Implementing a Blood Product Scanning Process for Massive Transfusion Protocols in a Trauma Center

Abstract

Purpose: The purpose of this project is to optimize nursing documentation of MTP blood products to improve documentation accuracy, timeliness, and completeness. Background: Massive transfusion protocols (MTP) provide a consistent approach for rapidly replacing blood volume with standardized blood products for patients experiencing uncontrolled hemorrhage. Blood product documentation for nurses during MTP activations at a large, urban academic medical center and safety-net hospital in the southeast was a manual process described as cumbersome, time-consuming, and often incomplete. Methods: A descriptive analysis was performed by comparing documentation from chart reviews of trauma patients with MTP activations or uncrossmatched blood transfusions in the month before and after the workflow implementation. A scanning workflow for documentation of MTP blood products was implemented. Results: Pre-implementation review of 10 charts within the 30 days before go-live found 79 units of MTP blood products documented. Ten charts reviewed within three weeks post-implementation revealed documentation of 26 units of MTP blood products. Chi-square analyses of each documentation variable were conducted to evaluate the differences between pre-and post-implementation results. Unit number documentation was 61% pre-implementation compared to 100% post-implementation (p=0.000), product codes 33% compared to 100% (p=0.000), donor type 51% compared to 100% (p=0.000), and expiration dates 29% versus 100% (p=0.000). Volume was documented for 95% of the units pre-implementation and 58% post-implementation (p=0.000) but was accurate for only 47% pre-implementation and 58% post (p=0.337). Timely documentation pre- and post-implementation was 66% and 65% respectively (p=0.967). The MTP scanning workflow improved the completeness of documentation but did not affect accuracy or timeliness. Conclusions: The MTP scanning workflow improved some aspects of MTP blood product documentation, specifically policy-required documentation, but did not solve all the issues noted pre-implementation. These issues may be mitigated by continued targeted education, practice in the playground environment, and increased comfort with the workflow.