310 - Massive Transfusion Drills to Improve Staff Competence and Comfort Level
Description: Description of Team The interdisciplinary team from a Level 2 Trauma Center included OR Educators, OR nurses, Trauma Educator, and Trauma Clinicians. Preparation The team came together to discuss where the downfalls were during a trauma/emergent case when a Massive Transfusion Protocol (MTP) had been activated. Assessment and Planning During a trauma or emergency, a critical care RN comes to assist in the OR because the OR nurse’s priority is to circulate the case; therefore, they rarely run the MTP. Due to the lack of hands-on experience, not all OR nurses are confident or competent in running an efficient MTP. The rapid infusion system (RIS) is reviewed twice a year, but there is a lack of opportunity to assemble it and trouble shoot the system in an emergent environment. To have a nursing staff be competent and confident running an MTP, they needed to participate in drills as well as demonstrate competence in managing the RIS. The team determined that the educators would lead monthly MTP drills and have one-on-one sessions to validate competence on the RIS. The AORN Guideline on Team Communication, Recommendation VIII states that team training and simulation scenarios are a necessary component for safe patient care. The educators scheduled MTP drills prior to the beginning of the shift. Blood bank was contacted to help supply demo blood product and role play when the OR nurse contacted them to request for blood products for the MTP. Implementation Each drill had a maximum of 8 nurses, and the roles of surgeon, scrub, anesthesiologist, circulator, and assistant were assigned. A scenario was read, and the team began the drill. During the drill, the blood bank was contacted to activate the MTP, an assistant nurse brought in the RIS and set it up, demo blood product was delivered, 9 units were transfused using the RIS, and then the MTP was discontinued. Limited instruction was provided during the drill, however, an intense debriefing occurred immediately after. The debriefing included questions about setting up the RIS, completing the log, emphasis on speed and accuracy, and what went well and what didn’t. Outcome Currently, over half of the OR nurses were involved in a drill and have been evaluated on our RIS. In the next few months, the plan is for all OR nurses to participate and be validated on the RIS. Some OR nurses are confident managing the MTP, but others have never been involved in an MTP on an actual patient. Staff is displaying competence and the confidence level has grown significantly in the nurses who have participated in the drills. The drill allowed the educators to assess the needs for future drills and competency validation. Implications for Perioperative Nursing Holding regular drills are a necessary component to provide safe patient care, especially in skills of high risk and low frequency, such as an MTP. In a trauma center, there is a high likelihood that MTP will be activated during a major trauma, and all nurses need to be competent in managing it.