Authors (including presenting author) :
Cheng KH(1), Chung EKJ(1), Ching WP(2), Pui MOY(2), Ho CH(1), Lai FY(1), Tsung PPK(1), Siu KY(2), LEE CK(1)
Affiliation :
(1)Operating Theatre, Department of Anaesthesia, Pain and Perioperative Medicine, Prince of Wales Hospital, (2) Department Of Obstetrics And Gynaecology, Prince Of Wales Hospital
Introduction :
Blood transfusion in operating theatres requires precision, efficiency, and clear communication to ensure patient safety. Errors in storage or communication can compromise blood product viability and effectiveness. To address this, the initiative "Enhancing Nursing Care for Blood Transfusion" introduced three key interventions: staff education, a redesigned whiteboard for clear communication, and improved blood storage workflows. These changes eliminated reports of mishandling or transfusion errors. The ongoing phase focused on replacing the old whiteboard, with continuous staff support, clear explanations, and a reference document to ensure understanding and smooth implementation of the new system. This improved workflow and communication efficiency
Objectives :
To eliminate risk of blood product mishandling in theatre
To enhance and develop communication tools for optimising blood product handling.
Methodology :
Plan: Communicate with key stakeholders including Nurse Consultant, Department Operations Manager, Ward Managers, nursing staff, healthcare assistants, and whiteboard vendor to finalize whiteboard designs, standardize whiteboard input method, standardize workflow for blood product handling using new design. Do: Implementing the replacement of the old message whiteboard with the new design, providing education training for nursing staff about the new whiteboard and workflow enhancement for blood product handling Check: Blood product handling incident rate, Review staff suggestions and comments regarding interventions through questionnaire. Act: Provide continuous support to staff. Design and send document that may act as a refresher on the changes and ensuring their understanding of the new whiteboard design.
Result & Outcome :
The project improved nursing care by
1. Improved Knowledge of Nurses:
Surveys identified gaps in areas like blood storage, ABO compatibility, and signs of transfusion reactions. Education sessions led to significant improvements, with a 36.82% average increase in correct answers on post-tests, demonstrating enhanced knowledge across all topics.
2. Optimized Workflow for Blood Handling
The use of blood boxes and timers improved significantly, with 98.1% of nurses reporting proficiency in their use. The new workflow streamlined processes and ensured better coordination, supported by the involvement of healthcare assistants in handling blood storage tools.
3. Enhanced Communication Tools
A redesigned whiteboard was introduced and trialed in Theater 504, with 89.1% of participants believing it could prevent miscommunication during transfusions.
Scenario-based exercises and education sessions helped staff adapt to the new tool, improving clarity and collaboration.
