Implementation of a Blood Product Conservation Project on the Cardiac Surgery Intensive Care Unit

Abstract

Problem: In 2020, 16 blood products were wasted (0.34% of products issued) on a 22-bed Cardiac Surgical Intensive Care Unit (CSICU), reflecting over $2,000 in wasted revenue. Wasting these limited life-saving resources infers disrespect to donors and indicates systemrelated inefficiencies. Incorrect storage conditions of unused Massive Transfusion Event (MTE) products render them unsuitable for re-entry into blood bank circulation due to internal product temperatures deviating from established safe parameters, contributing to 50% of the wastage in 2020. Purpose: The purpose of the quality improvement (QI) project was to implement and evaluate an evidence-based blood cooler checklist presented on MTE coolers that identifies the storage and transport conditions of blood products for registered nurses (RNs) in the CSICU. Methods: Registered nurses (RNs) were able to access a blood product storage checklist by scanning Quick Response (QR) codes on MTE cooler lids. CSICU RNs completed and submitted these checklists through Smartsheet, a HIPAA-compliant file-sharing system, permitting data collection on RN adherence to the practice change. One-on-one education and knowledge comprehension assessments for CSICU RNs, advanced practice providers (APPs), and blood bank staff were delivered by project champions. The project outcome, blood waste, was measured using the institution’s event-reporting system. Results: Post-implementation data revealed 100% (n=122) of CSICU RNs and 100% (n=19) of CSICU APPs were educated on blood product conservation techniques, 100% of MTE coolers issued (N=52) contained a QRcode accessible checklist, 67% (n=35) of the MTEs were associated with a completed checklist, and 13 blood products were wasted (0.86% of products issued [N=1,510]). While blood product wastage as a percentage issued increased from 0.34% pre to 0.86% post-implementation, there was a reduction in MTE blood waste due to improper storage conditions (50% pre versus 46% post-implementation). Blood waste due to improper storage was associated with only one MTE cooler post-implementation, as opposed to multiple MTE coolers pre-implementation. Conclusions: The use of an evidence-based checklist on MTE coolers in addition to RN and APP-directed educational sessions on blood conservation techniques can serve to increase staff adherence with proper blood product storage conditions, decreasing blood product wastage.