"A DESCRIPTIVE STUDY TO ASSESS THE KNOWLEDGE ON BLOOD TRANSFUSION AMONG STAFF NURSES WITH A VIEW TO PROVIDE SELF INSTRUCTIONAL MODULE IN SELECTED HOSPITALS AT TUMKUR."
PROFORMA FOR REGISTRATION OF SUBJECT
FOR DISSERTATION
SUBMITTED BY
Mrs. NISHA B.S.
FIRST YEAR M.Sc (NURSING)
MEDICAL AND SURGICAL NURSING
SRI SIDDHARTHA COLLEGE OF NURSING
AGALAKOTE, TUMKUR.
rajiv gandhi university of health science
bangalore, karnataka
proforma for registration of
subject for dissertation
1. / NAME OF THECANDIDATE AND
ADDRESS / Mrs. NISHA B.S.
FIRST YEAR MSC NURSING
SRI SIDDHARTHA COLLEGE OF NURSING
AGALAKOTE, TUMKUR.
2. / NAME OF THE
INSTITUTION / SRI SIDDHARTHA COLLEGE OF NURSING AGALAKOTE,
B.H. ROAD, TUMKUR.
3. / COURSE OF STUDY
AND SUBJECT / FIRST YEAR MSC NURSING
MEDICAL AND SURGICAL
NURSING
4. / DATE OF ADMISSION
TO COURSE / 08TH JUNE 2009
5. / TITLE OF THE STUDY / "A DESCRIPTIVE STUDY TO ASSESS THE KNOWLEDGE ON BLOOD TRANSFUSION AMONG STAFF NURSES WITH A VIEW TO PROVIDE SELF INSTRUCTIONAL MODULE IN SELECTED HOSPITALS AT TUMKUR."
6. BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION:
Life begins not at the time of fertilization or conception but when blood first appears in the embryo, at about 20 days following conception. A person can experience a relatively minor injury, and suffer the total process of exsanguinations the complete loss of blood. Their body may appear almost entirely intact and yet the person would lie dead in a pool of their own blood. Ancient people would have noticed this. Blood would come to be viewed as the life force, or as a fluid that contains the life force.3
Early religions including Judaism, assigned magical power to animal and human blood. The first writing of embryology, cellular microbiology and biological transformation / pleomorphism is found in the Old Testament. 'For the life of flesh is in the blood.' (Leviticus 17:14)3
The first documented human to human blood transfusion took place in 1818 and today packed red blood cells (PRBC) infusions are a corner stone therapy in modern critical care practice.4
There is no substitute for human blood. It cannot be manufactured. Transfusion of blood saves life. An error in the blood transfusion, at the same time takes life.5
Massive blood transfusion saves the lives of thousands of severely injured patients each year. Injury is rapidly becoming the second leading cause of death in the world. These deaths are highly preventable with social and engineering controls and good trauma care. Massive transfusion is readily available, safe, effective and cheap in the context of modern trauma center care.6
According to WHO 'safe blood' is blood that does no harm to the person who receives it. A transfusion is the transfer of whole blood or blood components (red blood cells only or plasma only) into the blood stream.1
A transfusion is most often given to alleviate anemia or when blood volume is low for example, after a severe hemorrhage.1 The procedure known as 'blood letting' has a much longer history in medical history : 2500 years. Ironically, thought to be the major treatment for 'all that ails you', blood letting has actually proved to be detrimental to health. We can only hope that our current practice of blood transfusion does more good than harm.4
In the early 1980's when human immunodeficiency virus was identified and found to be transmitted via blood, the risk/benefit analysis of PRBC transfusion came into question. From the subsequent changes in transfusion practices and clinical outcome evaluation data, much has been learned about the benefits and risk of blood administration.4
Not surprisingly, viruses are not the leading cause of transfusion caused illness and death (called transfusion - related morbidity / mortality). Illness / death from blood transfusions are most often caused by bacterial contamination of platelets (1:2000-3000 transfusions), transfusion errors from patient misidentification (1:16,000-19,000) and transfusion related acute lung injury (TRALI) (1:1000-5000).7
Blood transfusions could be likened to chemotherapy. A blood transfusion will only improve outcomes when used in the right patient for the right indication and in the right dose.7
6.1 NEED FOR THE STUDY
Nurses being responsible for the final bedside check before transfusion, have the final opportunity to prevent a mis-transfusion. Blood products most often transfusion by nurses include packed red blood cells, fresh frozen plasma, and platelets. An understanding and knowledge of the pathophysiology of transfusion reactions, symptoms and treatment is essential to safely administer and monitor transfusions.5
Nurses can increase compliance in high-risk areas of transfusion process and reduce the potential for errors by developing accessible blood transfusion policies, auditable performance standards and training and educational initiatives.5
Blood transfusion therapy can save and enhance patient’s lives but careful consideration must be given to the associated dangers. Nurses must have the skills and knowledge required to care for patients receiving blood components. It is important for nurses to understand the correct and safe way to approach transfusion practice as it is a constant and central component of modern health care. At every stage of the transfusion process the nurse is responsible for the part they play in making sure that the correct patient receives the correct blood and also that blood components are used and handled with care.8
A recent study has identified 1) Patient misidentification 2) Preliminary diagnostic errors and 3) Final diagnostic errors in blood transfusion.5
Blood transfusion side effects continue to persist despite of many advances in transfusion practice. Although numerous steps to reduce the risks of blood transfusions have been put in place by the blood collection industry, there is still considerable risk. Perhaps a blood transfusion has never been safer than in current times.7
Security, safety and trust in transfusion are variable. Guidance about blood and components depends on the expertise of personnel. Blood transfusion an elaborate procedure and performing this procedure for a patient requires adequate skills and knowledge.9
A serious immuno hemolytic accident occurs in about 1/6000 to 1/29000 transfusions. IN the united states, there are about 5,00,000 heart bypass operations performed each year. Researchers at the university of Michigan studied 9218 persons aged 65 or older who had coronary bypass surgery. They learned that patients who had received blood transfusion were five times more likely to die within 100 days of the surgery than patients who were not transfused.10
The 2004 CRIT study, was an observational study that looked at transfusion practices in the united states. The investigators found that despite the known risks, blood administration practices have not changed in the last decade.4
An earlier European study, the anemia and blood transfusion in critical care study( ABC Study), reached the same conclusion.4
An evaluative study was conducted to assess the student nurses knowledge of transfusion practice following a standardized teaching and learning programme within a school of nursing. The sample size(n) was 118. The result was attained on the day of the session 4-6 months, and 11-12 months following the session. The study showed that within the small sample completing at all 3 time points, that there is clear degradation of knowledge during the study period. The influence of experience on knowledge retention appears to have a positive effect at 6 months but no appreciable effect at 12 months.11
An evaluative study was conducted to assess the practice patterns and quality assurance on medical and non medical personnel. The study concluded the success of a change of practice patterns relies on hospital administration, positive role, education and feedback, written and immediately available guidelines, employment of specially trained personnel, longstanding actions. The study also suggest that future accreditation of hospitals based on well defined and well implemented procedures will also be a major help to increase the quality of the transfusion process.12
A nurse, by profession has opportunities to establish policies and procedures, design nursing practices, and educate staff to help avoid blood transfusion errors. There is an urgent need of training programmes in nursing units that educate nurses on blood transfusion risk reduction, latest safety guidelines, nurse interventions / decision making. There is also a need for the nurses to be aware the recent advances / technological innovations in planning / management of transfusion medicine. Evidence based clinical guidelines for individual blood components, transfusion monitoring systems / quality assurance programme are vital to prevent blood transfusion errors.5
6.2 REVIEW OF LITERATURE
1. A descriptive study was conducted in Iran : The objective was to assess the knowledge of health workers about proper methods of blood transfusion and how to promote their knowledge for proper performance if their knowledge is inadequate. The data were collected with aimed questionnaire and analysed by statistics software. Their sample size was 122. The main findings from this study showed that 26.2% of health care workers had low level knowledge, 22.1% moderate and 51.6% acceptable knowledge "the study concluded that results strongly emphasized the need for curriculum to promote knowledge of health care workers about blood transfusion and suggest that more attempts should be made to build up knowledge about blood transfusion.9
2. A study was conducted in 14 hospitals in Aquitaine, France in a setting of hospitalized care. The objectives of the study were to measure the potential threat for patient safety of poor transfusion related knowledge and practice as well as to identify factors associated with poor knowledge and practice. They did random sampling for selecting participants. The main outcome was hazardous knowledge and practice across have been constructed, reflecting the levels of potential danger in the answers to the questionnaire. The finding's was in a sample of 1090 nurses, poor knowledge and practice concerned mainly the bed side blood compatibility test (proportion of responses (PR) with potential life threat between 12.7 and 35.5%), pre transfusion compatibility check when receiving blood units (PR=34.5%), delay between screening of red cell antibodies and transfusion (PR=20.5%), delay in presentation of blood unit in the ward (PR = 33.4%) and recognition of abnormal reactions after transfusion (PR=47.1%). The study concluded that low training and transfusion activity were key determinants of poor transfusion related knowledge and practice.13
3. A cross sectional study to assess awareness about blood safety and blood donation among different categories of health care providers (HCP)s and to ascertain their perceptions about blood donation was conducted in Calcutta. The participants were 208 health care providers including doctors, trainee doctors, nurses, group D and other staff including technicians etc. The study concluded that awareness about blood safety was least among group D but not satisfactory even among doctors and other HCP's. Among HCP's, 69.7% of trainee doctors, 43.3% of 'other group' of staff, 23.3% doctors, 8% of nurses, and no group D staff knew about all the mandatory tests for collected blood. Regarding awareness about guidelines for blood donors and blood donation, most HCPs were aware about needle safety (70.7%), highest being the doctors (93.3%), followed by nurses (84%) and trainee doctors (81.8%).14
4. A Descriptive study was conducted to identify blood transfusion practice and knowledge of 100 nurses from three hospitals in Ankara, Turkey. Nurse's knowledge and practice related to blood transfusions were measured against a total score of 100. The finding was none of the participating nurses achieved a score of 100, and only a few had scores higher than 50. Although a positive correlation existed between the nurses knowledge and practice scores The results of the study should insufficient knowledge about blood transfusion, which was reflected in undesisable practice.15
5. An observational study was conducted in Mulago Hospital, Uganda on physicians, paramedics, nurses, medical students and nurse students to assess the relation between adverse transfusion reactions resulting in morbidity and death of patients who receive a blood transfusion. The findings. were guidelines for blood transfusion were not easily available. Students perform poorly due to inconsistency in their supervision. Documentation of blood transfusion in patient files is scarce. There is no immediate bedside observation, so transfusion reactions and obstructions in the blood transfusion flow are not observed. The study concluded that the poor blood transfusion practice is likely to play a role in the morbidity and mortality of patients who receive a blood transfusion. There is a need for a blood transfusion policy and current practical guidelines.16
6. A Descriptive study was conducted to identify blood transfusion practice and knowledge of 100 nurses from three hospitals in Ankara, Turkey. The data collected through observation and interviews were evaluated using percentages, X2, and correlation methods. Nurse's knowledge and practice related to blood transfusions were measured against a total score of 100. The finding was none of the participating nurses achieved a score of 100, and only a few had scores higher than 50. Although a positive correlation existed between the nurses knowledge and practice scores, the correlation coefficient was insignificant. There was a statistically significant relation between the experience and knowledge scores, but not between the experience and practice scores. The results of the study should insufficient knowledge about blood transfusion, which was reflected in undesirable practice.
7. A descriptive study was conducted in staff in 14 state-run hospitals in France to assess the knowledge in blood transfusion among medical staff. They used a structured questionnaire that contained 35 questions regarding: blood products, immuno hematology, and prescription of blood products, transfusion practice, and interpretation of the final bedside controls. The results obtained were the rate of correct answers (RCA) ranged from 14 to 89 %. The mean weighted score was 62%. This study has confirmed that medical staff have deficiencies in their knowledge of blood transfusion.18
8. A Retrospective study was conducted in medical intensive care unit of a tertiary care hospital in New Delhi with an objective to investigate current transfusion practice in the critically ill patients. The result of the study was that Nine hundred and eleven (50.1%) critically ill patients, comprising 71.6% males and 28.4% females, received blood/blood components. Out of this about 21.4% of PRC, 14.5% of FFP, and 19% of platelets were inappropriately indicated. In conclusion the Clinicians in this centre were conservative in keeping with recent transfusion guidelines. A significant number of blood request forms were still incomplete with baseline investigations not mentioned in the request forms.19