May 26, 2010When staff members at the Blood and Tissue Bank of Balearic Islands (FBSTIB), on the island of Mallorca, search for a bag of frozen plasma on order for one of the area's hospitals, they wear coats. It's no small project to locate the proper bag among as many as 30,000 stored there, all largely looking the same, packed tightly in crates that hold 80 bags. Employees often lug the crates out of storage, where the temperature is -35 degrees Celsius (-31 degrees Fahrenheit), into a warmer place, in order to sort through them with a bar-code scanner to determine the correct item, after which they put the crates back in storage before the warm temperatures can affect the product. Finding the right product for a particular patient is critical, and so workers take the necessary time, reading or scanning as many as five bar-coded and printed labels, to verify the product, the processes through which it has been and its expiration date.
With a new RFID system now being installed—to track hemo-derivatives from the point at which the blood is drawn in mobile blood donation clinic (typically, a bus or similar vehicle) until it leaves for a hospital—the process is going to become more efficient (by eliminating the need to scan a label's bar codes, or visually read its printed text) and safer (by ensuring mistakes are not made), according to Josep Muncunill, a medical doctor and FBSTIB's CEO. The system is being provided by Spanish RFID systems integrator Aifos Solutions. Aifos and FBSTIB tested the system this year in several pilots at the blood bank, before beginning the permanent installation, which includes a fixed reader at the plasma storage freezer to capture tags as they enter and leave it, handheld interrogators to locate items in the freezer, and desktop readers to update data on the tag as blood is processed. Passive ultrahigh-frequency (UHF) tags, containing Alien Technology's Higgs 3 EPC Gen 2 chip, are attached to each bag, and AIVLAND Blood Supply Toolbox software, provided by Aifos Solutions, links the RFID data with FBSTIB's management system to provide information regarding each bag's contents and location to FBSTIB's management, says Esteve Jané, Aifos' CEO.
When a bag of blood is first extracted from a donor, it undergoes a complicated journey of testing and processing before it reaches a recipient at one of the hospitals on Mallorca and the three other major Balearic islands. The blood is drawn at mobile units throughout the four islands, then is taken to FBSTIB's processing center in Palma de Mallorca, where it is tested for infectious disease and then broken into sub-products, such as platelets. A bag of blood product remains in storage until a hospital orders it for a specific patient, and it is then transported via airplane or ship to the neighboring island on which it is needed. Each step of the processing and storage of blood products must be tracked, to ensure the proper blood or plasma reaches the correct recipient, and that it has not expired.
A different label printed with bar-coding and text is attached to the bags at each event related to the blood product. When blood is drawn from a donor, it is put in what is known as the "mother bag," which is accompanied by three empty bags that will eventually be used to store the products made from that blood. At each event, all four bags receive bar-coded labels in addition to those already placed on them. For example, each of the bags has one label used at the time of the donation, with a donation identification number (DIN) label identifying that donation, the date and time, and the person's blood type. After testing for disease is conducted, another label is attached to each bag (whether empty or not) to indicate testing has been completed. The blood can then be separated into three different products—red blood cells, plasma and platelets—which are poured into the empty, labeled bags. Those bags are again labeled with the appropriate information as to what is in each individual bag, and all data is stored in the Blood Bank Information Management System (BBIMS). By the time a bag of blood product is ready to be administered, Muncunill says, there are typically as many as five or six labels attached to it.
The storage of blood products varies widely; platelets must be kept in motion (an agitator is used to ensure they do not lose their functionality) and can be stored for up to seven days at about 75 degrees Fahrenheit (24 degrees Celsius), while red blood cells must be stored at about 45 degrees Fahrenheit (7 degrees Celsius), for up to 45 days, and plasma may be stored frozen for up to 36 months.
The process works, Muncunill reports, but it is very manual. "Each single bag can have more than five bar codes, and every time we do something to that bag, we have to scan every single bar code," he explains. "That means if we have to do something to five bags, we'll have to scan at least 25 bar codes."
Scanning that number of labels is complicated enough, Muncunill notes, but in addition, because many bags are stored at -35 degrees Celsius, a layer of ice often builds on the labels, thus making it difficult to read the bar codes. Tracking plasma in the frozen storage unit is the greatest challenge, he says. Not only is it time-consuming to identify the proper item within the unit (workers thus often move the crates in order to look through them in more comfortable temperatures), it is also hard to track inventory and ensure that the stock levels of all product types are sufficient to meet demand, and that nothing expires before being used.
In seeking an RFID solution, the company worked with Roche Diagnostics, which helped fund the RFID installation, to determine whether radio frequency identification would be a realistic solution, and whether it could improve the company's processes. FBSTIB selected Aifos to provide a system, and the two firms chose Alien Technology's Squiggle tags, made with Alien's Higgs 3 chip for its reliable performance in harsh conditions and 512 bits of user memory. In that way, information related to the blood bag's contents could be stored on the chip, as well as in the back-end system.
One concern related to RFID was whether the tags' glue could leach through the porous plastic containers and into the blood products stored within. Given the extreme temperature changes to which the bags and labels would be exposed, Jané says, there was a risk of chemicals in the tags' glue contaminating the contents. For that reason, Aifos tested eight different types of glues, before settling on one that would not pose such a risk. Alien agreed to provide its labels to Aifos without the adhesive (dry inlay), and Aifos will apply the adhesive to each label before sending it to the blood bank.
The company piloted the RFID technology in parallel with the existing bar-code and text labeling system, Muncunill says. That, in some cases, doubled the staff's tasks, he states, since they were reading the RFID label and then scanning the bar-code and text label. Since determining that the system works, however, the facility has now begun integrating the RFID system with the BBIMS, and employees will be able to utilize the RFID system without needing to scan the bar codes. All information that can be read visually on the printed label will also be stored on the chip.
The bags will then all be taken to the processing center, where three desktop RFID readers cabled to the back-end system will be used to read each tag's ID number. The interrogators will be used each time the blood is tested or broken into sub-products, and additional bar-coded labels will still be attached, thereby providing a printed listing of the events, as well as bar-coded numbers that could be used by the hospital. But the Aifos software will also allow the data to be encoded on the RFID tag.
After plasma is extracted, it must be moved into the frozen plasma chamber. It is loaded into cases and carried through the door to the chamber, where an Alien fixed interrogator will read the unique ID number encoded to each tag, and capture the direction of the bags as they pass into and out of the chamber. That data will be transmitted to Aifos' software, to be translated and stored on the BBIMS on FBSTIB's back-end database. The staff must work quickly, as plasma defrosts in 16 minutes. The extreme cold in the chamber, however, makes it difficult to work there for an extended period of time. With RFID, they will be able to either identify the product more quickly using a PDA with a built-in RFID interrogator manufactured by NordicID, or carry a case out of the chamber. If the case is carried out, the device will record the time that occurred, and Aifos' software will issue an alert if it spends too much time outside the chamber before being returned.
Managers with an authorized user password can utilize the data to view information regarding the inventory and screening processes.
The system is expected to dramatically reduce labor hours previously spent scanning the bags' bar-coded labels, Muncunill says. "Now, we can find very specific bags stored in extreme conditions," he states.
The system is slated to go live in September 2010, if integration is completed as planned. The FBSTIB receives 40,000 donations annually, and will be tagging only red blood cells and plasma (not platelets, which do not spend much time in storage and are easy to track visually), totaling approximately 60,000 bags per year. Aifos will provide the RFID system to FBSTIB for a monthly fee. Due to the reduction in labor, Muncunill says his organization hopes to recoup that fee immediately.
