Timely Transfusions in Trauma: Instituting a Transfusion Guideline for Trauma Nurses

PURPOSE This project aims to reduce delays in the blood transfusion process in three non-monitored trauma units at a large academic Level I Trauma Center by decreasing the mean "RN transfusion process times" (RN-TPT) by 20 minutes. The project focuses on optimizing transfusion rates, nursing practices, and electronic documentation integration to enhance transfusion timeliness and improve overall patient care. BACKGROUND Delays in the blood transfusion process can negatively affect patient outcomes and increase healthcare costs. In three non-monitored trauma units at a Level I Trauma Center, inefficiencies in transfusion rates, nursing practices, and electronic documentation were identified. Barriers included concerns over transfusion rates, complications, and lab collection workflows. METHODOLOGY Donabedian’s Structure-Process-Outcome model guided the project. The structure focused on creating a transfusion guideline, and the process involved staff education and a lab draw turnaround time campaign. Outcomes were tracked through a retrospective chart review of 237 transfusions and hemoglobin result times. SurveyMonkey assessed nursing confidence in transfusion competency via a pre- and post-survey. Data limitations included missing data, sample size variation, nursing practice differences, and EMR integration. RESULTS Nursing confidence in transfusion competency significantly increased, particularly among nurses with less than one year of experience. The median RN-TPT for healthy patients improved by 22 minutes following guideline implementation and the hemoglobin campaign but only improved by 5 minutes during the EMR integration phase, suggesting data collection variation or lack of sustained efforts. Additionally, transfusions completed before 10 AM increased by 36%, and nursing compliance with transfusion guidelines rose from 34% to 57%. IMPLICATIONS Nursing guidelines are recommended to improve confidence and adherence to best practices, particularly among new nurses. No complications related to increased transfusion rates were observed, negating initial nursing fears about the transfusion process. Process changes should be minimized during EMR conversion to prevent performance anxiety and ensure process sustainability.