Quality Improvement Project of a Massive Transfusion Protocol (MTP) to Reduce Wastage of Blood Components

Abstract

Massive transfusion protocols (MTPs) facilitate the organized delivery of blood components for traumatically injured patients. MTPs vary across institutions, and ratios of blood components can change during clinical management. As a result, significant amounts of components can be wasted. We completed a review of all MTP activations from 2015 to 2018, providing an in-depth analysis of waste in our single Level 1 trauma center. An interdepartmental group analyzed patterns of blood component wastage to guide three quality improvement initiatives. Specifically, we (1) completed a digital timeline for each MTP activation and termination, (2) improved communications between departments, and (3) provided yearly training for all personnel about MTP deployment. The analysis identified an association between delayed MTP deactivations and waste (RR = 1.48, CI 1.19–1.85, p = 0.0005). An overall improvement in waste was seen over the years, but this could not be attributed to increased closed-loop communication as determined by the proportion of non-stop activations (F(124,3) = 0.98, not significant). Delayed MTP deactivations are the primary determinant of blood component waste. Our proactive intervention on communications between groups was not sufficient in reducing the number of delayed deactivations. However, implementing a digital timeline and regular repetitive training yielded a significant reduction in wasted blood components.

Blood shortages and changes to massive transfusion protocols: Survey of hospital practices during the COVID-19 pandemic

“…MTPs represent an important evidence-based strategy to prevent exsanguination and coagulopathy in patients with large-volume hemorrhage via constant provision of a pre-determined volume and composition of blood products [12,13]. As a result, large numbers of blood components are often dispensed during MTPs, which can lead to a significant amount of blood wastage during these procedures [14][15][16][17]. MTPs therefore represent a crucial area to address during blood supply constraints, as a single MTP is capable of depleting the blood inventory for an entire hospital or region [18].…”

Blood Lost: A Retrospective Review of Blood Wastage from a Massive Transfusion Protocol in a Tertiary Paediatric Hospital

“…According to adult studies, up to 61% of blood products issued to a massively bleeding patient may not be transfused [ 7 ]. Common causes of wastage cited in the literature include over-activation and late deactivation of the MTP [ 12 ]. Furthermore, upon returning the product to the blood bank, the products are often outside of acceptable temperature ranges, making it unsafe for it to be diverted to other patients [ 6 ].…”