Implementation of Parameter Transfusion Orders for Stem Cell Transplant Recipients Results in Increased Nursing Autonomy, Decreased Transfusion Delays, and Improved Patient Care

Introduction: Stem cell transplant patients require frequent CBC monitoring and blood product transfusions.  On a high-census pediatric inpatient teaching service, delays were observed with blood product transfusions with a main factor being order initiation.  A transfusion parameter order was piloted to enable nurses to initiate transfusions earlier and plan infusions efficiently.

Methods: We developed an order set with a nursing transfusion parameter process for implementation.  The order set included parameters for PRBC and platelet transfusion and options for pre-medications and post-transfusion diuretics.  Inpatient pediatric nurses and physicians received a pre and post survey measuring attitudes about nursing role, and parameter orders.  Parameter orders were piloted for current inpatients and new admissions over a 3 week period.  CBC results and timing of transfusions were tracked prior to and during the pilot project for comparison.

Results: Percentage of all blood products distributed within 6 hours of lab draw improved from 34% to 49.2% between the pre and post-parameter order set study periods (Table 1).  When PRBC were considered alone, distributions within 6 hours of lab draw improved from 30.8% to 50% (Table 2). 

A total of 11 nurses and 5 physicians responded to the pre-parameter order set survey.  The majority agreed initiating parameter order sets were within nursing scope of practice (9/11, 4/5) and were confident in the nurses' ability to initiate them (9/11, 5/5).   A total of 10 nurses responded to the post-parameter order set survey.  The majority agreed blood product transfusion orders are initiated earlier (8/10), infused earlier (10/10), and the order set improved patient care (7/10). 

Conclusion: Implementation of parameter order sets for blood product transfusion increases nursing autonomy to initiate indicated transfusions, decreases transfusion delays, and improves patient care.  Based on the positive results of this pilot, there is great potential for parameter order applications for electrolyte replacement.