[2085] Effectiveness of Targeted Education in Decreasing Utilization of Prophylactic Plasma Transfusion for Mildly Elevated INR

Bryn T Haws, Elora Thorpe, Lowell L Tilzer. University of Kansas Medical Center, Kansas City

Background: Despite the lack of evidence, there continues to be significant prophylactic use of plasma for mildly elevated INR (≤2.0). In an effort to bridge the gap between guidelines and actual clinical practice, a blood management initiative was implemented at our institution aimed at developing more effective educational strategies to increase understanding and compliance with evidence based guidelines. This quality study was designed to evaluate the effect of targeted education towards changes in 1) the overall use of FFP 2) the indications cited for transfusion of plasma, and 3) utilization practices of individual clinical services.
Design: Data was collected retrospectively for one month periods before (June 2010) and after (June 2011) the implementation of educational strategies, which included reporting the June 2010 data in a medical staff newsletter, individual meetings with clinical departments, (focusing on specialties with the most plasma usage for minimally invasive procedures [medicine]) and invitation of guest presenters with expertise in blood management. Plasma transfusion data was abstracted from the laboratory information system, and the following information was collected for each transfusion: pre-transfusion INR, ordering clinical service (cardiothoracic surgery, surgery [including all other surgical specialties], or medicine [GI, ER, internal medicine and critical care]), and indication for order (significant hemorrhage, emergency reversal of warfarin, or prophylaxis prior to procedure [PPP]).
Results:

Table 1. Number of plasma units ordered pre and post educational intervention
 Pre-InterventionPost-Intervention
Total Plasma216266
INR ≤2.0107 (49.5%)124 (46.6%)
INR ≤2.0 and indication PPP68 (31.5%)72 (27.1%)
Cardiothoracic Surgery2522
Surgery2644
Medicine176



Conclusions: There was no clinically significant decrease in overall plasma or plasma with an INR≤2 transfused before and after implementation of educational strategies. However, there was a clinically significant decrease (17 vs 6) in plasma utilization by medicine, which was specifically targeted by educational efforts. Surgery showed an increase in the number of units transfused (26 vs 44) which may reflect an unintended result of educational efforts which stressed that INR value ≤2 requires more units of plasma to approach a normal INR. Our data suggests that educational strategies based on clinical trends of plasma utilization improve compliance with evidence based guidelines and help identify additional specialties that need focused educational efforts.
Category: Quality Assurance

Monday, March 19, 2012 1:00 PM

Poster Session II # 271, Monday Afternoon

 

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