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Management of anaemia and blood transfusion in critical care - implementing national guidelines in ICU.

ABSTRACT: Anaemia in intensive care is common, with approximately 50% of patients receiving a red cell transfusion. Recognised complications from transfusion include 'transfusion associated lung injury', infection, and organ failure progression. Most cohort studies show a positive relationship between red cell transfusion and adverse outcomes. In 2012, the British Committee for Standards in Haematology issued guidelines for red cell (RBC) transfusion in critical care. They recommend a haemoglobin transfusion trigger of below 70 g/dL unless the patient is bleeding, has acute sepsis, neurological injury, or an acute coronary syndrome. RBC transfusions in a single intensive care unit (ICU) were prospectively assessed for compliance with national guidance. Each transfusion was categorised with a traffic light system: red for inappropriate, green for appropriate, and amber for those that were not clearly appropriate or inappropriate. The quality improvement project began with a clinical effectiveness audit of doctors' knowledge of critical care transfusion thresholds. Two quality improvement interventions were used: 1) a local blood transfusion guideline was produced and posters were placed in the ICU 2) this guidance was attached to the transfusion prescriptions. Data was collected after each intervention. A total of 30 random adult RBC transfusions were analysed between August 2013 and February 2014. Despite good results from the effectiveness audit an assessment of RBC transfusions demonstrated room for improvement. Prior to introduction of the guideline intervention, a total of two transfusions were green, one red and seven amber. Following both interventions there were seven green transfusions and three amber. No transfusions were classed as inappropriate. According to additional trust based ICU transfusion records, there was approximately a 50% reduction (41 to 18 RBC transfusions) in overall blood transfusions following the first intervention in October 2013. Simple interventions to raise awareness such as surveys, posters, and reminders can dramatically improve RBC prescribing in accordance to evidence based guidelines. Making prescribers aware of guidelines can dramatically reduce the total number of overall transfusions and increase transfusion appropriateness.

SUBMITTER: Watson S

PROVIDER: S-EPMC4645691 | biostudies-literature | 2014

REPOSITORIES: biostudies-literature

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Management of anaemia and blood transfusion in critical care - implementing national guidelines in ICU.

Watson Sethina S Kendrick Kate K

BMJ quality improvement reports 20140613 1

Anaemia in intensive care is common, with approximately 50% of patients receiving a red cell transfusion. Recognised complications from transfusion include 'transfusion associated lung injury', infection, and organ failure progression. Most cohort studies show a positive relationship between red cell transfusion and adverse outcomes. In 2012, the British Committee for Standards in Haematology issued guidelines for red cell (RBC) transfusion in critical care. They recommend a haemoglobin transfus ...[more]

PMID: 26734254

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Project description:BackgroundCancer-related fatigue (CRF) is a key concern for people living with cancer and can impair physical functioning and activities of daily living. Evidence-based guidelines for CRF are available, yet inconsistently implemented globally. This study aimed to identify barriers and enablers to applying a cancer fatigue guideline and to derive implementation strategies.MethodsA mixed-method study explored the feasibility of implementing the CRF guideline developed by the Canadian Association for Psychosocial Oncology (CAPO). Health professionals, managers and consumers from different practice settings participated in a modified Delphi study with two survey rounds. A reference group informed the design of the study including the surveys. The first round focused on guideline characteristics, compatibility with current practice and experience, and behaviour change. The second survey built upon and triangulated the first round.ResultsForty-five health practitioners and managers, and 68 cancer survivors completed the surveys. More than 75% of participants endorsed the CAPO cancer related fatigue guidelines. Some respondents perceived a lack of resources for accessible and expert fatigue management services. Further barriers to guideline implementation included complexity, limited practical details for some elements, and lack of clinical tools such as assessment tools or patient education materials. Recommendations to enhance guideline applicability centred around four main themes: (1) balancing the level of detail in the CAPO guideline with ease of use, (2) defining roles of different professional disciplines in CRF management, (3) how best to integrate CRF management into policy and practice, (4) how best to ensure a consumer-focused approach to CRF management.ConclusionsTranslating current knowledge on optimal management of CRF into clinical practice can be enhanced by the adoption of valid guidelines. This study indicates that it is feasible to adopt the CAPO guidelines. Clinical application may be further enhanced with guideline adaptation, professional education and integration with existing practices.

Project description:ObjectivesTo summarize the results of expert discussions and recommendations from a National Summit and survey on the promoting wellness and preventing and managing burnout in the ICU.Data sourcesLiterature review; Critical Care Societies Collaborative (CCSC) Statement on Burnout Syndrome in Critical Care Healthcare Professionals: A Call for Action; CCSC's National Summit on Prevention and Management of Burnout in the ICU; and a descriptive survey on strategies for addressing burnout using Research Electronic Data Capture (REDCap) (project-redcap.org).Data synthesisBuilding on the CCSC call for action to address burnout among critical care professionals, the CCSC sponsored the National Summit on Prevention and Management of Burnout in the ICU with 55 invited experts in various fields including psychology, sociology, integrative medicine, psychiatry, suicide prevention, bereavement support, ethics, palliative care, meditation, mindfulness-based stress reduction, among others. Attendees joined breakout groups, to identify factors influencing burnout in ICU professionals and the value of organizational and individual interventions. As a follow-up to the Summit, a descriptive survey assessing strategies for addressing burnout was sent via email or newsletter blast with responses received from 680 CCSC members, including physicians, nurses, pharmacists, therapists, and others.ConclusionsThe Summit attendees identified the importance of raising awareness among critical care clinicians and key stakeholders, advocating for workplace changes to promote healthy work environments, and promoting research to further explore practical strategies to address, mitigate, and prevent burnout. Critical care clinicians reported that a number of initiatives are being implemented both at their hospitals and at the unit level to build resilience and address burnout prevention. However, other respondents reported that no measures were being used within their organizations, and that colleagues were experiencing burnout. Dissemination and application of resiliency building measures and strategies to address burnout in critical care clinicians are needed.

Project description:Background and aimsTransfusion of blood products is an important part of the health care system. Since one of the significant challenges in nursing education is using an effective method that provides depth and stability of learning, this study aimed to assess using a learning management system (LMS) for intensive care unit (ICU) nurses' sustained learning about safe blood transfusion in southeast Iran.MethodsThis was a quasi-experimental study in southeast of Iran in 2021 in two groups, control and intervention. Two ICUs received lecture training and two ICUs received LMS. The samples 80 nurses were selected by random convenience sampling. In the LMS group, the educational content was presented using Edmodo software. The control group received no intervention except for traditional education (lecture). The questionnaires were completed immediately, 1 month, and 3 months after the intervention.ResultsThe mean score of knowledge immediately, 1 month and 3 months after the intervention were 9.53 ± 1.82, 9.46 ± 1.85, and 8 ± 2.94, in the lecture group and 8.91 ± 1.59, 9.47 ± 2.46, and 8.09 ± 1.94 in the LMS group, respectively. The mean score of practice immediately, 1 and 3 months after the intervention were 59.69 ± 39.6, 70.63 ± 7.4, and 83.70 ± 43.6 in the lecture group and 45.68 ± 55.5, 67.69 ± 4.56, and 35.70 ± 46.4 in the LMS group, respectively. The mean score of knowledge and practice in the two groups significantly increased immediately and 1 month and 3 months after intervention (p < 0.001). No significant difference was observed between the two groups (p > 0.05).ConclusionsLMS method has a significant effect on improving the sustained learning of ICU nurses, and no significant difference was observed between the two educational methods. Hence, considering the busy work schedule of nurses, lack of staff, and the impossibility of physical attendance in lecture classes, it seems that LMS-based methods are appropriate alternatives to traditional learning methods.

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Management of anaemia and blood transfusion in critical care - implementing national guidelines in ICU.

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Management of anaemia and blood transfusion in critical care - implementing national guidelines in ICU.

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