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Improving emergency department blood product use through nursing education
Author(s) -
Riveira Melora C.,
Fredrickson Tim A.,
Iha Bryant R.,
Mitchell Steven H.,
White Nathan J.,
Arbabi Saman,
Hess John R.
Publication year - 2020
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/trf.15834
Subject(s) - emergency department , blood product , medicine , emergency medicine , resuscitation , blood component , medical emergency , blood transfusion , nursing , surgery
BACKGROUND Rapid access to blood products can be lifesaving for hemorrhaging patients, but placing blood components in easily accessible locations in the emergency department (ED) can lead to wasteful patterns of use. Education can lead to improvements in transfusion behavior, but such changes for the better are often short lived. METHODS To facilitate the early initiation of balanced resuscitation, an emergency blood refrigerator was placed in our ED in February 2015. Physician education to give blood components in a 1:1 plasma:red blood cell (RBC) unit ratio with the plasma given first was given repeatedly with short‐term success. Finally, nurses were trained and empowered to strongly suggest that blood components be given in balanced ratios and that plasma be given first. Plasma:RBC unit ratios were compared in successive years with the chi‐square test for trend. RESULTS A total of 1165 RBC units and 623 plasma units were issued from the ED emergency blood refrigerator over 5 years. Intensive physician education is documented at start, in late 2016 to early 2017, and again in early and late 2018. Ratios of components (U plasma/U RBCs) were 2015, 17%; 2016, 26%; 2017, 61%; 2018, 49%; and 2019, 91% (p < 10 −18 chi‐square for trend). Higher ratios of plasma use were associated with $40,000+ annual savings. CONCLUSIONS Giving the ED senior nurses formal education about the need for and a policy to give guidance on massive transfusion protocol (MTP) blood component administration sequence has achieved compliance with our MTPʼs intention. Increasing plasma use reduces group O RBC use and total blood costs.