Massive Transfusion Expectations:

Lost in TranslationPatricia Ablitt

Monash HealthDandenong Hospital

NICE 2017

Dandenong Hospital

Laboratory

• 4 units red cells• 2 FFP• 1 platelets• Contact Haematology Registrar• Consider tranexamic acid• Consider cryoprecipitate if:

• Fibrinogen < 2.0g/L for obstetric patients• Fibrinogen <1.5g/L for other patients

The Problem

• A consultant anaesthetist with trauma experience activated MTP in theatre

• Expectation was that products would be sent to theatre immediately

• Red cells ready, FFP thawing – runner given RCs & told FFP not ready, still thawing

• Message relayed to theatre “BB will not give FFP”

The Aftermath

• Phone call from one anaesthetist to thank the scientist for her hard work

• Several days later an incident report was received from the consultant anaesthetist claiming serious delays in obtaining product & Blood Bank refused to issue products

Meeting of the Minds

Several meetings were held with:

• Scientists• Quality manager• Transfusion nurses• Haematology

consultants & registrars• Head of anaesthetics• MH Pathology director• Senior medical director

Decisions were Made

The Solutions

• Create a clinical training power point • Develop clear communication – ISBAR• Training of theatre & anaesthetics staff at all MH

sites• TWG to review the next 10 MTP activation• Create & run mock activation of MTP with

scientific staff• Have 2 AB FFP thawed & ready at all times

MTP ISBAR

I IDENTIFY• Provide BB with your name, position & phone contact details. • ONE contact person

S SITUATION• BRIEF description of clinical problem e.g. major bleed, coagulopathy• INFORM whether products required immediately or time estimate of

when requiredB BACKGROUND

• Inform BB if patient on anticoagulants/anti-platelet etc• Inform BB of current Hb (ABG, Hemocue) if available

A ASSESSMENT• Inform BB of estimate of type & quantity of products likely to be

required

ISBAR (cont)

R REQUEST• Inform BB type & number products require NOW• BB will inform you of the QUANTITY & TYPE OF PRODUCTS

THEY CAN IMMEDIATELY RELEASE• BB will inform you of ANY delay in being able to provide

products• If MTP is verbally triggered or product request meets or

exceeds MTP, BB scientist will contact Haem Reg or consultant to RING the theatre contact anaesthetist to provide ongoing clinical support

• BB will release immediately the initially requested number of red cells, without approval from Haem Reg

Is it Working?

• Training has occurred for medical & scientific staff

• So far – no further complaints but thanks• Scientists are aware of the communication

required• 2 AB FFP thawed at all times across all MH

sites

Team Work – all pulling in the same direction

Thank you