Correlation between nursing practices regarding blood transfusion and its adverse reactions among patients at medical department

Introduction

Blood transfusion considered  one of the most effective therapeutic alternatives in the treatment of certain conditions as surgery, trauma severe anemia , acute blood loss  and in the replacement of blood components that are essential for maintenance of life  (Cherem et al., 2017). It  is defined as the process by which the blood of one person is injected into another one’s circulation for medical purposes (IslamiVaghar, 2018). Although blood transfusion is a common medical procedure that is often lifesaving, there is a risk for the patient to develop transfusion-related adverse reactions (Miao, 2019).

Transfusion reactions can occur during the transfusion (acute transfusion reactions) or days to weeks later (delayed transfusion reactions) (Khoyumthem et al., 2018).Acute transfusion reactions (ATR)  are those occurring within 24 hours of the administration of blood or blood components ,they occur in about 0.5%–3% of transfusions and include the following; Acute hemolytic reactions(AHTRs), Febrile non-hemolytic reactions (FNHTRs), Allergic and anaphylactic reactions, septic (bacterial contamination), Transfusion-Related Acute Lung Injury (TRALI), Transfusion-Associated Circulatory Overload (TACO)(Castillo et al., 2018). Any reaction beyond 24 hours of transfusion is termed a delayed transfusion reaction (Tinegate et al., 2012; Hillis et al., 2016).

Nursing professionals have a central role in the transfusion process, when performing a blood transfusion nurses must pay attention to 4 basic elements: appropriate blood, correct patient, proper procedure and right timing of transfusion these requires specific knowledge and skills to ensure the safety and efficiency of this procedure. Errors in practice may therefore lead to severe and sometimes life-threatening consequences to the patients (da Sila et al., 2016; Kavaklioglu et al., 2017). According to statistics the majority of mistakes related to blood transfusion occurring in hospitals, include neglect in observation of recipients during transfusion, patient misidentification and transfusion of wrong blood units, these errors are associated with inadequate training and lack of experience (Shamshirian et al., 2017)

Significance of the Study

According to world Health Organization (WHO, 2016) and  Global Database on Blood Safety (GDBS) more than (67,000) hospitals performing  blood transfusions serving globally, (Gu et al., 2015)). Flood and Higbie, (2016) stated that (WHO) reported that over nine million patients in ( 90) different countries receive blood in a year (Gu et al., 2015) . According to Serious Hazards of Transfusion program (SHOT, 2016) about (62.6%) of all reported adverse reactions were related to unsafe practice by individual staff members (SHOT, 2016).Through the researcher' clinical opinion during students training period  at medical department many patients who received blood transfusion were exposed to many complications, the researcher revised that there was no previous studies was done in this location about this point of research.

Aim of the Study:

Assess correlation between nursing practices regarding blood transfusion among patients at medical department and its adverse reactions.

Research question: 

What is the relation between nursing practices regarding blood transfusion among patients at medical department and its adverse reactions?

Subjects and Methods

Study design:-

     Descriptive correlation study design was utilized to fulfill the purpose of this study.

Setting:-

 The current study was carried out in medical department at Minia university hospital,

Subject:

   A convenience sampling of (39) adult patient who were going to receive blood transfusion during the study period and were meet the inclusion criteria in medical department was assigned in this study sample size that  was calculated by Slovin’S formula (Slovin, 1960)which is computed as n = N / (1+Ne²); whereas:

n = sample size                                   N = total population

e = desired margin of error                  n= 43 / [1+ (43) (0.05)² = 39 patients

Inclusion criteria:

1.  Patient's age from 18 to 65 years.
2. Conscious patient.

Exclusion criteria: Patients with previous history of blood transfusion adverse reactions.

Data Collection Tools

Two tools were used in this study that were developed and collected by the researcher after revising extensive relevant literature review as (Dougherty et al., 2015; Rutala et al., 2015; Bolton‐Maggs, 2017)and also reviewed by a panel of five experts, three in the field of Medical Surgical Nursing Faculty of Nursing Assuit  University, one in the field of Medical Surgical Nursing Faculty of Nursing Ain Shams  University and one in the field of Community Nursing Faculty of Nursing at Minia University for validity testing. These tools were as following:-

Tool I: Patient's assessment sheet: that was contain two parts

Part 1: Personal data, to collect patient personal data through individually interview related to the following: age, gender and educational level.

Part 2: Patient's clinical profile: to assess patient’s medical data though patient’s medical file and individually interview and it was consisted of six itemssuch as (history of previous blood transfusion, patient's medical diagnosis, chief complaint for blood transfusion)

Tool II: immediate reactions of blood transfusion assessment sheet: it was filled through patients ‘subjective and objective data and was consisted of signs, symptoms of immediate transfusion reactions which might be occur for patient within (24) hours from transfusion, It was ranked as present or not present of the following signs and symptoms as (fever, flushing, headache and dyspnea, …………… etc.)

Validity

Content validity was done to identify the degree to which the used tools measure what was supposed to be measured. The developed tools were examined by a panel of five experts opinion in the field of the study {one from Minia University faculty of nursing (Community Nursing Department), three from Assuit University faculty of nursing (Medical –surgical Nursing Department), and one from Ain-Shams University faculty of nursing (Medical –surgical Nursing Department). All jury members (100%) agreed that current study tools were valid and relevant with the aim of the study. 

Reliability

Reliability was ascertained statistically by using Alpha Cronbach's test to ensure that the study tools were reliable and the results of patient’s assessment sheet was (0.92) and immediate reactions from blood transfusion assessment sheet was (0.77)

Ethical Consideration

A written approval obtained from the ethical and research committee of the faculty of Nursing, Minia University, Agreement from Egypt Academic for Research Center and Technology. And Hospital, Oral consent obtained from each participant after explaining the nature & objectives of the study to gain their cooperation, each assessment sheet was coded and subjects' names were not appeared on the sheets for the purpose of anonymity and confidentiality. Subjects were free to withdraw from the study at any time.

Study procedure

The current study was conducted by preparing of different data collection tools, in addition to obtaining formal paper agreement from study setting. Collection of study data was done through daily basis (2 days / week) during evening shift. Within average (2-3 patients through day).

The data collection was assessed by researcher from studied sample who received a routine hospital care during blood transfusion administration by their nursing staff in about three months by using tool I and tool II.

The researcher  trained the internship nursing students who had shift in  the same study setting as co- researcher  to use tool II (immediate reactions from blood transfusion assessment  sheet)  to follow up   the studied sample for signs and symptoms of   blood transfusion adverse reactions during the time when the researcher didn’t attain with the patients.

Pilot study

A pilot study was carried out on 10% (n = 4)   of the total sample to test the clarity of tools and estimate the time required for fulfilling it. Based on results of the pilot study no modifications or refinements were done and the subjects included to the actual sample.

Statistical analysis of data

Data were summarized, tabulated, and presented using descriptive statistics in the form of means and standard deviations as a measure of dispersion. A statistical package for the social science (SPSS), IBM (24) was used for statistical analysis of the data, as it contains the test of significance given in standard statistical books. Qualitative data were expressed as percentage. For quantitative data, Probability (P-value) is the degree of significance, less than 0.05 was considered significant. The smaller the P-value obtained, the more significant is the result (*), less than 0.001 was considered highly significant (**) .Graphs were done for data visualization using Microsoft Excel

Results

Table (1):Distribution of the studied sample according to personal data and clinical profile(n = 39).

Table (1): Showed that the mean age among studied sample was (49.3 ± 10.5). In respect to gender; the results revealed that the highest percentage were female .Related to educational level the majority of the current studied sample were illiterate while the minority were university.  Also the table illustrated that the majority of the same group had no history of previous blood transfusion that constituted (56.4%), concerning their medical diagnosis more than half of the studied sample (64.1%) had liver cirrhosis, moreover the table represented that the highest percentage constituted (38.5%) had bleeding, 

Figure (1): Mean average scoring and standard deviation for nursing practice regarding three phases of blood transfusion (pre, administration  and end ) for studied samples (n=39)

Figure (1): illustrated that there were a markedly decline in the total nursing practices regarding three phases of blood transfusion (pre, administration  and end) for studied sample as the Mean ± SD was 11.7 ± 0.9

Figure (2) Percentage distribution of the studied sample according to observation of immediate blood transfusion adverse reactions’ signs (n = 39)

Figure (2): Showed that the highest percentage of the studied sample had fever and the lowest percentage of the same group had flushing constituted (46.2%) (10.3%) respectively

Figure (3) Percentage distribution of the studied sample regarding to immediate blood transfusion adverse reactions’ symptoms (n = 39)

Figure (3): Represented that the highest percentage of symptoms among the studied sample was headache, mild dyspnea and chest pain constituted (48.70% & 25.6% & 25.6%) respectively.

Table (2): Correlations between Level of Blood Transfusion Practices Score and Immediate blood transfusion adverse reactions (n=39)

Table (2): Highlighted that there was a negative correlation (-0.080) between the studied sample’ immediate blood transfusion adverse reactions and level of blood transfusion practices score.