Knowledge and practice of blood transfusion: a survey of nurses in the north and middle regions of Jordan

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Knowledge and practice of blood transfusion a
survey of nurses in the north and middle regions
of Jordan
By
Dr. Belal M Hijji, RN. PhDAssistant
ProfessorFaculty of Nursing, Philadelphia
UniversityPresented at theKing Abdullah
University Hospital, Irbid, Jordan 5th April
2009Co-investigators Dr. Awa Oweis, Dr. Rasha
Dabbour
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Where does this area fit within Jordans
classifications of research priorities?
Quality of care has been identified by the JNC in
the national health strategy as a high priority
area
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Learning objectives
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By the end of this presentation, nurses/
educators will be able to

• Appreciate the central role that nursing research
  plays in clinical practice
• Value the importance of knowledge to competent
  nursing practice
• Have an up-to-date knowledge underpinning the
  care of patient in need of blood transfusion
• Understand how patients in need of transfusion
  are vulnerable to various types of errors that
  nurses can prevent or eliminate

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Contents

• Background
• Aim and objectives
• Methods
• Results
• Recommendations

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Background
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Nurses play a crucial role in the administration
of blood transfusions
Their relevant knowledge and practice are
important determinants of the safety of
transfusions
Published information about nurses' blood
transfusion knowledge and practice is lacking
To fill this information gap, this study was
undertaken in Jordan
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Aim
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Principal Aim
To investigate nurses knowledge and practice of
blood transfusion

• Objectives
• A. Investigate nurses knowledge and/ or reported
  practice of
• Patient preparation before blood collection
• Blood pack collection
• Pre-transfusion initiation nursing activities
• Post transfusion initiation activities and
  issues
• B. Identify statistically significant differences
  in mean knowledge scores of nurses with different
  characteristics

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Methods
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Design, Settings and Access

• A descriptive cross-sectional survey using an
  interviewer-administered questionnaire
• The study involved in-patient areas where blood
  transfusion events were common
• 3. Four teaching and public hospitals
• 4. Ethical approvals
• 5. Participant information sheet
• 6. Voluntary informed consent
• 7. Anonymity and confidentiality

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Population and sample
Population 906 nurses Sample 320 nurses
selected at random Inclusion criteria
Registered nurses with direct care
responsibilities Exclusion criteria Auxiliary
staff, head nurses, and nurses in out-patient
areas and OT.
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An overview of data collection
Nurses knowledge and reported practice of blood
transfusion was measured via a questionnaire
developed following consultation with nursing
literature. It has 44 items in seven sections. A
nurses demographics and training (8 items) B
patient preparation before blood collection (4
items) C blood bag collection (3 items) D
pre-transfusion initiation nursing
responsibilities (8 items) E post transfusion
initiation nursing responsibilities (11 items)
F complications related to blood transfusion (8
items) and G issues related to local policies
(2 items).
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Validity and Reliability of the Questionnaire

1. A panel of seven international transfusion
   specialist nurses
2. Pilot study
3. The Flesch Reading Ease (RE) Index is 66.15.

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An overview of data collection (continued)
Data collection started on 5th November 2008 and
was completed by 31st January 2009.

• Two research assistants collected the data
• They attended a session on questionnaire
  administration and collection
• They received written instructions

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Data Analysis
Allocation of scores
For most items, one point was awarded for
the correct answer and 0 for the incorrect one.
The maximum score was 57 (100) points.
Descriptive and inferential statistics were used
to analyse data
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Results
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Knowledge Scores
Mean Median Mode Range Skewness Kurtosis SD
51.3 52 53 13-70 - 0.74 2.44 7.3
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305 nurses (95.3) filled in the questionnaire
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Possible Transfusion Combinations
From http//www.redcrossblood.org/portal/NC/facts
.htm
Blood Type Can be given to patients with type
0 0, A, B, AB
A A, AB
B B, AB
AB AB
0- 0, A, B, AB, 0- , A- , -B , AB-
A- A, AB, A- , AB-
B- B, AB, B- , AB-
AB- AB, AB-
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Inferential Statistics One-way ANOVA revealed no
statistically significant differences in nurses
mean knowledge scores with different hospital
affiliation, qualifications, gender, level of
involvement in blood transfusion, ward
experience, and previous training
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• Key Findings
• Nurses had serious knowledge deficits and
  practice deficiencies that are potentially
  threatening to patients health and safety
• Patients were at risk of developing
  complications, in particular bacterial infection,
  destruction of red blood cells, and receiving
  incorrect transfusions

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Recommendations
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Action is needed, nationwide, to assist nurses in
the pursuit of safer blood transfusion practice

• Strengthening the nursing workforce by
  implementing urgent bedside training as
  recommended by the WHO
• Systems must be developed to ensure that nurses
  are competent in performing blood transfusion
• Development of blood transfusion policies and
  guidelines for nurses
• Collaboration between service providers and
  higher education institutions

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Errors in blood transfusion (3.3 million red cell
units) (McClelland, D. and Phillips, P. (1994).
BMJ 3081205-6)

Wrong blood was transfused
No of incidents (incidence per units supplied for transfusion) Total 111 (1/29 000) Cause or place of error Wrong blood in tube 23 Laboratory 6 Ward or theatre staff checked or 82 transfused wrong blood Outcome of error Death 6 (1/550000) Morbidity 12 (1/275 000) No adverse effect 93 (1/36 000)
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Re-produced with permission from the UK Serious
Hazards of Transfusion (2008) Initiative
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How does Jordan compare with the UK concerning
blood transfusion safety regulations?
The UK Jordan
Blood Safety and Quality Regulation is a law in force, and the Health Service Circular, Better Blood Transfusion Safe and Appropriate Use of Blood Do we have similar legislation????
Training and competency assessment is required by law Absent. Nurses transfuse pts. without any training
Mandatory adverse incidents reporting to a competent authority Some form of voluntary reporting is in place

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Acknowledgements
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We are immensely grateful to the Ministry of
Health, all nursing staff, and hospitals for
their valuable support. We express our gratitude
to Philadelphia University Deanship of Scientific
Research and Postgraduate Studies for funding the
study.
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Thank You
Principal Investigator bhijji_at_philadelphia.edu.jo