Saving Time and Lives with a Blood Fridge

Aim: : Previous process for critical patients within the emergency department (ED) requiring immediate blood transfusions had a potential for a delay in care due to the location in relation to the blood bank. Due to increased census growth and staffing shortages within blood bank department, implementation and utilization of a blood fridge became inevitable. Receiving blood products from the blood bank and beginning transfusion could average 10 minutes or more.

The development of a process that allows staff to quickly remove blood from a blood refrigerator and to safely administer in a timely manner has the potential to improve patient outcomes. Our aim is to improve the efficiency in which critical patients receive blood products within the emergency department (ED).

Framework:: The PDSA cycle was utilized in development of an implementation for the process change. A multidisciplinary team was formed to include nursing staff from Emergency Services, nursing leadership, Emergency and Trauma services providers, and blood bank staff. Discussions included locations of fridges, development of nursing and physician procedures, and electronic documentation. Initial meetings with key stake holders occurred weekly to review utilization and opportunities for education and improvement.

Setting:: A magnet designated facility and the primary academic partner for a local university. The regions only combined pediatric and adult level 1 trauma and academic medical center located in the southwest. The hospital ED averages over 87,000 visits annually.

Stakeholder Team:: A multidisciplinary team was formed to include nursing staff from Emergency Services, nursing leadership, Emergency and Trauma services providers, and blood bank staff.
The group also met with the electronic charting development team and discussed needs for the orders being placed as well as nursing staff to successfully chart administration of blood.

Methods: : Our multidisciplinary team held discussions on current process for delivery and administration incomparison to ideal state. From these discussions the standard operating procedure (SOP) was outlined. Next steps included plans for education of staff, notification of all departments involved, and meeting with our electronic charting development team to make changes to the system. Quick charting of administration was immediately created in order to meet go live date with plans for optimization at a later time. We also created order sets for nursing and physician group to be able to utilize. For education, the nursing staff was given the opportunity to practice using the blood fridge with electronic charting and provided with a training video for reference.

Outcomes:: Placement and usage of fridges in high acuity areas has decreased blood bank’s need to individually prepare units for patients and respond in person. Implementation of this process has decreased over utilization of whole blood and shown to decrease time taken to administer. We successfully limited our use of paper documentation and implemented the process being recorded in the electronic health record.

Implications:: While decreasing delay times, we have also alleviated the demand on blood bank staff to respond in person to various patient scenarios amid staffing shortages. We have also seen a decrease in blood products waste with the implementation of unit fridges.