Issue |
J Extra Corpor Technol
Volume 46, Number 1, March 2014
|
|
---|---|---|
Page(s) | 45 - 52 | |
DOI | https://doi.org/10.1051/ject/201446045 | |
Published online | 15 March 2014 |
Original Articles
Quality Improvement Methodologies Increase Autologous Blood Product Administration
* The Heart Center, Nationwide Children’s Hospital, Columbus, Ohio
† Division of Pediatric Critical Care Medicine, Nationwide Children’s Hospital, Columbus, Ohio
‡ Department of Quality Improvement Services, Nationwide Children’s Hospital, Columbus, Ohio
§ Department of Pathology, Nationwide Children’s Hospital, Columbus, Ohio
‖ Department of Anesthesiology and Pain Medicine, Nationwide Children’s Hospital, Columbus, Ohio
¶ Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio
Address correspondence to: Ashley B. Hodge, MBA, CCP, FPP, Cardiothoracic Surgery Quality and Safety Officer/Cardiovascular Perfusionist, The Heart Center, Nationwide Children’s Hospital, 700 Children’s Drive, Room T2298, Columbus, OH 43205. E-mail: ashley.hodge@nationwidechildrens.org
Received:
1
October
2013
Accepted:
9
February
2014
Whole blood from the heart–lung (bypass) machine may be processed through a cell salvaging device (i.e., cell saver [CS]) and subsequently administered to the patient during cardiac surgery. It was determined at our institution that CS volume was being discarded. A multidisciplinary team consisting of anesthesiologists, perfusionists, intensive care physicians, quality improvement (QI) professionals, and bedside nurses met to determine the challenges surrounding autologous blood delivery in its entirety. A review of cardiac surgery patients’ charts (n = 21) was conducted for analysis of CS waste. After identification of practices that were leading to CS waste, interventions were designed and implemented. Fishbone diagram, key driver diagram, Plan–Do–Study–Act (PDSA) cycles, and data collection forms were used throughout this QI process to track and guide progress regarding CS waste. Of patients under 6 kg (n = 5), 80% had wasted CS blood before interventions, whereas those patients larger than 36 kg (n = 8) had 25% wasted CS before interventions. Seventy-five percent of patients under 6 kg who had wasted CS blood received packed red blood cell transfusions in the cardiothoracic intensive care unit within 24 hours of their operation. After data collection and didactic education sessions (PDSA Cycle I), CS blood volume waste was reduced to 5% in all patients. Identification and analysis of the root cause followed by implementation of education, training, and management of change (PDSA Cycle II) resulted in successful use of 100% of all CS blood volume.
Key words: autologous blood / cell saver / quality improvement / Plan–Do–Study–Act / fishbone / key driver diagram / multidisciplinary team / cardiopulmonary bypass / continuous quality improvement / cell saver waste / pediatric
© 2014 AMSECT
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