Evidence-based practice (EBP) focuses on the core of the nursing concept, patient care. EBP in nursing entails providing quality holistic care based on the most recent knowledge and research. The elements of EBP include asking the clinical issues, evaluating current literature on the same, integrating the evidence with clinical expertise, implementing care procedures, and assessing and reassessing the procedure’s effectiveness. Nurses are best positioned to implement evidence-based practices since they are around the patients and understand their patient’s physical, mental, and emotional status well, which is vital to improving patient outcomes. Blood transmission is a critical aspect of clinical practice. This paper will compare various Kaiser policy protocols and policies on blood transfusion reaction procedures to the current EBP suggestions.
Importance of Evidence-Based Practice
EBP positively impacts nursing as it seeks to identify solutions that enhance patient outcomes. It allows nurses to embrace new procedures. Usually, it may be challenging to change care standards that are already in place, especially in a hospital setting. Embracing EBP prevents nurses from falling into old patterns and adopting new, proven, effective procedures (AdventHealth University, 2022). Moreover, implementations of evidence-based practices uphold the relevance of new interventions and care protocols. These new interventions are developed from advanced existing practices or discoveries that ensure positive patient outcomes.
Allowing nurses to implement EBP in their work leads to their career development. It encourages them to research more on new skills. They develop their interest areas and knowledge. They also develop critical thinking and decision-making skills that sharpen their expertise, thus becoming a reference person in case of any inquiries. EBP involves a combination of nurses’ expertise and current research, which empowers them through aiding established effective care practices, thus improving their job satisfaction. It also contributes to the growth of science in nursing.
Hospital Policy
I will focus on five areas of the policy that should be followed after stopping the transfusion. They include;
- Initiate proper emergency interventions based on clinical presentation. Anaphylaxis can quickly lead to cardiopulmonary arrest [5.3.2].
- Immediately and simultaneously notify the physician responsible for the patient and the blood bank of a suspected transfusion reaction [5.3.3].
- Immediately recheck/verify that the information on the crossmatch report matches correctly [5.3.5].
- Monitor and document the patient’s vital signs every 15 minutes during a transfusion reaction in section [5.3.14].
In instances of a transfusion reaction, the most vital steps to ensure the patient’s safety involve establishing an effective response strategy, finding out the cause of the reaction, and monitoring the patient’s vitals for any effects that may cause challenges. Accordingly, I selected the above policy sections since they help ensure positive patient care and outcomes.
Research Studies Review
The above Kaiser policy areas follow EBPs. These practices present various management procedures in case of blood transfusion reaction, suggesting that in case of a reaction, blood transfusion should immediately be stopped. Then, adequate measures are taken to ensure the patient’s safety. The policy statement in [5.3.2] says that in case of a reaction, the first step is to stop and initiate a response accordingly due to the risk of anaphylaxis. Suddock and Crookston (2023) explain that Anaphylactic is an acute form of reaction that causes severe reactions in patients with IgA deficiency. Most EBPs also suggest informing physicians and the blood bank if a reaction occurs, as per [5.3.3]. The Royal Children’s Hospital Melbourne (2023) urges that the reaction be reported to the physician in charge of the patient and the blood bank as quickly as possible.
In the same line, Tobian et al. (2023) acknowledge the need to check if the product administered was correct. Checking involves confirming if the transfused blood was correct and if the patient and product labeling were accurate; the patient was identified correctly, then checking the product for any changes in color or presence of bubbles that would suggest contamination from bacteria. Ensuring that the units provided are intended for the recipient is also essential. According to the authors, the preparation steps involve establishing compatibility tests between recipient antibodies and donor red blood cells. Therefore, It is one of the vital steps before conducting a blood transfusion.
Evidence practices recommend vital signs be obtained every 15-minute intervals as outlined in the Kaiser policy [5.3.14]. Suddock and Crookston (2023) state that transfusion reactions may range from mild to life-threatening symptoms. The authors acknowledge that one vital aspect of managing a transfusion reaction is to monitor the patient’s vital signs while recording them at fifteen-minute intervals. Monitoring the patient’s vitals as some reactions can lead to complications and, in cases with severe effects, death.
Tonino et al. (2019) also say that frequent assessment of vital signs is for various clinical circumstances such as blood transfusion. They acknowledge that receiving any transfusion could result in reactions that could manifest in abnormal vital signs before leading to an adverse event. Roney et al. (2022) recognize that vital signs usually have standard value ranges. However, there could be deviations from this range in some instances, which could be expected or signify a problem. The interpretation of the values depends on the contextual situation.
Consequences
According to the policy, a transfusion reaction is an adverse patient outcome for a blood product transfusion. Chills, fever, skin rash, hypotension, or cardiac arrest characterize reactions. In some cases, there may be delayed reactions; thus, nurses should notify physicians immediately if any of the symptoms occur. Therefore, the practice of stopping the transfusion, informing the relevant physicians, rechecking, and verifying documentation leads to practical benefits due to the effective management of transfusion reactions.
Additionally, assessing vital signs is a critical aspect, especially in the event of a transfusion reaction. Part of the scheduled monitoring of patients after a blood transfusion reaction includes checking a patient’s temperature, heart rate, respiration rate, oxygen saturation, and systolic blood pressure. Monitoring these vital signs is essential to avoid poor patient outcomes; It helps to detect any anomalies (Tobian et al., 2023). Any changes in the critical symptoms help identify any possible issues.
According to various studies, reactions can sometimes go unrecognized due to inconsistencies in vital signs monitoring. One study indicated that many nurses estimate some of the patient’s vital signs, such as the respiration rate, which leaves the possibility of undetected any other reactions. The findings demonstrate the need for monitoring the vitals of patients. There have been policies such as monitoring patients’ signs at intervals to improve such occurrences.
Summary
Management of transfusion reaction depends on the severity of the reaction. Nonetheless, the standard practices involve stopping blood transfusion, informing physicians and the blood bank, monitoring the patient’s vital signs during a reaction, and reassessing the patient’s documentation to help determine the problems and improve positive patient outcomes. The purpose of this policy is to ensure that there is proper management of transfusion reactions to avoid any adverse effects. The current EBPs show that the policy is still functional, and adhering to it will lead to appropriate management of reactions and positive patient outcomes due to minimal risks of severe consequences.
My Role in Evidence-Based Practice as a Future New RN
As a future registered nurse (RN), I consider EBP an empowering tool that will enable me to use scientific knowledge to determine the appropriate care model. As an RN, I implement evidence-based practices to provide quality care and positive patient outcomes. For this reason, I should stay informed. Being updated with the latest research articles and journals will help me be at par with updated solutions in my nursing field (AdventHealth University, 2022). I would also need to develop critical skills that will assess the quality and validity of the research and the significance of the findings to my nursing practice. These skills will also help me evaluate and implement practices that suit the patient’s situation perfectly.
Accordingly, I should be able to incorporate the most effective evidence-based guidelines into my daily practice. It is vital for the practices also to be patient-centered and tailored to the needs of the specific patient while making decisions. In addition, I should employ collaborative strategies with other healthcare professionals to ensure that the EBPs are implemented all around. Moreover, my role would also involve educating and sharing knowledge with other colleagues in the bato to foster a culture of using EBPs.
In case there is an opportunity to participate in research, I would take part in it. My participation would help generate new evidence that is likely to improve care. EBP involves continuous learning and collaboration to improve patient care and outcomes and advance nursing practice.
References
AdventHealth University. (2022, January 9). Why is evidence-based nursing important?https://www.ahu.edu/blog/evidence-based-nursing
Roney, J. K., Long, J. D., Cason, E. R., Johnston, L. M., Emery, E., Deleon, M., Whitley, B. E., & Baggerly, K. (2022). Detecting blood transfusion reactions: What are vital signs anyway? Nursing Forum, 57(3), 486-490. https://doi.org/10.1111/nuf.12697
The Royal Children’s Hospital Melbourne. (2023). Blood transfusion: Adverse effects of transfusion. The Royal Children’s Hospital: The Royal Children’s Hospital. https://www.rch.org.au/bloodtrans/adverse_effects/Adverse_effects_of_transfusion/
Suddock, J. T., & Crookston., K. P. (2023). Transfusion reactions. StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482202/
Tobian, A., Kleinman, S., & Tirnauer, J. S. (2023, June 5). Approach to the patient with a suspected acute transfusion reaction. کتاب پزشکی 2023 | جدیدترین ژورنال | uptodate | آپتودیت. https://medilib.ir/uptodate/show/95132
Tonino, R. P., Larimer, K., Eissen, O., & Schipperus, M. R. (2019). Remote patient monitoring in adults receiving transfusion or infusion for hematological disorders using the VitalPatch and accelerateIQ monitoring system: Quantitative feasibility study. JMIR Human Factors, 6(4), e15103. https://doi.org/10.2196/15103
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