be dispensed in under a minute.
“If something goes wrong during surgery, there is more blood available, but if [the clinicians] don’t need it, it doesn’t go to waste,” she said of the system, which was implemented at Oxford Radcliffe Hospitals in 2005.
Generally, there are about 15 A- and O-positive units, eight A- and O-negative bags, and two B or AB units in the machine at Staves’ facility at any one time. If a patient with a rare blood type is being transfused on a given day, personnel will make sure that product is included in the machine beforehand.
Learning to use the equipment is fairly easy, said Kendall Crookston, MD, PhD, director of transfusion medicine at the University of New Mexico, which also uses the vending machine.
“Training takes about 45 minutes, and afterward trained individuals have access to the machine,” he said. “It is no more confusing than using a kiosk in an airport.”
Like All Children’s, his facility decided to invest in this device when the hospital opened a pavilion some distance away from the blood bank. The center now has eight refrigerators, seven at the hospital and one at a cancer center. Crookston finds the device most useful for trauma cases, estimating that a quarter to a third of products retrieved from the vending machines are for these situations.
Blood bank staff stock the refrigerator at their convenience several times a week, Crookston said. “The machine will flag you when units are low,” he added. The device’s $100,000 price tag is hefty, Crookston admitted, but he said that similar but less advanced systems cost $40,000, so comparisons can be difficult. The fact that the University of New Mexico is planning to purchase more vending machines evinces its commitment to this technology.
“We’d really like one right outside the blood bank, just as ATMs can be right outside banks,” Crookston said. “It is quicker than manually delivering the product, but if there are concerns, the clinical staff can go inside and ask questions.”
Employees at Hamilton Regional Laboratory Medicine Program in Ontario have taken the opposite approach: They have first placed the vending machine close to the blood bank to try it out and are planning to unveil more in clinical areas in the near future. Right now, only technologists and technicians have permission to use the refrigerator that went “live” last November. To date, the machine has dispensed between 4,200 and 4,400 units of blood.
“We worked to create a customized, bidirectional interface, and we wanted to get the bugs out and tweak it before we made it available to the clinical side of our facility,” said Mary Kokoski, MLT, a laboratory information specialist at the center. She noted that already there have been fewer human errors. “It only allows cross-matching on patients with current blood group and antibody screens,” she said. Blood bankers do not always remember to abide by that, she added.
Her colleague Duane Boychuk, MBA, MLT, the laboratory program director, noted that the vending machine frees up time for lab workers and makes their jobs more enjoyable. “It lets them do more esoteric, more complex work,” he said. “There are a lot of other things that these techs could be using their expertise for.”
Right now, its benefits are “invisible to the clinical workers, but they are very, very excited about the opportunity to provide blood quicker to their patients and also to let them [the clinical workers] have direct access to the blood supply,” Boychuk said.
The vending machine is not without its flaws, experts say. Perhaps ironically, the ability to dispense blood so quickly and easily works against it at times, Staves said.
“Very occasionally, the clinical staff panic and may take out more than they really need,” she said. The system, she explained, does let people reinsert unused bags during a specific time window. There also are ongoing efforts to educate staff about retrieving too much blood, Staves added. Crookston agreed, saying that when the machine was first introduced and employees realized how easy it was to use, at times they took out more blood than was necessary. But as individuals have become more familiar with the device, that practice has died down.
One limitation noted at All Children’s is that the device cannot distribute partial blood products, a concern because many pediatric cases do not require a full unit of blood.
The drawbacks notwithstanding, the vending machine is the wave of the future, especially as blood centers and hospitals are expanding and merging, Boychuk said. Right now, there are four hospitals serviced by Hamilton Regional Laboratory Medicine Program, each with its own blood bank. However, with the advent of the vending machine, the facility is planning to move blood testing to one site and reduce the laboratory presence at the other three facilities. “The machine is a true enabler for the consolidation of transfusion medicine services,” he said.
Crookston concurred: “It is a technology that has a place, especially at larger institutions where blood usage is spread out but there still needs to be control over it.”
This article was published in the current issue of AABB News.