Code Red: Labor and Delivery

Posted on August 20, 2010 by thannon

As an anesthesiologist, I have always said that obstetric anesthesia is the best of times and the worst of times. It often seems that pregnant women are happier to see me than to see their obstetrician, because I am the guy putting in the epidural and taking away their labor pains (aka, Dr. Feelgood). Watching the pregnant patient relax and then literally feeling tension ease in the room is a great thing. However, when you work with a high risk obstetric population, things can go from good to very bad at the blink of an eye. While modern management of labor and delivery is generally very safe, complications still can occur for the baby and mother. Although losing a patient’s airway during a “crash” cesarean section is a constant fear of OB anesthesiologists, the clear and present danger is obstetric hemorrhage. Continue reading →

Posted in Patient Safety | Leave a comment

A Washed Cell is a Happy Cell

Posted on July 26, 2010 by thannon

I recall fondly a button that my early blood management mentor, Dr. Paul Potter, used to wear on his lab coat with that particular saying. Dr. Potter was a staff anesthesiologist at the Naval Medical Center San Diego, and he was an early proponent of all things blood management, especially autotransfusion (commonly referred to as “cell saver” or “cell salvage”). Dr. Potter was introduced to early versions of autotransfusion machines as a young Navy Corpsman during the Vietnam era. The Navy- Marine Corps team has always worked in austere environments, and the ability to retransfuse shed blood in a combat setting was a tremendous advance. Many combat ships and most forward medical aid stations did not have the ability to store blood products, so autotransfusion greatly enhanced the capabilities of the “walking blood bank.” Dr. Potter taught a generation of Navy anesthesiologists, including myself and Dr. Jonathan Waters, the benefits of autotransfusion as a tool in the blood management tool box. It is interesting to note that another Naval Medical Center San Diego alumnus, Dr. Carlos Brown from University Medical Center Brackenridge, just published a case series noting the safety and cost effectiveness of autotransfusion in trauma patients.1

Continue reading →

Posted in Blood Management Best Practices | Leave a comment

Wrong Patient – Wrong Unit: Preventing Transfusion Errors

Posted on July 6, 2010 by sstephenson

Previous newsletter articles have discussed the importance of appropriate transfusion decisions as a critical element of transfusion safety, as well as the role of bedside nursing as vigilant advocates during the transfusion administration process. This month’s article focuses on the technical and regulatory aspects of avoiding transfusion errors through the prevention of pre-analytical mistakes, bedside identification errors, and the use of event reporting systems.

Continue reading →

Posted in Patient Safety | Tagged | Leave a comment

Nurses at the Heart of Transfusion Safety

Posted on May 15, 2010 by jthomas

This month as we celebrated Nurse’s Week I hope you were all able to reflect on the many contributions that the profession of nursing has made in healthcare. More nursing programs than ever before are embracing evidence-based care models, developing multidisciplinary care teams and establishing professional accountability. Significant progress with hospital initiatives focusing on the prevention of falls, pressure ulcers and hospital-acquired infections are nurse-driven and a testament to the success of coordination and teamwork in the healthcare setting. However, our work is far from finished. Hospital blood management and transfusion safety are two areas that have received minimal attention over the years. Continue reading →

Posted in Patient Safety | Leave a comment

Blood Money

Posted on April 15, 2010 by thannon

In the current environment of healthcare reform, the pressure for cost savings and cost effective healthcare has never been greater. As I define it, blood management is about quality, safety and stewardship, with a goal to ensure the careful and responsible management of the community blood supply as well as the safe and efficient use of healthcare resources involved in blood management. Blood management promotes the optimal use of blood products. Implementing evidence-based guidelines successfully is the most cost effective way to reduce unnecessary blood expenditures. A previous newsletter article emphasized effective blood utilization committees as the heart of blood management programs, making sure patients get no more or no less blood than they need. A quote by Dr. Donald Berwick from the Institute of Healthcare Improvement that sums up this balanced approach is: “Patient’s should get all the care they need and none they don’t; safely, efficiently and at low cost.” Continue reading →

Posted in Stewardship | Leave a comment

Proactive Vs. Reactive Patient Care: Preoperative Anemia Management

Posted on March 15, 2010 by jthomas

Submitted by: Joseph Thomas, BSN, RN | Vice President, Clinical Systems, Strategic Healthcare Group, LLC

Preoperative preparation and planning are essential for the safe and optimal management of surgical patients. This principal applies to the management of preoperative anemia in elective surgical patients with anticipated major blood loss. As the use of autologous predonation continues to fall out of favor due to its ineffectiveness as a blood conservation measure, there is growing interest in proactively addressing anemia in high risk surgical patients. Of all the risk factors for transfusion in surgical procedures, low red cell mass is consistently at the top of the list; more importantly, it is one of the few risk factors that is modifiable. Anemia and transfusion in surgical patients have been associated with a higher incidence of complications, including infection, longer length of stay, and increased perioperative mortality. Continue reading →

Posted in Blood Management Best Practices | Leave a comment

The Importance of Effective Blood Utilization Committees

Posted on February 3, 2010 by thannon

February is always a good month to talk about blood utilization oversight because it is the anniversary of the Transfusion Requirements in Critical Care (TRICC) trial, published in the New England Journal of Medicine on February 11th, 1999.1 In this study, 838 anemic critically ill patients were prospectively randomized into one of two treatment strategies: transfuse at a hemoglobin level of 10 gm/dL, a very traditional approach to these challenging patients, or transfuse at a hemoglobin level of 7 gm/dL, which was a very radical departure from common practice in 1999. Continue reading →

Posted in Appropriate Blood Utilization | Leave a comment

Trauma Blood Management: Avoiding the Collateral Damage of Trauma Resuscitation Protocols

Posted on January 15, 2010 by thannon

Transfusion therapy has come full cycle in Iraq and Afghanistan as fresh whole blood (FWB) use has again found a place in the resuscitation of military casualties. The use of equal ratios of packed red blood cells, plasma and platelets (so called 1:1:1 therapy) to effectively reconstitute whole blood is gaining ground in civilian trauma centers to attempt to replicate the approach of military trauma teams. While this is an exciting and potential live saving therapy, have we considered the “collateral damage” of these trauma resuscitation protocols and does the current evidence support this approach? Continue reading →

Posted in Interdisciplinary Collaboration | Leave a comment

Pediatric Blood Conservation a Global Concern

Posted on December 15, 2009 by abaffa

Of the 14 million units of packed red blood cells administered to 4.8 million patients in the United States every year, approximately 1 percent is administered to pediatric patients. Although a small number when compared to adult transfusions, this still amounts to hundreds of thousands of blood products administered to our smallest and most delicate patient population. One would imagine that such a widely administered product would be regulated to specific clinical review and oversight; however, red blood cell transfusion has not been subjected to the formal risk/benefit analysis that would be routine for new biological therapeutics. Therefore it begs the question, how safe is blood transfusion therapy in children? What are the alternatives to transfusion therapy? What role does blood volume management play in transfusion exposure? Continue reading →

Posted in Blood Management Best Practices | Leave a comment

Blood Management and Transfusion Safety: Recognizing Nursing’s Leading Role

Posted on November 15, 2009 by jthomas

Millions of blood products are transfused each year in the United States–the majority of which are administered by nurses with little formal training in transfusion therapy. While health care resources and the public have focused on the safety of the blood product itself, the safety of the transfusion process has received minimal attention. Transfusions are one of the most hazardous procedures performed by nurses in which complacency, cavalier attitudes, and lack of competence can result in poor patient outcomes. In spite of this, hospitals often meet only the minimal regulatory requirements for nursing education and oversight related to blood component administration. Typically, computer-based training programs, that require little or no skills proficiency, are utilized to fulfill these regulatory mandates. Due, in part, to this knowledge and proficiency gap, a number of regulatory, safety, and quality gaps in the transfusion process have been uncovered in nursing practice audits. Continue reading →

Posted in Blood Management Awareness & Education | Leave a comment