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P22
Implementing a Blood Product Scanning Process for Massive Transfusion Protocols in a Trauma Center
Purpose: The purpose of this project was to optimize nursing documentation of MTP blood products to improve documentation accuracy, timeliness, and completeness.
Background: Massive transfusion protocols (MTP) provide a consistent approach for rapidly replacing blood volume with standardized blood products for patients experiencing uncontrolled hemorrhage. Blood product documentation for nurses during MTP activations at a large, urban academic medical center and safety-net hospital in the southeast was a manual process described as cumbersome, time-consuming, and often incomplete.
Methods: A descriptive analysis was performed by comparing documentation from chart reviews of trauma patients with MTP activations or uncrossmatched blood transfusions in the month before and after the workflow implementation. A scanning workflow for documentation of MTP blood products was implemented.
Results: Pre-implementation review of 10 charts within the 30 days before go-live found 79 units of MTP blood products documented. Ten charts reviewed within three weeks post-implementation revealed documentation of 26 units of MTP blood products. Chi-square analyses of each documentation variable were conducted to evaluate the differences between pre- and post-implementation results. Unit number documentation was 61% pre-implementation compared to 100% post-implementation (p=0.000), product codes 33% compared to 100% (p=0.000), donor type 51% compared to 100% (p=0.000), and expiration dates 29% versus 100% (p=0.000). Volume was documented for 95% of the units pre-implementation and 58% post-implementation (p=0.000) but was accurate for only 47% pre-implementation and 58% post (p=0.337). Timely documentation pre- and post-implementation was 66% and 65%, respectively (p=0.967). The MTP scanning workflow improved the completeness of documentation but did not affect accuracy or timeliness.
Conclusions: The MTP scanning workflow improved some aspects of MTP blood product documentation, specifically policy-required documentation, but did not solve all the issues noted pre-implementation. These issues may be mitigated by continued targeted education, practice in the playground environment, and increased comfort with the workflow.
Background: Massive transfusion protocols (MTP) provide a consistent approach for rapidly replacing blood volume with standardized blood products for patients experiencing uncontrolled hemorrhage. Blood product documentation for nurses during MTP activations at a large, urban academic medical center and safety-net hospital in the southeast was a manual process described as cumbersome, time-consuming, and often incomplete.
Methods: A descriptive analysis was performed by comparing documentation from chart reviews of trauma patients with MTP activations or uncrossmatched blood transfusions in the month before and after the workflow implementation. A scanning workflow for documentation of MTP blood products was implemented.
Results: Pre-implementation review of 10 charts within the 30 days before go-live found 79 units of MTP blood products documented. Ten charts reviewed within three weeks post-implementation revealed documentation of 26 units of MTP blood products. Chi-square analyses of each documentation variable were conducted to evaluate the differences between pre- and post-implementation results. Unit number documentation was 61% pre-implementation compared to 100% post-implementation (p=0.000), product codes 33% compared to 100% (p=0.000), donor type 51% compared to 100% (p=0.000), and expiration dates 29% versus 100% (p=0.000). Volume was documented for 95% of the units pre-implementation and 58% post-implementation (p=0.000) but was accurate for only 47% pre-implementation and 58% post (p=0.337). Timely documentation pre- and post-implementation was 66% and 65%, respectively (p=0.967). The MTP scanning workflow improved the completeness of documentation but did not affect accuracy or timeliness.
Conclusions: The MTP scanning workflow improved some aspects of MTP blood product documentation, specifically policy-required documentation, but did not solve all the issues noted pre-implementation. These issues may be mitigated by continued targeted education, practice in the playground environment, and increased comfort with the workflow.
Learning Objective
- After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.
Speaker
Sherri Duarte, DNP, RN, NI-BC, CPHIMS, BRMP
General
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