Implementation of a Massive Transfusion Protocol: Evaluation of Its Use and Efficacy

Research output: Contribution to journalArticle

Abstract

Massive transfusion protocols (MTPs) allow practitioners to follow a prescribed algorithm for the rapid replacement of blood products during a massive hemorrhage. They function as an established protocol to provide consistent treatment. Once implemented, the MTP must be evaluated to ensure best practice. The purpose of this clinical improvement project was to formally evaluate the use and efficacy of an MTP during its first year of implementation. The specific aims were to (1) determine whether MTP activations were missed; (2) compare outcomes between those patients managed by the MTP and those who were not; and (3) provide recommendations to the institution's stakeholders. A retrospective medical record review was conducted with 101 electronic medical records of adult trauma patients treated over 1 year. Patients were identified to have experienced massive bleeding if their medical record contained 1 of 4 indicators: (1) transfusion of uncrossmatched blood; (2) tranexamic acid administration; (3) transfusion of 4 or more units of packed red blood cells (PRBCs) in 1 hr; and/or (4) transfusion of 10 or more units of PRBCs in 24 hr. While 58 patients experienced massive bleeding, only 16 (28%) were managed using the MTP. Although the non-MTP group received fewer transfused blood products due to higher initial and 24-hr hemoglobin levels, more deaths occurred in this group than in the MTP group. The recommendations were to (1) establish well-defined criteria for MTP activation based on the 4 indicators of massive bleeding and (2) regularly evaluate the use and efficacy of the MTP to ensure positive patient outcomes.

Original languageEnglish (US)
Pages (from-to)92-97
Number of pages6
JournalJournal of Trauma Nursing
Volume25
Issue number2
DOIs
StatePublished - Jan 1 2018

Fingerprint

Hemorrhage
Medical Records
Erythrocytes
Tranexamic Acid
Electronic Health Records
Practice Guidelines
Blood Transfusion
Hemoglobins
Wounds and Injuries
Therapeutics

Keywords

  • Broxton MTP evaluation tool
  • Massive transfusion protocol
  • Nursing care bleeding patient
  • Protocol evaluation

ASJC Scopus subject areas

  • Emergency
  • Critical Care
  • Advanced and Specialized Nursing

Cite this

Implementation of a Massive Transfusion Protocol : Evaluation of Its Use and Efficacy. / Broxton, Shannon L.; Medeiros, Regina; Abuzeid, Adel Mohamed Osman; Peterson, Corey Rex; Schumacher, Autumn.

In: Journal of Trauma Nursing, Vol. 25, No. 2, 01.01.2018, p. 92-97.

Research output: Contribution to journalArticle

@article{5cd3d427215647348af7618bb212bb38,
title = "Implementation of a Massive Transfusion Protocol: Evaluation of Its Use and Efficacy",
abstract = "Massive transfusion protocols (MTPs) allow practitioners to follow a prescribed algorithm for the rapid replacement of blood products during a massive hemorrhage. They function as an established protocol to provide consistent treatment. Once implemented, the MTP must be evaluated to ensure best practice. The purpose of this clinical improvement project was to formally evaluate the use and efficacy of an MTP during its first year of implementation. The specific aims were to (1) determine whether MTP activations were missed; (2) compare outcomes between those patients managed by the MTP and those who were not; and (3) provide recommendations to the institution's stakeholders. A retrospective medical record review was conducted with 101 electronic medical records of adult trauma patients treated over 1 year. Patients were identified to have experienced massive bleeding if their medical record contained 1 of 4 indicators: (1) transfusion of uncrossmatched blood; (2) tranexamic acid administration; (3) transfusion of 4 or more units of packed red blood cells (PRBCs) in 1 hr; and/or (4) transfusion of 10 or more units of PRBCs in 24 hr. While 58 patients experienced massive bleeding, only 16 (28{\%}) were managed using the MTP. Although the non-MTP group received fewer transfused blood products due to higher initial and 24-hr hemoglobin levels, more deaths occurred in this group than in the MTP group. The recommendations were to (1) establish well-defined criteria for MTP activation based on the 4 indicators of massive bleeding and (2) regularly evaluate the use and efficacy of the MTP to ensure positive patient outcomes.",
keywords = "Broxton MTP evaluation tool, Massive transfusion protocol, Nursing care bleeding patient, Protocol evaluation",
author = "Broxton, {Shannon L.} and Regina Medeiros and Abuzeid, {Adel Mohamed Osman} and Peterson, {Corey Rex} and Autumn Schumacher",
year = "2018",
month = "1",
day = "1",
doi = "10.1097/JTN.0000000000000350",
language = "English (US)",
volume = "25",
pages = "92--97",
journal = "Journal of trauma nursing : the official journal of the Society of Trauma Nurses",
issn = "1078-7496",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - Implementation of a Massive Transfusion Protocol

T2 - Evaluation of Its Use and Efficacy

AU - Broxton, Shannon L.

AU - Medeiros, Regina

AU - Abuzeid, Adel Mohamed Osman

AU - Peterson, Corey Rex

AU - Schumacher, Autumn

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Massive transfusion protocols (MTPs) allow practitioners to follow a prescribed algorithm for the rapid replacement of blood products during a massive hemorrhage. They function as an established protocol to provide consistent treatment. Once implemented, the MTP must be evaluated to ensure best practice. The purpose of this clinical improvement project was to formally evaluate the use and efficacy of an MTP during its first year of implementation. The specific aims were to (1) determine whether MTP activations were missed; (2) compare outcomes between those patients managed by the MTP and those who were not; and (3) provide recommendations to the institution's stakeholders. A retrospective medical record review was conducted with 101 electronic medical records of adult trauma patients treated over 1 year. Patients were identified to have experienced massive bleeding if their medical record contained 1 of 4 indicators: (1) transfusion of uncrossmatched blood; (2) tranexamic acid administration; (3) transfusion of 4 or more units of packed red blood cells (PRBCs) in 1 hr; and/or (4) transfusion of 10 or more units of PRBCs in 24 hr. While 58 patients experienced massive bleeding, only 16 (28%) were managed using the MTP. Although the non-MTP group received fewer transfused blood products due to higher initial and 24-hr hemoglobin levels, more deaths occurred in this group than in the MTP group. The recommendations were to (1) establish well-defined criteria for MTP activation based on the 4 indicators of massive bleeding and (2) regularly evaluate the use and efficacy of the MTP to ensure positive patient outcomes.

AB - Massive transfusion protocols (MTPs) allow practitioners to follow a prescribed algorithm for the rapid replacement of blood products during a massive hemorrhage. They function as an established protocol to provide consistent treatment. Once implemented, the MTP must be evaluated to ensure best practice. The purpose of this clinical improvement project was to formally evaluate the use and efficacy of an MTP during its first year of implementation. The specific aims were to (1) determine whether MTP activations were missed; (2) compare outcomes between those patients managed by the MTP and those who were not; and (3) provide recommendations to the institution's stakeholders. A retrospective medical record review was conducted with 101 electronic medical records of adult trauma patients treated over 1 year. Patients were identified to have experienced massive bleeding if their medical record contained 1 of 4 indicators: (1) transfusion of uncrossmatched blood; (2) tranexamic acid administration; (3) transfusion of 4 or more units of packed red blood cells (PRBCs) in 1 hr; and/or (4) transfusion of 10 or more units of PRBCs in 24 hr. While 58 patients experienced massive bleeding, only 16 (28%) were managed using the MTP. Although the non-MTP group received fewer transfused blood products due to higher initial and 24-hr hemoglobin levels, more deaths occurred in this group than in the MTP group. The recommendations were to (1) establish well-defined criteria for MTP activation based on the 4 indicators of massive bleeding and (2) regularly evaluate the use and efficacy of the MTP to ensure positive patient outcomes.

KW - Broxton MTP evaluation tool

KW - Massive transfusion protocol

KW - Nursing care bleeding patient

KW - Protocol evaluation

UR - http://www.scopus.com/inward/record.url?scp=85045575353&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85045575353&partnerID=8YFLogxK

U2 - 10.1097/JTN.0000000000000350

DO - 10.1097/JTN.0000000000000350

M3 - Article

C2 - 29521775

AN - SCOPUS:85045575353

VL - 25

SP - 92

EP - 97

JO - Journal of trauma nursing : the official journal of the Society of Trauma Nurses

JF - Journal of trauma nursing : the official journal of the Society of Trauma Nurses

SN - 1078-7496

IS - 2

ER -