(P-TS-67) Massive Transfusion Protocol Improvement: A Multi-Disciplinary Approach

Background/Case Studies: Managing the Massive Transfusion Protocol (MTP) requires great communication and streamlined processes to ensure blood and components used for resuscitation are immediately and continuously available to the patient care team.  Our System utilizes an MTP poster to help with education, training and management of MTP in all ORs, Trauma Bays and ICUs.  With the utilization of Whole Blood (WB) in the prehospital setting and for trauma resuscitation, the Transfusion Medicine team needed to revise our standard MTP management poster.

Study

Design/Methods: Transfusion Medicine presented our current MTP poster to our two Level 1 Trauma Centers in their Trauma Multidisciplinary workgroups, to our Pediatric Trauma Multidisciplinary workgroup, and then to the System Patient Blood Management committee to review the requested changes and additions to the poster.

Results/Findings: Engagement in revising the MTP poster was broad and deep.  Trauma, Pediatrics, Obstetrics, Anesthesiology and Pharmacy all worked closely with the Transfusion Medicine team to include their needs in the management of the MTP. Our new MTP poster, Figure A, was updated to include: limiting crystalloids, maintaining normothermia, giving TXA within 3 hours of injury, calcium dosing for adults and pediatrics and instructions for when to give cryoprecipitate.  The three MTP pathways, Adult, Pediatric and Obstetric remained with updates to include whole blood when available and special attention to when pre-pooled cryoprecipitate would be included in the round.  Total Blood Volume and dosing guidelines for whole blood and components were also added to the Pediatric MTP pathway.

Conclusions: Affording all disciplines utilizing the MTP poster the opportunity to define their needs allowed for great conversation, multi-site and multidisciplinary collaboration, and led to the creation of a complete MTP poster to be utilized for training, education, and provide a real time guide in the management of the Massive Transfusion Protocol for staff in the Blood Bank, the Emergency department, the OR, the ICU and in Labor and Delivery at all of our hospital sites.