VHA SimLEARN
Improving Veteran care with Blood Transfusion Administration Course
By Jean Borck, MSN, BSN RN
Simulation Education Specialist
Zablocki VA Medical Center
MILWAUKEE, Wisc. – Blood transfusion reaction is a high-risk, low volume event in clinical areas requiring quick interventions from nursing staff. Research has shown ensuring proper identification of the blood product and patient identification can prevent blood transfusion reactions from occurring. The occurrence of transfusion reactions is one in 100 transfusions and are the most frequent adverse event with blood transfusions (Delaney, Wendel, Bercovitz, Cid, Cohn, Dunbar, Apelseth, ... Ziman, 2016). Incidents of wrong blood error numbers continue to grow each year making up half of all blood-transfusion related events, but very few are ABO-incompatible transfusions (Bolton‐Maggs, & Cohen, 2013).
The Blood Transfusion Administration (BTA) course at the Zablocki VA Medical Center combines a didactic psychomotor case study simulation facilitated by an instructor, followed by two high-fidelity clinical immersive simulations. Nurses attend the course within six months of hire and often have various experiences from different schools and hospital systems on blood transfusion workflow. In providing a didactic case study, the nurse can initiate blood transfusion therapy while following the organizational protocol and policy.
The nurse is provided all the necessary clinical equipment, including a patient arm with ID band, IV access, IV pump with IV and blood tubing, saline infusion bag, computer and scanner. The blood product is provided to the RN after the necessary verifications have taken place. Providing the necessary props to mirror the clinical setting is important in building the nurses’ confidence with the BTA process. The nurse then demonstrates the skills learned and knowledge gained during the immersive high-fidelity simulations by utilizing their critical thinking skills. Most nurses do not get the opportunity to participate in BTA during orientation since blood transfusion therapy is a high-risk, low volume procedure.
The BTA course utilizes the change to the hospital system in documenting blood transfusion within the electronic health record (EHR). Combining the immersive high-fidelity simulations with the EHR in simulation allows the nurse real-world tools in a safe environment. A medical technologist blood bank specialist participates in the simulations, as well as the debriefing after each simulation and serves as a simulation partner as the subject matter expert from the blood bank side of care.
During the blood transfusion simulation, the nurse applies decision making interprofessional and communication skills in the multistep process of BTA. Having the blood simulations as a collaborative team effort, with the blood bank, helps to continually assist with changes within the blood transfusion process. The simulations provide a better understanding for the medical technologist and the nurse regarding each other’s role and responsibilities.
Outcomes from the BTA course by blood bank, after observing the labor-intensive responsibilities of the nurse during BTA include:
- Streamline process steps for nurse calling blood bank for blood delivery
- Blood bank calls lab for an immediate collect for a blood reaction
- Blood bank created a form for consistent questions to assist and ask the nurse during a blood transfusion reaction, improving interprofessional communication
Other outcomes from the BTA course:
- After attending the course, a Progressive Care RN took care of a Veteran receiving a blood transfusion and attributes her quick responses in knowing what to do for a blood reaction to the simulation course
- Another nurse from Medical Surgical performing a BTA stated she became a resource to other seasoned staff on the unit
- All departments are now documenting within the EHR for BTA
Staff comments on how the class has assisted in their clinical practice demonstrates how beneficial the BTA course has been.
The pre- and posttest evaluation method is useful in determining knowledge change by comparing the pre- and posttest answers from participants (Holtschneider & Park, 2019). The pre- and post-test results show 82% pre-test average to 94% posttest average, validating an increase in knowledge for learners who attended the BTA course.
Qualitative reflections within BTA post-course evaluations include an ED RN, nurse resident, acute care and a palliative care RN. They said, “Keep the patient involved throughout the process of blood transfusion; heightened awareness of 15 minutes after initiation/necessary volume to be infused, verification is key to safety in blood administration." Other comments included, "I will now utilize the knowledge to provide care appropriately and per policy for blood admin/reactions, and helpful to increase confidence in administering blood products and what to do for infusion reactions.”
Reference
Bolton‐Maggs, P.H.B. & Cohen, H. (2013). Serious Hazards of Transfusion (SHOT) haemovigilance and progress is improving transfusion safety. Br J Haematol, 163: 303-314. doi:10.1111/bjh.12547
Delaney, M., Wendel, S., Bercovitz, R. S., Cid, J., Cohn, C., Dunbar, N. M., Apelseth, T. O., ... Ziman, A. (2016). Transfusion reactions: prevention, diagnosis, and treatment. The Lancet, 388, 10061, 2825-2836. http://dx.doi.org/10.1016/S0140-6736(15)01313-6
Holtschneider, M. E., & Park, C. W. (2019). Evaluating Simulation Education in the Workplace: Kirkpatrick’s Levels and Beyond. Journal for Nurses in Professional Development, 35, 1, 44-45. DOI: 10.1097/NND.0000000000000509
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