Platelet Transfusion Guidelines Development and Implementation in a Pediatric Hematology/ Oncology Population
Karen J. Vander Laan, PhD, MSN, RN, Renita Kuiper BSN, RN, CPHON, Lisa Hovingh, MSN, PNP, CPON, Lynn Stachel MSN, RN, CPON, and Susan Dunn, PhD, RN
The threshold for transfusing platelets in the pediatric hematology/oncology population is not standardized, resulting in potentially inappropriate transfusions. Consequently, patients can be unnecessarily exposed to foreign antigens or infection, the donor platelet supply could be depleted, and organizations may experience unnecessary costs. These problems can significantly impact patient safety, quality of care, and healthcare costs. The objective of this project is to survey providers regarding their current practice in prophylactic, pre-procedural, and therapeutic platelet transfusions. This project exists within a greater evidenced based initiative in which guidelines detailing thresholds to transfuse platelets will be implemented into practice. The impetus for the larger project included an internal study that showed platelet transfusions given at a median count of 22,000; much higher than many institutions. A literature review reinforced a critical need to standardize platelet transfusions. This review also revealed the existence of an established questionnaire regarding institution platelet transfusion practices and algorithms that direct appropriate times to transfuse. The steps of this project are being guided by the institution’s Channels for Change Framework, based on the Iowa Model for Evidence-Based Practice. A team of nurses and a physician has tailored a pre-existing platelet transfusion questionnaire for use in one large Midwest children's teaching hospital. The survey will be distributed electronically by January 2015 to physicians, surgeons, and intensivists who care for patients on a pediatric hematology/oncology unit. A potential challenge of this project is a low response rate to the survey. Survey data will be analyzed using descriptive statistics. A synthesis of current provider practices will be completed, with identification of potential inconsistencies among physicians, surgeons, and intensivists. The results of this project are pending. However, it is anticipated that results will be used to direct the development of evidenced-based guidelines focused on platelet transfusion practices.
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