Shih Andrew W, Morrison Douglas, Sekhon Amardeep S, Lin Yulia, Chargé Sophie, Chipperfield Kate, Beaveridge Jennifer
Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada.
Transfusion. 2020 Jun;60(6):1142-1148. doi: 10.1111/trf.15755. Epub 2020 Mar 20.
Blood transfusion is common and potentially lifesaving but is associated with risk and overuse. Nurse practitioners (NPs) in multidisciplinary care teams are increasingly expanding their scope of practice to transfusion medicine (TM). Resources aimed at NPs are lacking, and little is known about NP TM knowledge. Thus, we developed a pilot TM curriculum for NP credentialing and assessed its impact.
NP leads and TM directors adapted the successful Canadian Transfusion Camp for medical postgraduate trainees into a 3-day curriculum for NPs. Two modalities were used to assess the pilot: 1) a participant demographics survey and needs assessment; and 2) the validated BEST-TEST knowledge assessment exam administered before and after the course.
Of the 23 volunteer participants, the majority reported prescribing blood products within the last year, primarily red blood cells. Minimal opportunities to undertake continuing medical education in TM were identified. NPs often used preprinted order forms, consultation with physicians sharing care, or local fact sheets to guide transfusion; rather than TM physician consultation or guidelines. Exam scores significantly improved after the course (before, 35.2% vs. after, 50.3%; p = 0.005), suggesting average initial knowledge being below medical postgraduate trainee-level improving to postgraduate trainee level. Questions on appropriate transfusion triggers and correct recipient identification were most correctly answered; and responses to transfusion reaction questions required improvement.
Our needs assessment suggests that TM resources for NPs are relevant but lacking. Our initiative supports the generalizability, scalability, and effectiveness of the Transfusion Camp program. Further implementation, refinement, and future impact assessments are required.
输血很常见，可能挽救生命，但也存在风险和过度使用的问题。多学科护理团队中的执业护士（NP）正日益扩大其在输血医学（TM）方面的执业范围。针对NP的资源匮乏，对NP的TM知识了解甚少。因此，我们开发了一个用于NP认证的TM试点课程，并评估了其影响。
NP负责人和TM主任将成功的针对医学研究生学员的加拿大输血训练营改编为一个为期3天的NP课程。使用两种方式评估该试点：1）参与者人口统计学调查和需求评估；2）在课程前后进行的经过验证的BEST-TEST知识评估考试。
在23名志愿者参与者中，大多数人报告在过去一年中开具过血液制品，主要是红细胞。发现参与TM继续医学教育的机会很少。NP通常使用预先印制的订单表格、与共同护理的医生协商或当地情况说明书来指导输血；而不是咨询TM医生或遵循指南。课程结束后考试成绩显著提高（之前为35.2%，之后为50.3%；p = 0.005），这表明平均初始知识水平从低于医学研究生学员水平提高到了研究生学员水平。关于适当输血触发因素和正确受血者识别的问题回答正确率最高；对输血反应问题的回答需要改进。
我们的需求评估表明，针对NP的TM资源是相关的，但很匮乏。我们的举措支持了输血训练营项目的可推广性、可扩展性和有效性。需要进一步实施、完善并进行未来影响评估。
