Pre-registration adult nurses’ knowledge of safe transfusion practice: Results of a 12month follow-up study

The Development and Effectiveness of Combining Case-Based Online Lecture and Simulation Programs to Facilitate Interprofessional Function Care Training in Nursing Homes

The aim of this study was to (1) develop a case-based combination of online lectures and simulations for function-focused care by nursing home interdisciplinary caregivers and (2) evaluate participants' increasing shared team and task knowledge by surrogate measures of team process and team performance. The study comprised the following steps: (1) the design of a learning module using a shared understanding of function-focused care as a shared mental model; (2) the establishment of two computer programs for online lectures and simulations using cases involving older adults with disabilities; and (3) testing the educational programs using a repeated-measures design. Participants were 61 interdisciplinary caregivers from seven nursing homes in four regions. Data from participants' team process and team performance were collected pre test, post online lecture, and post simulation. Repeated-measures analysis of variance showed that the mean scores for scales of "transactive memory system," "knowledge sharing and utilization," "team outcomes," "motivation for learning transfer," "self-efficacy," "interpersonal understanding," "proactivity in problem solving," and "function-focused care knowledge" differed significantly between the time points. The results indicate that a case-based program of a combination of online lectures and simulations elicits significant improvements in participants' team process and team performance.

Safe Blood Transfusion Practices among Nurses in a Major Referral Center in Ghana

Errors in transfusion of blood and blood products can lead to preventable morbidity and mortality. Nurses constitute a significant aspect of the transfusion process as they are the last in the chain of getting blood directly to the patient. They must, therefore, be conversant with the current standard of national and international guidelines on blood transfusion and appropriate management of adverse transfusion events. This study assesses the knowledge and practices of blood transfusion safety among nurses at Komfo Anokye Teaching Hospital. A descriptive cross-sectional design was employed, and structured questionnaire (Routine Blood Transfusion Knowledge Questionnaire) was used to collect data from 279 nurses from seven clinical directorates of the hospital. The data were processed with Stata version 14.0. Variables were analyzed using descriptive statistics, and relationships were drawn using inferential statistics. Over 90% of the respondents had a minimum of a diploma in nursing or midwifery, 63% had performed blood transfusion at least 5 times, and 46% had never received any training on blood transfusion. The mean score obtained in all four categories of blood transfusion knowledge assessed was 29, with 54% of the respondents scoring below the mean. The highest overall score on knowledge was 53%. This indicates that nurses had poor knowledge regarding safe blood transfusion practices as stipulated in the clinical guidelines for blood transfusion by Ghana's National Blood Service. There was no statistically significant relationship between training/experience and knowledge of safe blood transfusion practices. Regular and continuous update training and audit are needed to safeguard patient safety during blood transfusion.

A survey of nurses to assess transfusion practice at the bedside using an electronic identification system: Experience at a university hospital

OBJECTIVES

The objective of this study was to assess the performance and recognition of transfusion practice at the bedside by nurses in our hospital, where a barcode-based electronic identification system (EIS) has been used since 2002.

BACKGROUND

More than half of the steps in the transfusion chain are dependent on nurses' awareness and skills.

METHODS

Our transfusion policy at the bedside includes two-person checking of the patient and two-person signing of the label at the time of collecting blood samples for pre-transfusion testing and two-person blood administration, which generally involved a doctor-nurse pair but sometimes involved two nurses. Anonymous, paper-based questionnaires were sent in January 2018 to 1051 nurses who were working in Juntendo University Hospital, Tokyo, Japan. The questionnaire consisted of three parts: (a) background of respondents, (b) performance of collection of blood samples for pre-transfusion testing and (c) performance of pre-transfusion check procedures at the bedside using an EIS based on a total of 20 questions.

RESULTS

There was a good response rate of individual nurses (1006/1051, 96%). Most nurses (>90%) performed two-person checking of the patient and two-person signing of the label at the time of collecting blood samples. Most nurses (>90%) performed two-person blood administration involving a doctor-nurse pair and electronic pre-transfusion check using an EIS before blood administration.

CONCLUSIONS

The survey revealed that most nurses complied with our transfusion policy at the bedside, but some nurses did not. Further education/training and continuous support by the transfusion service may be needed for all nurses.

Using Failure Mode and Effects Analysis in Blood Administration Process in Surgical Care Units: New Categories of Errors

BACKGROUND

Blood administration failures and errors have been a crucial issue in health care settings. Failure mode and effects analysis is an effective tool for the analysis of failures and errors in such lifesaving procedures. These failures or errors would lead to adverse outcomes for patients during blood administration.

OBJECTIVES

The study aimed to: use health care failure mode and effect analysis (HFMEA) for assessing potential failure modes associated with blood administration processes among nurses; develop a categorization of blood administration errors; and identify underlying reasons, proactive measures for identified failure modes, and corrective actions for identified high-risk failures.

METHODS

A cross-sectional descriptive study was conducted in surgical care units by using observation, HFMEA, and brainstorming techniques. Prioritization of detected potential failures was performed by Pareto analysis.

RESULTS

Eleven practical steps and 38 potential failure modes associated with 11 categories of errors were detected in this process. These categories of errors were newly developed in this study. In total, 17 of 38 potential failures were detected as high-risk failures that occurred during the sample-drawing, checking, preparing, administering, and monitoring steps. For cause analysis of failures and errors, proactive suggested actions were undertaken for 38 potential failure modes, and corrective actions for 17 high-risk failures.

CONCLUSION

HFMEA is an efficient and well-organized tool for identification of and reduction in high-risk failures and errors in the blood administration process among nurses without building punitive culture. This tool also helps pay attention to redesigning and standardizing the blood administration process as well as providing training and educational programs for providing knowledge.

Assessment of Knowledge and Practice of Blood Transfusion Among Nurses in a Tertiary Care Hospital in India

The purpose of this study was to assess the knowledge and awareness of blood transfusion practices among nurses working in a tertiary care hospital. The objective was to make use of the results to decide the necessity of targeted teaching using lectures and simulated ward scenes. This was a cross sectional study in which a questionnaire comprising of 25 single best-response type multiple choice questions related to blood products and blood transfusion was distributed to nurses who were selected randomly. Questions were both knowledge and practice based. Five hundred and forty-six nurses consented and were assessed. The data was collected, entered and statistically assessed. The number of 'Correct', 'Incorrect' and 'Don't Know' answers were noted. Each correct answer was awarded 1 point, whereas a wrong answer and a 'Don't Know' answer received no points. The individual scores were noted and then multiplied by 4 to get a percentage value. Nurses with 1-5 years of experience scored statistically better than nurses with < 1 year and > 5 years of experience. Nurses working in the haematology-oncology ward scored the most number of correct responses, followed by nurses working in ICU. Only 9.9% of nurses answered > 80% questions correctly. Nurses who had 1-5 years of experience scored better. All nurses were trained in blood transfusion at induction. Though there were occasional non-compulsory lectures as ongoing programs, they had no specific impact on knowledge and awareness. The authors suggest that targeted and regular simulated training is essential at all levels of nursing experience.

Designing and evaluating the effectiveness of a serious game for safe administration of blood transfusion: A randomized controlled trial

BACKGROUND

Preparing nursing students for the knowledge and skills required for the administration and monitoring of blood components is crucial for entry into clinical practice. Serious games create opportunities to develop this competency, which can be used as a self-directed learning strategy to complement existing didactic learning and simulation-based strategies.

AIM

To describe the development and evaluation of a serious game to improve nursing students' knowledge, confidence, and performance in blood transfusion.

METHOD

An experiential gaming model was applied to guide the design of the serious game environment. A clustered, randomized controlled trial was conducted with 103 second-year undergraduate nursing students who were randomized into control or experimental groups. After a baseline evaluation of the participants' knowledge and confidence on blood transfusion procedure, the experimental group undertook a blood transfusion serious game and completed a questionnaire to evaluate their learning experience. All participants' clinical performances were evaluated in a simulated environment.

RESULTS

The post-test knowledge and confidence mean scores of the experimental group improved significantly (p<0.001) after the serious game intervention compared to pre-test mean scores and to post-test mean scores of the control group (p<0.001). However, no significance difference (p=0.11) was found between the experimental and control groups on the post-test performance mean scores. The participants evaluated the serious game positively.

CONCLUSION

The study provided evidence on the effectiveness of a serious game in improving the knowledge and confidence of nursing students on blood transfusion practice. The features of this serious game could be further developed to incorporate additional scenarios with repetitive exercises and feedback to enhance the impact on clinical performance. Given the flexibility, practicality, and scalability of such a game, they can serve as a promising approach to optimize learning when blended with high-fidelity simulation.

[Professional knowledge and practice mapping among nurses regarding transfusion therapy. A pilot study on reliability and validity testing]

INTRODUCTION

All people involved in transfusion therapy have professional, legal and ethical responsibility for their own actions.

AIM

The aims of the authors were to evaluate competencies, knowledge and practice of nurses about transfusion therapy.

METHOD

Descriptive statistical approach using observation, questionnaire survey and interview was applied. Reliability and validity of the self-made questionnaire were examined with statistical methods. Variance, standard deviation, Cronbach's alpha and Pearson correlations were calculated.

RESULTS

Transfusiology-related knowledge of nurses regarding current transfusion regulations was almost 90%, and 56.2% of nurses systematized the nursing functions correctly. Significant differences were found among different institutions in transfusion therapy, transfusion practice and the use of relevant documentation. 75-77% of the institutions examined had their own protocol, and assigned transfusion care nurses worked in more than 20% of the wards.

CONCLUSIONS

The authors propose a better supervision by leaders in nursing aspects of transfusion therapy, and an increased professional responsibility.

[Blood transfusion practices: about transfusions at night]

Blood transfusion safety covers all stages from prescription of immuno-haematological examinations until the completion of the transfusion. According to the 05/11/2006 Afssaps' decision on good transfusion practices, transfusions should not be given at night unless the patient is actively bleeding or has some other urgent clinical need. A retrospective study was used to assess the proportion of transfusions at night. Through this professional practice evaluation, we analyze the reasons leading to perform transfusions at late hours, in order to reduce errors and improve safety for patients.