ArticleBMJ open quality2026
Quality improvement project for minimising red blood cell unit wastage at a secondary referral hospital in Malawi.
Article in BMJ open quality, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Poor blood bank stock management can result in excess or understocking of blood units for transfusion. A retrospective analysis of blood bank records from 2020 to 2024 at a secondary referral hospital in Malawi revealed a consistently high number of expired red blood cell units. This quality improvement project (QIP) was implemented to reduce blood unit wastage from over 4% to zero of the total blood units received per month.We developed an intervention package to address gaps in blood bank inventory stock management. The package comprised change ideas such as adjusted blood ordering mechanism, strict adherence to the First Expire First Out (FEFO) strategy, improved coordination and staff coverage for the blood bank. The iterative Plan-Do-Study-Adjust (PDSA) cycle guided the implementation of the change ideas. Key outcomes from the pre-intervention and post-intervention phases were compared to evaluate the effectiveness of the interventions.Overall, five PDSA cycles were completed in the implementation phase. Baseline assessment uncovered multiple non-conforming practices, including non-adherence to standard methods for issuing blood cell units and over-ordering of blood units, a practice driven by long distance and transport logistical challenges. The mean expiry rate of blood units for the pre-intervention period (March-July 2024) was 4.16% (37/890 units), with March recording the highest wastage (5.4%). Following implementation of QIP strategies, a significant decline in wastage of blood units was observed (1% (6/520), p=0.007), with zero-unit expiries recorded from September 2024 to March 2025. The proportion of ward returned blood units declined from 1.1% (8 of 713) to 0.7% (4 of 570) (p=0.45).Our QIP identified and addressed operational gaps contributing to blood unit wastage. Through a step-by-step implementation of a multifaceted strategy, to improve staff coverage, coordination and compliance with blood bank standard practices, blood unit wastage due to expiry was reduced to zero.
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