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Identifying barriers to complying with new restrictive NICU transfusion guidelines
Sarah M Tweddell1,2, Thomas M Morelli3, Timothy M Bahr4,5
1Department of Neonatology, Intermountain Healthcare, Murray, UT, USA.
Objectives:
Our NICU transfusion stewardship group proposed new, more restrictive guidelines for red blood cell and platelet transfusions. To evaluate our clinician's support for these, we conducted a series of structured interviews.
Study Design:
We presented 11 scenarios involving the new guidelines to each of 24 clinicians. After every scenario we asked whether they would abide by the guideline, and if not, why.
Results:
For 88% of scenarios, participants said they supported the guideline and would not transfuse. The most common reasons for wanting to transfuse when the guidelines said not to were; 1) the scenario-patient did not meet the guideline but was "close" and 2) the guideline was insufficiently explicit.
Conclusions:
Structured interviews like these can identify barriers to complying with transfusion guidelines and can suggest guideline modifications. Future studies will determine the effect of this discovery process on guideline adherence and patient outcomes.
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