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  3. Clinical audit of transfusion of blood products in children with thalassemia in the department and blood clinic of Tabriz Children's Medical Education Center.

Clinical audit of transfusion of blood products in children with thalassemia in the department and blood clinic of Tabriz Children's Medical Education Center.

Number of pages: 110 File Format: word File Code: 31977
Year: 2016 University Degree: Master's degree Category: Paramedical
Tags/Keywords: audit - blood clinic - Blood incompatibilities - Blood products - Blood transfusion - Clinical audit - thalassemia - Thalassemia patients - Transfusion
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  • Summary of Clinical audit of transfusion of blood products in children with thalassemia in the department and blood clinic of Tabriz Children's Medical Education Center.

    Dissertation to receive a master's degree in nursing

    Children orientation

    Abstract
    Introduction: Thalassemia patients are constant consumers of blood, blood transfusion without complications depends on the knowledge, proper and timely implementation of nursing skills that It can lead to increasing the survival and life of thalassemia patients, how to apply and comply with safe transfusion nursing standards by nurses is important, based on this, this study was conducted with the aim of auditing compliance with nursing standards in safe blood transfusion by nurses in Tabriz Children's Hospital. Materials and methods: This research is an action research study, and the research population is all nurses working in the department and blood clinic of Children's Hospital. Tabriz, which was in charge of blood transfusion. In this study, a two-part questionnaire was used, the first part of which was related to the registration of the personal and occupational factors of nurses and the characteristics of children undergoing blood transfusion, and the second part included an observation checklist to check the performance status of nurses in performing blood transfusion, to check the current status of blood transfusion and related care and its compliance with relevant standards. 106 cases of transfusion of blood products in children with thalassemia were observed in the department and blood clinic of Tabriz Children's Educational Center, which were performed by 11 nurses in the morning shifts, and the clinical audit of the transfusion process was examined. Data analysis was done using SPSS version 13.
    Findings:
    About 63.6% of the nurses participating in the study (45.5% once and 18.2% twice a year) were trained about the blood transfusion process. In 46.8% of the cases of the checklist, the performance of the nurses was fully consistent with the standards. But in only 0.9% of cases, the nurses had washed their hands and wore latex gloves before starting blood transfusion, and in 97.2% of cases, wristbands were used to identify the child. The average (standard deviation) score of the total performance of the nurses was 37.05 (1.26), with a minimum of 34 and a maximum of 40 points out of 49.
    Conclusion: The results of this study showed that compliance with nursing standards in the process of blood transfusion is generally desirable, although in some cases it is not completely desirable and indicates the need to pay attention to improving the quality of blood transfusion. is Based on this, attention to the weak points of nurses' performance is strongly felt.
    Key words: blood transfusion, audit, thalassemia, performance, nurses

    This chapter has been compiled in relation to the research field. The scope of the research includes the title of the research, the introduction of the problem, the objectives of the research, the research questions and the definition of the words.
    1-1 The title of the research
    Clinical audit of transfusion of blood products in the department and blood clinic of the Tabriz Children's Medical Education Center
    2-1 Introduction, background and importance of the research
    Blood is a life-giving resource that has no substitute (1). The first mention of blood transfusion in history is more of a legend. The first attempt to transfer blood to humans was made in 1376 AD by a young doctor named Jean. The initial scientific research on blood transfusion was carried out by James Mellatorell in the 18th century, and in many years of research and various developments in this field, blood transfusion has been made into its current form (2). The purpose of blood transfusion is to increase tissue oxygenation and prevent bleeding, which will ultimately improve the prognosis of the disease (3). 
    Blood transfusion is considered an important part of medical care, which if done correctly, can save lives (4). The use of blood transfusion is only for the treatment of cases that lead to clear death and cannot be effectively prevented and treated through other methods (4, 5).The process of blood transfusion is faced with issues such as limited storage time and high maintenance costs (6). There is evidence of significant differences in the pattern of clinical use of blood between hospitals, clinical specialists and even between collaborating doctors in the same group (4, 5). Blood transfusion is of vital importance in many diseases, including thalassemia, surgery and childbirth (7), but at the same time, it always comes with many risks and problems, such as: infectious diseases such as hepatitis, AIDS, infectious mononucleosis, weakening of the immune system, hemolytic and non-hemolytic reactions, blood incompatibilities, etc. is accompanied In addition, blood transfusion requires a high cost (8). So that a unit of dense red blood cells costs about 151 dollars (9) in America and about 600,000 rials in Iran. The cost of blood transfusion and its products in England is 165.5 million pounds annually, 76% of which is related to the injection of packed red blood cells (10). 
    Despite the importance of blood transfusion as a "life link", there is also a risk of its reactions, which vary from allergic reactions to life-threatening hemolysis (11-13). More than 20% of all blood transfusions lead to different reactions (12, 14). Reactions that occur within the first 24 hours of blood transfusion are considered early reactions and occur in 1% to 3% of injections (13). So that in a 7-year study, 1500 premature reactions were identified in 440,000 blood product injection cases (15). The Food and Drug Administration reported the cases of blood transfusion deaths from 1976 to 1985, and 51% of the 256 deaths reported were due to acute hemolysis following the injection of blood products with ABO incompatibility. Linder et al. calculated the risk of transfusion with ABO incompatibility, which was one in 38,000 units, and included incorrect administration of 1 in 19,000 RBC units prescribed in New York State (16).
    Since the problems of providing healthy blood, preserving blood against various contaminations, along with the ever-increasing cost of blood products, are the major issues related to blood transfusion (17) and considering this that blood transfusion is not safe and free of cost (18), therefore, considering these problems and the high cost of providing healthy blood, as well as the numerous complications caused by blood transfusion and blood products, it is necessary to prescribe the said products based on scientific criteria and only if necessary (9). have been, clinical governance has been proposed as a method to achieve a responsive quality. Due to the importance of accountability for improving quality in clinical governance, clinical audit is considered one of the main components of this thinking. In fact, clinical governance has introduced clinical audit and provided the necessary tools in order to support nurses and service provider organizations in order to improve the quality of their services. Clinical audit is a process to improve the quality of clinical services that is carried out through the systematic review and compliance of care with standards and the implementation of appropriate changes, in order to improve patient care and the resulting outcomes.
    The audit is the review and evaluation of the activities performed in comparison with predefined standards, which improves the quality of services provided to customers and related results through organized review and compliance of service processes with predefined criteria and standards. improves the performance of the health system (19). 
    Also, the results of a study in Mashhad entitled "Audit of compliance with nursing standards in the process of blood transfusion of Umm al-Binin Women's Specialized Hospital (S)" (2013) showed that the basic skills in preparing blood for transfusion in 42% of cases, performing care during blood transfusion in 48% of cases, and post-transfusion care in 25% of cases, are not performed according to nursing standards. And in total, the level of compliance and the way of applying nursing standards in blood transfusion by nursing personnel was favorable in 56% of cases (20).

  • Contents & References of Clinical audit of transfusion of blood products in children with thalassemia in the department and blood clinic of Tabriz Children's Medical Education Center.

    List:

    Abstract

    First chapter

               

    Research field             .         1

    Research objectives         5

    Research questions.         6

    Definition of specific words.         7

     

    Chapter Two

     

    Conceptual framework            .         10

    A review of the studies done.         34

     

    The third chapter

               

    Type of research                .         41

    Research Society               .     44

    Research sample               .     44

    Sample size             .     44

    Sampling method             .     45

    Research environment                .     45

    Inclusion and exclusion criteria from the study.     46

    Data collection tool.     46

    Scientific validity (validity) of the tool.     47

    Scientific trust (reliability) of the tool.     47

    The method of data collection.         47

    The method of data analysis        .     49

     

    Ethical considerations         .     50

    Chapter Four

    Research findings           .     52

    Chapter Five

    Interpretation of the findings.     69

    Final conclusion           .     81

    Application of research findings.     83

    Research limitations.     84

    Suggestions for future research.     85

     

    Appendices

    Information collection form

    Resources

    Articles acceptance certificate

    English summary

     

     

    Source:

    Referencess:

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    2. Farhadi Langrodi M, Eftekhari MA, Ahmadi J. Darsname Osole Enteghale Khon dar Pezeshki. Tehran: Sazmane Enteghale Khon Iran; 1998.

    3. Sullivan MT, McCullough J, Schreiber GB, Wallace EL. Blood collection and transfusion in the United States in 1997. Transfusion. 2002;42(10):1253-60.

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    5. Zamani A, Kabirzadeh A, Khademloo M, Hashemi Maad M. Frequency of blood transfusion and its products in Emam Hospital of Sari. J Mazandaran Univ Med Sci. 2008;18(67):5-91.

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Clinical audit of transfusion of blood products in children with thalassemia in the department and blood clinic of Tabriz Children's Medical Education Center.
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