LIQUID GOLD: Improving massive transfusion
Wendy Hyatt, BSN, RN, CEN
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Session G presented Friday, September 28, 1:00-2:00 pm
Purpose: Hemorrhage is the major cause of preventable death after injury. Massive transfusion protocols are included in damage control resuscitation strategies for hemorrhaging trauma patients. The American College of Surgeons (ACS) sets the guidelines and standards for care of trauma patients. The ACS standard for massive transfusion requires that universal blood products be immediately available on patient arrival to support ration-based transfusion. The purpose of the project was to change practice and improve availability of plasma product based upon the evidence of early deployment of plasma creates better outcomes.
Design: This project was a process improvement project.
Setting: The setting was a 408 bed metropolitan Level 1 trauma center with over 2600 trauma admissions annually.
Participants/Subjects: All patients receiving massive transfusion as part of their care between September 2016 and September 2017 (n=17) were included. All staff in the hospital administering massive transfusion participated in the project. Methods: One issue identified when evaluating the immediate availability of plasma products was the frequency of bag breakage when thawing fresh frozen plasma (FFP). Our blood bank contacted two major national blood product suppliers to assess and track broken FFP rates related to the manufacturing, packing and shipping processes. Bonfils Blood Center identified a trend in the broken FFP rates with one bag type. American Red Cross identified an increased rate of broken plasma bags when using specific packaging materials. Both organizations made changes to their process. Our facility researched the use of liquid plasma during massive transfusion. The benefits of using liquid plasma included no delay in plasma support during MTP, products being issued in correct ratios, sufficient time to thaw FFP, and less waste than thawed FFP. The information was presented to our multidisciplinary performance improvement committee and approved. A multidisciplinary team met to make revisions to the massive transfusion policy. The revisions included adding the use of liquid plasma and making adjustment to the ratio of blood products using a 1:1:1 ratio for packed cells, plasma/FFP and platelets.
Results/Outcomes: Prior to working with our blood suppliers on FFP bag breakage, our facility’s rate was 12%. After our blood suppliers implemented the changes, our FFP bag breakage rate decreased to 5% with a similar impact seen nationally by other facilities that utilize the same suppliers. After the initiation of liquid plasma, we monitored time from initiation of massive transfusion and first unit of plasma. The median time improved from 26 minutes to 3 minutes. After the implementation of liquid plasma and revisions made to the massive transfusion policy, 100% of massive transfusion patients have met the ACS requirements for ratios between 1:1 and 1:2.
Implications: The blood bank continues to monitor FFP bag breakage rates. Liquid plasma has improved the availability of products for massive transfusion in our facility and we plan to continue using liquid plasma. Monitoring of massive transfusion for timeliness and ratios of products is essential for continued success with these changes. Future plans include evaluating the most current research, products, and resources for massive transfusion to support improved care and outcomes for trauma patients.
Emergency Nursing 2018. Held at David L. Lawrence Convention Center, Pittsburgh, Pennsylvania, USA
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