280 - Interdepartmental Collaboration to Optimize Massive Transfusion Protocol
Description: Clinical Issue Improving massive transfusion processes and outcomes by• Optimizing timely management, delivery and blood loss replacement with appropriate components.• Facilitating collaboration among participants.• Using military tested, ratio driven, physiologically based guidelines, to reduce morbidity and mortality.• Promoting early recognition and activation of the massive transfusion protocol (MTP) to facilitate prompt treatment.TeamA multidisciplinary committee, consisting of representatives from Laboratory Services, Family Childbirth Center (FBC), Perioperative Services (OR), Emergency Department (ED), Interventional Radiology (IR) and the Critical Care Unit (ICU), formed after an actual massive transfusion event, in which gaps preventing optimal management of blood loss replacement were identified.Preparation and PlanningA literature review and inquiry into standard of practice of area hospitals was performed. The committee identified and developed essential roles and responsibilities for our institution.Assessments• Time from MTP code called to first packed red-blood cell (pRBC) released from laboratory services.• Time from blood component arrival at the bedside to initiation of transfusion.• Cooperation among participants.• Increased familiarity with massive transfusion protocol.• Needed documentation revisions.• Electronic Medical Record and Laboratory equipment limitations.ImplementationAn MTP Kit for the units (ED, OR, IR, ICU, FBC and the lab) was created, containing the required information and supplies for an MTP event. The MTP Kit includes• A binder with MTP policy and associated guidelines; • Forms to document transfusion products given, lab results and debriefing notes;• Instructions for calling an MTP code;• Color-coded bags, each including a lanyard with a role responsibilities placard, a color-coded name tag and supplies needed for the role. Laboratory responders use their own kit with their role responsibilities placard, information, and equipment.With interdepartmental collaboration, the committee established monthly MTP drills. MTP drills rotate between ED, FCB, OR, IR and ICU. The drills are facilitated by the unit educator and unit staff participate filling the various roles. Laboratory responders participate in all MTP drills. Drills last one hour and a post-drill debrief is completed. Outcomes• Time for delivery of blood components to the bedside saw a 56% decrease.• Time for initiation of transfusion, once at bedside, has decreased by 90%.• Participants report improved cooperation among responders.• Most participants report an increased familiarity with the MTP process.Implications for Perioperative NursingPerioperative nurses need to be familiar with the roles and responsibilities of responders to an MTP event in the OR. By participating in MTP drills, the perioperative nurse can respond quickly and provide appropriate direction for personnel and resources, improving outcomes and decreasing morbidity and mortality.
Co-Authors: Rebecca Hawkins, Marika Jovanovich, Karen Anthony, Phil Baker, Kathryn Bateman, Aaron Storey, Judy Borish