Improving emergency department blood product use through nursing education.

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  • Additional Information
    • Affiliation:
      Department of Nursing, Harborview Medical Center, Seattle Washington, USA
      Emergency Room Nursing Service, Harborview Medical Center, Seattle Washington, USA
      Department of Emergency Medicine, University of Washington, Seattle Washington, USA
      Department of Surgery, University of Washington, Seattle Washington, USA
      Department of Laboratory Medicine, University of Washington, Seattle Washington, USA
    • Abstract:
      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 MTP's intention. Increasing plasma use reduces group O RBC use and total blood costs.
    • Journal Subset:
      Allied Health; Biomedical; Peer Reviewed; USA
    • ISSN:
      0041-1132
    • MEDLINE Info:
      PMID: NLM32378208 NLM UID: 0417360
    • Publication Date:
      In Process
    • Publication Date:
      20200703
    • DOI:
      http://dx.doi.org/10.1111/trf.15834
    • Accession Number:
      143800963
  • Citations
    • ABNT:
      RIVEIRA, M. C. et al. Improving emergency department blood product use through nursing education. Transfusion, [s. l.], v. 60, n. 6, p. 1227–1230, 2020. DOI 10.1111/trf.15834. Disponível em: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=rzh&AN=143800963. Acesso em: 14 ago. 2020.
    • AMA:
      Riveira MC, Fredrickson TA, Iha BR, et al. Improving emergency department blood product use through nursing education. Transfusion. 2020;60(6):1227-1230. doi:10.1111/trf.15834
    • APA:
      Riveira, M. C., Fredrickson, T. A., Iha, B. R., Mitchell, S. H., White, N. J., Arbabi, S., & Hess, J. R. (2020). Improving emergency department blood product use through nursing education. Transfusion, 60(6), 1227–1230. https://doi.org/10.1111/trf.15834
    • Chicago/Turabian: Author-Date:
      Riveira, Melora C., Tim A. Fredrickson, Bryant R. Iha, Steven H. Mitchell, Nathan J. White, Saman Arbabi, and John R. Hess. 2020. “Improving Emergency Department Blood Product Use through Nursing Education.” Transfusion 60 (6): 1227–30. doi:10.1111/trf.15834.
    • Harvard:
      Riveira, M. C. et al. (2020) ‘Improving emergency department blood product use through nursing education’, Transfusion, 60(6), pp. 1227–1230. doi: 10.1111/trf.15834.
    • Harvard: Australian:
      Riveira, MC, Fredrickson, TA, Iha, BR, Mitchell, SH, White, NJ, Arbabi, S & Hess, JR 2020, ‘Improving emergency department blood product use through nursing education’, Transfusion, vol. 60, no. 6, pp. 1227–1230, viewed 14 August 2020, .
    • MLA:
      Riveira, Melora C., et al. “Improving Emergency Department Blood Product Use through Nursing Education.” Transfusion, vol. 60, no. 6, June 2020, pp. 1227–1230. EBSCOhost, doi:10.1111/trf.15834.
    • Chicago/Turabian: Humanities:
      Riveira, Melora C., Tim A. Fredrickson, Bryant R. Iha, Steven H. Mitchell, Nathan J. White, Saman Arbabi, and John R. Hess. “Improving Emergency Department Blood Product Use through Nursing Education.” Transfusion 60, no. 6 (June 2020): 1227–30. doi:10.1111/trf.15834.
    • Vancouver/ICMJE:
      Riveira MC, Fredrickson TA, Iha BR, Mitchell SH, White NJ, Arbabi S, et al. Improving emergency department blood product use through nursing education. Transfusion [Internet]. 2020 Jun [cited 2020 Aug 14];60(6):1227–30. Available from: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=rzh&AN=143800963