01:53am Thursday 21 September 2017

Keeping transfusions flowing for trauma patients

Dr. Larissa Matukas identifies a strain of bacteria
Emergency Department nurse Kate Coffin and clinical nurse educator Lee Barratt ensure a patient’s documentation is consistent with the information on the patient’s arm band. This helps to ensure his or her blood transfusion is as smooth as possible. (Photo by Katie Cooper)

Jane or John Doe trauma patients will no longer experience delays to their transfusions, thanks to an agreement between the Emergency Department and the blood lab.

Trauma patients often arrive in the Emergency Department without any identification. They’re admitted as John or Jane Doe and standard unidentified information is inputted to create a new chart and other identification items, including a wrist band.

In some cases, identification is retrieved or brought in to the ED by police or family during a transfusion. The admitting clerk then enters the patient’s real name into the Soarian information system.

However, patients’ armbands, transfusion record labels and transfusion medicine labels must match at all times. If one piece of patient identification is different as a result of a change to the patient’s date of birth or name in Soarian, for example, then no blood or blood products can leave the lab, delaying the transfusion.

“It was a particularly challenging barrier because in some cases, the care team was abruptly prevented from continuing to give these patients blood halfway during a transfusion,” said Dr. Katerina Pavenski, director of transfusion medicine. “Although we were able to work around it quite rapidly, and eventually did provide these patients with blood, we didn’t want to have to keep running into this roadblock.”

Members of the admitting, ER, lab and risk management teams began working together at the start of 2015 on a quality improvement and safety planning initiative that now means information is updated in Soarian only when patients are not actively receiving blood. The admitting clerk now calls the lab before making any changes to John or Jane Doe patient’s health or personal information.

      Transfusion facts:

  • Around 108 million blood donations are collected globally every year
  • People in high-income counties donate more blood than in other countries
  • In low- and middle-income countries, transfusions are used more often for management of pregnancy-related complications, childhood malaria complicated by severe anemia, and trauma-related injuries

Source: World Health Organization

“Anything that helps the blood lab function and deliver products in a timely fashion also helps us to deliver safe and efficient care,” said Lee Barratt, clinical nurse educator for the ED. “The last thing we’d want to do is cripple the lab’s process, which is why emergency was happy to partner with others to devise a strategy to tackle the issue.”

Transfusion safety nurse Yvonne Davis-Read said communication between the lab and the ED has improved.

“Once we were able to identify the problem, we knew it was imperative for both teams to be at the table,” she said. “This quality improvement initiative allows us to deliver the best possible care.”

About St. Michael’s Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.


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