Massive Blood Transfusion Protocol: We Need Blood NOW!
Author DetailsSarah Berry, DNP, RN, AGCNS-BC, CEN
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Session D presented Thursday, September 27, 2:30-3:30 pm Purpose: The purpose of this project was to decrease the time of blood arrival to the bedside for patients who required a massive blood transfusion (MBT). During the organization's journey of becoming a Level II trauma center, it was identified an extensive amount of time, upwards of twenty-five minutes, was taken to obtain blood for MBT patients. In order to align with guidelines set out by the American College of Surgeons (ACS) regarding MBT and to improve patient outcomes, a MBT protocol for the Emergency Center was created with a goal of obtaining blood at the bedside within 10 minutes of order placement. Design: The MBT protocol development and implementation was a quality improvement project focused on patient outcomes. Setting: The study setting is a Level 2 Trauma Emergency Center which consists of approximately 41 acute care beds with three trauma bays in a 520-bed community hospital. Participants/Subjects: The patient population used for this project was any patient who the Emergency provider determined to require MBT. The patients were identified by MBT protocol order placement. All ED staff participated in this project. Methods: An interprofessional committee including the Emergency Center, Blood Bank, Trauma Services, Quality department, and Registration collaborated to determine the protocol. An algorithm was created which outlined the steps taken when a MBT protocol was ordered for a patient. All EC staff were educated on the new protocol. Unannounced MBT mock drills were conducted which included all EC staff, Trauma services, and OR. After protocol implementation, MBT protocols were monitored by EC leadership. An audit sheet was used to determine time in minutes from order entry to blood at the bedside. One on one coaching for staff regarding the MBT process was provided if any errors occurred during the mock drills or actual patient case. Data analysis included calculation of time in minutes to have blood at the bedside. An average time in minutes was determined monthly using all MBT cases in the EC in that month. Results/Outcomes: As a result of the new protocol, there was a dramatic decrease in time to receive blood at the bedside for MBT patients. The average time for 2016 to have blood at the bedside under the current MBT protocol is 7.9 minutes from order placement. These results meet the initial goal of having blood at the bedside with in 10 minutes of order placement. Implications: The current MBT protocol has been proven to decrease the time for blood to arrive at the patient bedside for a MBT patient. The protocol also aligns with the guidelines set out by the ACS which is required for a certified Trauma Center. This quality improvement project not only improved patient outcomes but also displays the importance of interprofessional collaboration in the health care setting.