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Emergency Blood Coordinator

A formal role for emergency department massive transfusion protocol resuscitations

Daniel Van Vorst

A/Clinical Nurse Consultant

Liverpool Emergency Department

Introduction

• Liverpool Emergency department had increased numbers of blood product wastage during Massive Transfusion Protocols (MTP).
• There was a high prevalence of clinical incidents compromising patient safety.
• Complaints about miscommunication with blood bank around MTPs.

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Blood product wastage results in not only in a loss of the product's cost, but also of the fees involved in transporting, handling, and administering these products.

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In the six month period between September 2020 and February 2021:

• 83 units of blood products were wasted during MTP activations in Liverpool ED.
• 5 blood related incidents reported in the Incident Management System IMS+.

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Aim

The rate of blood wastage during a Massive Transfusion Protocol in the ED is to be reduced by 20% by September 2021.

Method and issues identified

• Key stakeholders were engaged, including: Trauma, ED medical, ED nursing, Blood bank, ward orderlies and theatre staff.
• The process from recognition of a patient requiring an MTP until the patient was handed over out of the ED or the MTP was ceased was analysed to identify areas for improvement

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It was found that there were cold chain breaches both in ED and upon patient transfer out of the ED, issues with administration and issues with the coordination of MTP shipments from blood bank.

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Results

• Wastage rates dropped from 14 units per month, to 8.6 units per month. This is a 38% improvement in blood wastage
• IMS+ went from five incidents in a 6 month period to only two incidents in a 6 month period which is a 40% reduction
• Cost savings were to the value of $9200.26

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Next steps

• Incorporate into Resus transition orientation
• Standing item at the Resus working party
• Blood wastage audits and blood clinical incident reviews will continue
• Blood coordinator role to be developed in theatres
• Upgrade the ED blood fridge to have RFID tag capability to assist with cold chain documentation accuracy

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Contact Details

Daniel Van Vorst

 A/Clinical Nurse Consultant (A/CNC) | Emergency Department Liverpool Hospital

Mobile 0421189322

Email: Daniel.vanvorst@health.nsw.gov.au

Change Ideas

Our 1^st change idea was for blood bank to put a cold chain sticker onto the blood form so that cold chain was better recorded

Our 2^nd change idea was the implementation of an alarming timer being attached to all MTP shipments on a red esky bag from blood bank to alert staff of cold chain timings.

The blood coordinator role was created. to be the direct point of contact between blood-bank and the resuscitation team-leader A phone was purchased and painted red to be used for all communication.

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Resource cards were given to staff to outline the role

Along with the staff information cards, a training package was created to ensure a robust understanding of the role that staff could also use as a reference guide..

A portable whiteboard was developed to assist with the tallying of blood products during an MTP while also assisting as a visual for the resuscitation team leader

Blood Coordinator Role

• They assist in the cross-check & administration of blood products
• Maintain cold-chain preservation and documentation by prompting the resuscitation scribe nurse to record the transfer of blood products in & out of refrigeration in the patient’s resuscitation phase documentation.
• They continue coordination of cold chain maintenance with other clinical teams including operating theatres (OT), ICU and Interventional Radiology (IR) when patients move beyond the Emergency Department.

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