Where does this area fit within Jordan’s classifications of research priorities?

Knowledge and practice of blood transfusion: a survey of nurses in the north and middle regions of Jordan

Dr. Belal M Hijji, RN. PhDDr. Belal M Hijji, RN. PhDAssistant ProfessorAssistant Professor

Faculty of Nursing, Philadelphia UniversityFaculty of Nursing, Philadelphia University

Presented at thePresented at theKing Abdullah University Hospital, Irbid, King Abdullah University Hospital, Irbid,

Jordan Jordan 55thth April 2009 April 2009

Co-investigatorsCo-investigators Dr. Awa Oweis, Dr. Rasha Dabbour Dr. Awa Oweis, Dr. Rasha Dabbour

By

King Abdullah University King Abdullah University HospitalHospital 05.04.200905.04.2009 22

Where does this area fit within Jordan’s classifications of research priorities?

Quality of care has been identified by the JNC in the national health strategy as a high priority area


Learning objectives


By the end of this presentation, nurses/ educators will be able to:

Appreciate Appreciate the central role that nursing research plays in clinical practice

Value the importance of knowledge to competent nursing practice

Have an up-to-date knowledge underpinning the care of patient in need of blood transfusion

Understand how patients in need of transfusion are vulnerable to various types of errors that nurses can prevent or eliminate


ContentsContents

• BackgroundBackground• Aim and objectivesAim and objectives• MethodsMethods• ResultsResults• RecommendationsRecommendations


BackgroundBackground


Nurses play a crucial role in the administration of Nurses play a crucial role in the administration of blood transfusionsblood transfusions

Their relevant knowledge and practice are Their relevant knowledge and practice are important determinants of the safety of important determinants of the safety of

transfusionstransfusions

Published information about nurses' blood Published information about nurses' blood transfusion knowledge and practice is lackingtransfusion knowledge and practice is lacking

To fill this information gap, this study To fill this information gap, this study was undertaken in Jordanwas undertaken in Jordan


AimAim


Principal AimPrincipal Aim

To investigate nurses’ knowledge and practice of To investigate nurses’ knowledge and practice of blood transfusionblood transfusion

Objectives

A. Investigate nurses’ knowledge and/ or reported practice of:1. Patient preparation before blood collection2. Blood pack collection3. Pre-transfusion initiation nursing activities4. Post transfusion initiation activities and issues

B. Identify statistically significant differences in mean knowledge scores of nurses with different characteristics


MethodsMethods


Design, Settings and Access

1. A descriptive cross-sectional survey using an interviewer-administered questionnaire

2. The study involved in-patient areas where blood transfusion events were common

3. Four teaching and public hospitals

4. Ethical approvals5. Participant information sheet6. Voluntary informed consent7. Anonymity and confidentiality


Population and sample

Population: 906 nursesPopulation: 906 nursesSample: 320 nurses selected at random Sample: 320 nurses selected at random Inclusion criteria: Registered nurses with Inclusion criteria: Registered nurses with direct care responsibilitiesdirect care responsibilitiesExclusion criteria: Auxiliary staff, head Exclusion criteria: Auxiliary staff, head nurses, and nurses in out-patient areas and nurses, and nurses in out-patient areas and OT.OT.


An overview of data collection

Nurses’ knowledge and reported practice of blood transfusion was measured via a questionnaire developed following consultation with nursing literature. It has 44 items in seven sections. A: nurses’ demographics and training (8 items); B: patient preparation before blood collection (4 items); C: blood bag collection (3 items); D: pre-transfusion initiation nursing responsibilities (8 items); E: post transfusion initiation nursing responsibilities (11 items); F: complications related to blood transfusion (8 items); and G: issues related to local policies (2 items).


Validity and Reliability of the Questionnaire

1. A panel of seven international transfusion specialist nurses

2. Pilot study3.3. The Flesch Reading Ease (RE) Index is 66.15.


An overview of data collection (continued…)

Data collection started on 5th November 2008 and was completed by 31st January 2009.

Two research assistants collected the data They attended a session on questionnaire

administration and collection They received written instructions


Data AnalysisData Analysis

Allocation of scores

For most items, one point was awarded for the

correct answer and 0 for the incorrect one. The

maximum score was 57 (100%) points. Descriptive

and inferential statistics were used to analyse data


ResultsResults


Knowledge ScoresMean Median Mode Range Skewness Kurtosis SD

51.3 52 53 13-70 - 0.74 2.44 7.3

Scores out of 100

70.060.050.040.030.020.0

Nurses' knowledge scores

Num

ber

of

nurs

es

160

140

120

100

80

60

40

200

100

152

42


305 nurses (95.3%) filled in the questionnaire

City of study and hospital affiliation

120.00

185.00

143.00

162.00

MOH hospital

univ. hospital

Irbid

Amman


Nurses' demographic characteristics

189.00

115.00

5.00

36.00

249.00

13.00female

male

other qualifications

dip. gen. nur.

BSN

Master


Nurses' length of ward experience

Num

ber

of nurs

es

200

160

120

80

40

0


Level of involvement in blood transfusion

75.00 / 24.7%

31.00 / 10.2%

70.00 / 23.0%

95.00 / 31.3%

33.00 / 10.9%> 12 times

9-12 times

5-8 time

1-4 times

None at all


In-service training

279.00 / 92.4%

23.00 / 7.6%

Never

Yes


Nurses' perceived training needs

25.00 / 4.6%

146.00 / 26.7%

154.00 / 28.2%

100.00 / 18.3%

65.00 / 11.9%

56.00 / 10.3%

none

serious hazards

adv. reactions

administration

blood collection

sampling


Patient preparation before blood collection

38.00

100.00

90.00

143.00

incomplete order

premedication

patient is ready

patency of IV line


Blood pack collection

26.00

100.00 154.00

knowledge of ABO

transport box Right blood


Possible Transfusion Combinations

From: http://www.redcrossblood.org/portal/NC/facts.htm

Blood Type Can be given to patients with type

0+0+ 0+, A+, B+, AB+ 0+, A+, B+, AB+

A+ A+, AB+

B+ B+, AB+

AB+ AB+ AB+

0- 0+, A+, B+, AB+, 0- , A- , -B , AB-

A- A+, AB+, A- , AB-

B- B+, AB+, B- , AB-

AB- AB+, AB-


Preadministration nursing responsibilities

210.00

88.00

138.00

241.00

91.00final check omission

cause of fatality

blood warming

pt. education

pt. identification


Preadministration nursing responsibilities (continued...)

169.00

24.00

117.00

ident. proc.

blood handling

timeliness


Pre transfusion initiation activities (contin...)

15.00

71.00

273.00

administration set

filter size

vital signs


Post transfusion initiation nursing responsibilities

136.00

171.00

61.00127.00

226.00

physical observation

ind. for slow bt.

slow transfusionvital signs

routine activities


Post transfusion initiation responsibilities (contin...)

151.00

172.00

144.00

compatible agents

preventive practice

risk of bact. growth


Post transfusion initiation responsibilities (contin..)

193.00

134.00

138.00

255.00

219.00

cardiac arrythmias

mgt of rash

urticaria

mgt of AHTR

hemolytic reactions


Inferential StatisticsOne-way ANOVA revealed no statistically significant differences in nurses’ mean knowledge scores with different hospital affiliation, qualifications, gender, level of involvement in blood transfusion, ward experience, and previous training


Key Findings Nurses had serious knowledge deficits and practice deficiencies that are potentially threatening to patients health and safety Patients were at risk of developing complications, in particular bacterial infection, destruction of red blood cells, and receiving incorrect transfusions


RecommendationsRecommendations


Action is needed, nationwide, to assist nurses in the pursuit of safer blood transfusion practice

Strengthening the nursing workforce by implementing urgent bedside training as recommended by the WHOSystems must be developed to ensure that nurses are competent in performing blood transfusionDevelopment of blood transfusion policies and guidelines for nurses Collaboration between service providers and higher education institutions


Wrong blood was transfused

No of incidents (incidence per units supplied for transfusion)

Total 111* (1/29 000)

Cause or place of error:

Wrong blood in tube 23

Laboratory 6

Ward or theatre staff checked or 82

transfused wrong blood

Outcome of error:

Death 6 (1/550000)

Morbidity 12 (1/275 000)

No adverse effect 93 (1/36 000)

Errors in blood transfusion (3.3 million red cell units)

(McClelland, D. and Phillips, P. (1994). BMJ ;308:1205-6)


Cumulative numbers of cases reviewed 1996-2007 (n = 4335)

128.00 / 3.0%

396.00 / 9.1%

534.00 / 12.3%

342.00 / 7.9%

219.00 / 5.1%

2716.00 / 62.7%

Other

Anti-D

ATR

HTR

TRALI

IBCT

Re-produced with permission from the UK Serious Hazards of Transfusion (2008) Initiative


The UKThe UK JordanJordan

Blood Safety and Quality Regulation is a law in force, and the Health Service Circular, Better Blood Transfusion – Safe and Appropriate Use of Blood

Do we have similar legislation????

Training and competency assessment is required by law

Absent. Nurses transfuse pts. without any training

Mandatory adverse incidents reporting to a competent authority

Some form of voluntary reporting is in place

How does Jordan compare with the UK concerning blood transfusion safety regulations?


AcknowledgementsAcknowledgements


We are immensely grateful to the Ministry of Health, all nursing staff, and hospitals for their valuable support. We express our gratitude to Philadelphia University Deanship of Scientific Research and Postgraduate Studies for funding the study.


Thank You

Principal Investigator

[email protected]

Where does this area fit within Jordan’s classifications of research priorities?

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