2.50
Hdl Handle:
http://hdl.handle.net/10755/162914
Type:
Presentation
Title:
Trauma Secrets of Success: The Redesign of a Massive Transfusion Tray
Abstract:
Trauma Secrets of Success: The Redesign of a Massive Transfusion Tray
Conference Sponsor:Emergency Nurses Association
Conference Year:2006
Author:Mastropieri, Cynthia J., RN, MSN, CNS, CCRN
P.I. Institution Name:Baylor University Medical Center
Title:Trauma Program Coordinator
Contact Address:3500 Gaston Ave., Div. of Trauma,, AW Roberts Bldg. 4NICU, Dallas, TX, 75246, USA
Contact Telephone:(214) 820-1978
Co-Authors:Michael Foreman, MD, FACS
Clinical Topic: "Massive transfusion" refers to infusion of 10 or more units of packed red blood cells (PRBC) over a period of 24 hours, and is usually administered when blood volume loss reaches 50% over a period of 3 hours. While PRBC is the first line infusion preference in massive transfusion, early and aggressive administration of component therapy (CT) platelets and fresh frozen plasma (FFP) is critical to preventing coagulopathy and thereby improving patient outcomes. Nonetheless, ordering CT from the blood bank during acute resuscitations can be easily overlooked. Typically, CT is not ordered until after the infusion of PRBC, and after blood type and cross-matching results come back from the lab. Further delays occur because FFP must be thawed before delivery to the trauma team. Historically, the processes followed at this institution called for separate ordering and delivering of CT and PRBC. To address this issue, a multidisciplinary team developed a unique protocol that ensures simultaneous access to both PRBC and component therapy at the time of transfusion. Implementation: In September 2004, a team of nurses, physicians and blood bank personnel evaluated current blood administration processes and outcomes and reviewed relevant research literature and standards of care on massive transfusion. Guided by their findings, the team developed a unique massive transfusion protocol (MTP) that supports the rapid transfusion of both PRBC and component therapy. The "uniqueness"of the MTP lies in the design of an innovative massive transfusion tray. Lying flat on the bottom of one half of the tray are quality tested ice packs. These cool 6 units of O negative PRBC and 4 units of pre-thawed FFP. On the non-ice pack side, lies a container with 5 units of pooled platelets. These are delivered on every other tray, beginning with the first tray. A timer is attached to the tray and set for 45 minutes to ensure timely return of unused blood. MTP is activated for anticipated transfusion of 10 or more units of blood products in 24 hours, or 50% of blood volume loss in 3 hours. The protocol calls for delivery of trays to the requesting unit every 20 minutes or more frequently until discontinued. Outcomes: A review of the data suggests an overall decrease in coagulopathy after implementation of MTP. Data comparisons were made between 13 patients treated within 5 months after implementing MTP and 24 patients treated without MTP, between June and December, 2004. Rates of blunt trauma and penetrating trauma, as well as average age and Injury Severity Scores were comparable for the two groups. However, there was a slight improvement in length of stay for the MTP group (14.6 days) versus the non-MTP group (16 days) although the difference in overall mortality rate was striking: 30% in the MTP group compared to 54% in the non-MTP group. Units of PRBC, FFP, and platelets used was higher in the MTP group and no blood product wastage occurred in either group. The majority of patients in both groups experienced different levels of coagulopathy, and further studies should be conducted to look at the time coagulopathy reversed. Recommendations: Massive transfusion presents unique challenges to the trauma team, and the effectiveness of its execution reflects the efficacy of the team. Any changes to processes must include input from all departments involved. The creation of our MTP reflects enhanced levels of collaboration across many disciplines. In the end we have created an MTP that ensures timely and efficient ordering, preparing and delivering of multiple blood products that has resulted in improved care outcomes and increased staff satisfaction.
Repository Posting Date:
27-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Emergency Nurses Association

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleTrauma Secrets of Success: The Redesign of a Massive Transfusion Trayen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162914-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Trauma Secrets of Success: The Redesign of a Massive Transfusion Tray</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2006</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Mastropieri, Cynthia J., RN, MSN, CNS, CCRN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Baylor University Medical Center</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Trauma Program Coordinator</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">3500 Gaston Ave., Div. of Trauma,, AW Roberts Bldg. 4NICU, Dallas, TX, 75246, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">(214) 820-1978</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">cyndima@baylorhealth.edu, cjmastropieri@aol.com</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Michael Foreman, MD, FACS</td></tr><tr><td colspan="2" class="item-abstract">Clinical Topic: &quot;Massive transfusion&quot; refers to infusion of 10 or more units of packed red blood cells (PRBC) over a period of 24 hours, and is usually administered when blood volume loss reaches 50% over a period of 3 hours. While PRBC is the first line infusion preference in massive transfusion, early and aggressive administration of component therapy (CT) platelets and fresh frozen plasma (FFP) is critical to preventing coagulopathy and thereby improving patient outcomes. Nonetheless, ordering CT from the blood bank during acute resuscitations can be easily overlooked. Typically, CT is not ordered until after the infusion of PRBC, and after blood type and cross-matching results come back from the lab. Further delays occur because FFP must be thawed before delivery to the trauma team. Historically, the processes followed at this institution called for separate ordering and delivering of CT and PRBC. To address this issue, a multidisciplinary team developed a unique protocol that ensures simultaneous access to both PRBC and component therapy at the time of transfusion. Implementation: In September 2004, a team of nurses, physicians and blood bank personnel evaluated current blood administration processes and outcomes and reviewed relevant research literature and standards of care on massive transfusion. Guided by their findings, the team developed a unique massive transfusion protocol (MTP) that supports the rapid transfusion of both PRBC and component therapy. The &quot;uniqueness&quot;of the MTP lies in the design of an innovative massive transfusion tray. Lying flat on the bottom of one half of the tray are quality tested ice packs. These cool 6 units of O negative PRBC and 4 units of pre-thawed FFP. On the non-ice pack side, lies a container with 5 units of pooled platelets. These are delivered on every other tray, beginning with the first tray. A timer is attached to the tray and set for 45 minutes to ensure timely return of unused blood. MTP is activated for anticipated transfusion of 10 or more units of blood products in 24 hours, or 50% of blood volume loss in 3 hours. The protocol calls for delivery of trays to the requesting unit every 20 minutes or more frequently until discontinued. Outcomes: A review of the data suggests an overall decrease in coagulopathy after implementation of MTP. Data comparisons were made between 13 patients treated within 5 months after implementing MTP and 24 patients treated without MTP, between June and December, 2004. Rates of blunt trauma and penetrating trauma, as well as average age and Injury Severity Scores were comparable for the two groups. However, there was a slight improvement in length of stay for the MTP group (14.6 days) versus the non-MTP group (16 days) although the difference in overall mortality rate was striking: 30% in the MTP group compared to 54% in the non-MTP group. Units of PRBC, FFP, and platelets used was higher in the MTP group and no blood product wastage occurred in either group. The majority of patients in both groups experienced different levels of coagulopathy, and further studies should be conducted to look at the time coagulopathy reversed. Recommendations: Massive transfusion presents unique challenges to the trauma team, and the effectiveness of its execution reflects the efficacy of the team. Any changes to processes must include input from all departments involved. The creation of our MTP reflects enhanced levels of collaboration across many disciplines. In the end we have created an MTP that ensures timely and efficient ordering, preparing and delivering of multiple blood products that has resulted in improved care outcomes and increased staff satisfaction.</td></tr></table>en_GB
dc.date.available2011-10-27T10:36:19Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:36:19Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
All Items in this repository are protected by copyright, with all rights reserved, unless otherwise indicated.