Insights from developing and evaluating the NHS blood choices transfusion app to support junior and middle-grade doctor decision making against guidelines.

OBJECTIVES: To: 1. Develop a CE-marked smartphone App to support doctors' concordance with transfusion guidelines in non-bleeding adult patients, emphasising informed consent and anaemia management. 2. Test App accuracy and potential to improve user decisions. BACKGROUND: Studies have shown inappropriate use of blood components and that most junior doctors own smartphones with medical apps. METHODS: A multidisciplinary team developed App screens and logic through an iterative process based on national guidelines. Thirty medical or surgical transfusion scenarios were developed based on national guidelines and each sent to Consultant Haematologist experts in Transfusion Medicine. To obtain a clinical consensus and exclude ambiguous scenarios, their independent decisions and associated certainty were compared. The consensus clinical decision was then compared with guidance from the App. To explore potential App impact on simulated user decisions, 26 junior doctors responded to five transfusion scenarios before and after access to the App. RESULTS: The Blood Choices App agreed with 91% (95% CI: 72%-99%) of expert decisions with a sensitivity of 100% (69% to 100%) and specificity of 85% (55%-98%). Excluding one malfunction scenario, the App had the potential to increase correct decisions by junior doctors from 83% (73%-90%) pre-App use to 96% (88%-99%) post (p-value 0.013), with 90% (67%-99%) saying they would use it in practice. CONCLUSIONS: Transfusion guidelines can be converted into an App with potential to improve guideline concordance. However, evaluating such Apps is essential to understand their limitations, detect malfunctions and prevent harm.

Role of the nurse in patient blood management and treating anaemia.

Patient blood management has been defined as a patient-focused and evidence-based approach to optimising the management of patients during the transfusion of blood components. This article explores the complex factors that can influence clinical decisions and enhance patient safety in the administration of blood components, particularly red blood cell transfusions in patients with anaemia. The article also explores the nurse's role in acting as a patient advocate and considering alternatives to the use of blood components. While this article focuses on anaemia-related transfusions, the author relates the principles of patient blood management to all transfusion care.

A qualitative exploration of the factors influencing the decision to transfuse elective platelets in cancer care.

OBJECTIVES: To explore factors contributing to decisions to transfuse platelets in cancer care outside guidelines using case study methods. METHODS: Two case studies were examined, using instrumental case study methodology, to qualitatively explore factors that influence the decision to transfuse platelets. Interviews (n=10) were conducted around cases in haematology and critical care. In-depth review of documentary evidence was undertaken and propositions were developed to provide rigour during the investigation. Thematic analysis and triangulation of documents was undertaken to find specific factors, and propositions analysed, as per instrumental case study methods. RESULTS: Both cases emphasised how patient complexity, and individual response to platelet administration, was an influencing factor. Other themes included uncertainty of clinical situations coupled with uncertainty about platelet availability. Other factors worthy of further investigation include the concept of professional safety and the trustworthiness of platelet thresholds against platelet monitoring for bleeding episodes. CONCLUSION: The findings indicated several factors influence decisions to transfuse, including clinical context, and individual ability to trust guidelines and assume any perceived risks.

Developing nursing practice in platelet transfusions.

The number of platelet transfusions has risen steadily over the past five years. This article addresses some of the reasons for this increase and examines current transfusion practice in relation to findings of national audits of platelet use and current research. It explores the extended role of the nurse in platelet transfusions, including nurse authorisation, and presents an overview of education material available to inform practice and to ensure judicious use of platelet transfusions with maximum benefit for the patient.