Children's Mercy Kansas City, Missouri, United States
Background/Case Studies: Massive Transfusion Protocol (MTP) poses a particular challenge in the pediatric population. This institution struggled to meet expectations due to lack of standardization. The areas of concern were overactivation, missed turnaround time (TAT), missed plasma to RBC ratio, and wasted blood products. To improve the process, a multidisciplinary team from Blood Bank, Trauma, Emergency Medicine, Anesthesia, and Critical Care was created. The goal was to standardize MTP through the creation of a care process model (CPM) to guide MTP administration for all life-threatening bleeding events in either the traumatic or medically indicated pediatric patient.
Study
Design/Methods: The team used A3 Problem Solving to work through the process improvement. A current state flowchart was developed via swim lane evaluation from all departments involved in the MTP process. It was determined that the areas of focus were activation/cessation criteria, pack contents, and product storage improvements. The team developed a CPM for clinical improvements and standardization as well as blood bank specific process changes. TAT, plasma:RBC ratio, and product wastage were the key indicators of the project success.
Results/Findings: The CPM the team created contained a clear and concise definition for MTP as well as appropriate activation/cessation criteria for the responsible provider to follow. Roles were defined based on clinical task rather than staff position. This allowed for standardization regardless of the location within the organization the MTP occurred. The pack contents were chosen based on a patient weight cutoff of 30 kg. This placed less of a burden on blood bank staff in decision making. To decrease the TAT, a designated MTP shelf was created containing the entirety of the first pack including pre-thawed plasma. Coolers were validated to ensure proper storage of the RBC and plasma at 1-10C and the platelets at 20-24C for up to 8 hours. The results of a retrospective evaluation of the two years prior (43 activations) and two years after (42 activations) the implementation of these changes is summarized in Table 1. Conclusions: This institution was able to improve upon key indicators by utilizing a multidisciplinary team to address frequently encountered problems. This method of process improvement was superior to the siloed method of each specialty attempting to implement process improvements for their respective areas. It allowed for organization-wide standardization, and a better understanding of each area’s specific role in the complex, and highly stressful scenario.
Importance of research: There is very little evidence-based practice in pediatric MTP. This showcases how our pediatric institution has improved our MTP process.
