*1 unit apheresis = 2 units whole blood. Lowest platelet count this episode: Massive Transfusion Protocol. Clinical Audi
Massive Transfusion Protocol Clinical Audit Tool Audit Information Facility Name:
Date of Audit:
Clinical unit/ward MTP initiated:
Date of MTP Activation: Time of MTP activation: Time of MTP deactivation: *if times are not known, enter 'unknown' in boxe
1. Does the organisation use a MTP that includes the dose, timing and ratio of blood component therapy
1.
Patient Demographics Patient identification/medical record number:
Patient gender:
Consultant/treating specialist:
Patient age (years):
Clinical Speciality:
Reason for admission: Type of case: Thoracic trauma Abdominal trauma Pelvic trauma Multiple long bone trauma Obstetric haemorrhage Gastrointestinal bleeding Vascular surgery Surgical bleeding Other
2. Did the patient have a pre-existing bleeding risk?
2.
Numerical Outcomes Number of RBC units:
Lowest Hb this episode:
Number of platelet units:
Lowest platelet count this episode:
Number of FFP units:
Highest INR this episode:
Number of cryoprecipitate units
Highest APTT this episode:
g/L
Count x 10
9
/L
*1 unit apheresis = 2 units whole blood Lowest fibrinogen this episode: Other:
g/L
*Episode is defined as the time between activation and deactivation of the MTP (product)
(units)
Cell salvage volume reinfused: mL
MTP Audit Details 3. Was the MTP activated appropriately according to your organisation's definition (in accordance with local policy)?
3.
4. Were RBCs released prior to activation?
4.
If so, how many? 5. Was the patient's identity known at the time of activation?
5.
6. Was the lab notified of massive blood loss (if known)?
6.
7. Was a haematologist/transfusion specialist notified?
7.
8. Was early baseline pathology performed (within 15 minutes of MTP activation)?
8.
(Full Blood Count, Coagulation screen (PT,INR, APTT, Fibrinogen), biochemistry, arterial blood gases) 9. Was ongoing pathology performed (every 30 - 60 minutes)?
9.
(Full Blood Count, Coagulation screen, ionised calcium, arterial blood gases) 10. Was the patient's temperature documented early and frequently?
10.
(within 15 minutes of MTP activation and every 15 minutes thereafter) 11. Was the lab notified of MTP cessation?
11.
Additional Measures 12. What was implemented to stop bleeding? Surgical Management Angiography Other 13. Was intraoperative cell salvage used?
13.
14. Was tranexamic acid administered?
14.
15. Was Factor VIIa administered?
15.
16. What was the outcome for trauma patients?
16.
17. What was the outcome for non-trauma patients?
17.
Appropriate activation RBCs released prior to activation Patient identity Lab notification of massive blood loss Haematologist Baseline pathology Ongoing pathology Temperature
MTP AUDIT DETAILS
NUMERICAL OUTCOMES
Pre‐existing bleeding risk
Type of case
Reason for admission
Patient Gender
Patient Age (years)
Patient ID/Patient Number
PATIENT DEMOGRAPHICS
Massive Transfusion Protocol
Date of MTP Activation
Clinical unit/ward MTP initiated
Massive transfusion
Critical bleeding
15 Factor VIIa
14 Tranxemic acid
13 Intraoperative cell salvage
12 Surgical management or angiography
11 MTP cessation
3 4 5 6 7 8 9 10
2
1
Data point
AUDIT INFORMATION
Rationale:
Compliance with Patient Blood Management Guidelines Module 1: Critical Bleeding Massive Transfusion Recommendation 2; 4.6 Effect of recombinant activated Factor VIIa on outcomes
4.5 Effect of non‐transusion interventions to increase haemoglobin concentration 4.9 Effect of tranxemic acid
3.5 Surgical management
3.3 Early clinical assessment; 4.1 Effect of physiological paramenters on outcomes Appendix G Massive Transfusion Protocol template
4.4 Effect of red cell transfusion on outcomes 4.6 Effect of recombinant activated factor VII on outcomes 4.7 Effect of blood components on outcomes 4.8 Triggers for blood component transfusion
Compliance with Patient Blood Management Guidelines Module 1: Critical Bleeding Massive Transfusion Recommendation 1; 4.2
What Guideline/Standard does it support
…compliance with Patient Blood Management guidelines recommendation
…if the lab was notified when the MTP had ended
…if the patient received adequate early clinical assesment
…to determine if the patients identity was known …if the lab was notified of massive blood loss …if the haematologist was notified of massive blood loss
…if the MTP was activated in accordance with local policy
Collection of this data allows for filtering and reporting on specific patient groups
Collection of this data allows for filtering and reporting on specific patient groups and time frames
…compliance with Patient Blood Management guidelines recommendation
Collection of this data allows for filtering and reporting on specific patient groups and time frames
The data point is being collected to assess..
Collection of this data point can assist in evaluating the use of Factor VIIa
These data points may assist in the assessment of the MTP process and patient management
Notification of MTP cessation can assist in evaluating communication as part of the MTP process
These data points may indicate whether adequate patient assessment and monitoring has occurred
These data points can assist in evaluating appropriate management and communication as part of the MTP process
Numerical outcomes can assist in assessing the effect of transfusion on patient outcomes, determining whether the process meets patients clincial needs, ordering and communication during MTP and risk
These data points may assist in identifying particular patient groups at risk
This is a system‐level data point to ascertain compliance with PBM guideline
An example of how this data point can be used to support quality improvement
In children, 'massive transfusion' may be defined as a transfusion o f more than 40 mL blood/kg (the normal blood volume of a child is 80mL/kg)
In adults, 'massive transfusion' may be defined as a transfusion of half of one blood volume in 4 hours, or more than one blood volume in 24 hours (adult blood volume is approximately 70mL/kg)
Major haemorrhage that is life threatening and is likely to result in the need for massive transfusion
This data point refers to damage control surgery or angiography to stop bleeding. It may constitute a return to theatre or additional measures during routine or emergency surgery to stop haemorrhage
The collection of numerical outcomes is voluntary and can be used to determine a snapshot of local patient population. Hb result can be obtained from pathology results or Point of Care testing. Caution should be taken in interpreting Haemacue results.
Oral Anticoagulants (NOACs/Warfarin), Haemophilia,Other Blood Disorder, Other
Medical record number Age of the patient at the time of transfusion, calculated from the date of birth Sex at the time of transfusion ‐ male, female, indeterminate
This data point needs to be completed once per participating facility
The place where the transfusion was administered
Notes/Definitions
