“People could die if we get this wrong”: junior docs lack skills in transfusion

Junior doctors feel ill equipped to order or perform red cell blood transfusions, new research suggests.

When it comes to transfusion practices such as indications for red blood cell transfusion, haemoglobin and platelet thresholds, acute reactions and warfarin reversal, junior doctors say they would like more education and guidance to build their skills.

In a national survey 52 recent postgraduate doctors from six hospitals were asked in focus groups about how they were taught transfusions, their levels of comfort performing them, and their thoughts on their ability to practice safely.

Their responses suggest that more resources are needed, according to Dr Cindy Flores a Project Officer for Transfusion Practice and Education the Australian Red Cross Blood Service.

The doctors reported that their undergraduate learning was generally confined to one or two lectures and while workplaces required a mandatory online eLearning module, in both instances information was poorly retained. They described feeling poorly equipped and lacking confidence in clinical transfusion practice when they started working in the hospital system, being unclear on the process to prescribe and order blood and the forms and resources to use.

“Unclear role expectations and scope were also described as negatively impacting confidence,” wrote Dr Flores and colleagues in an article in Vox Sanguinis: the International Journal of Transfusion Medicine.

“For instance, junior doctors did not often initiate the decision to transfuse as this was directed by senior colleagues, yet they were expected to order blood, consent the patient and to manage adverse reactions.”

The focus groups gave a strong message that junior doctors want to provide safe and appropriate care, and are aware of the consequences if they don’t, with one commenting “this is something where people could potentially die if we get this wrong”.

The participants’ feedback was used to inform the development of a range of print and online resources designed to fill identified gaps. The tools were put into an “Transfusion Orientation Pack” tested on a second group of new junior doctors who were starting work at the five hospitals.

Out of a total 39 doctors’ responses, the most popular resources were credit-card sized lanyards featuring information on blood prescribing and acute reaction to transfusion, a poster providing an overview on transfusion and a comprehensive app. These doctors also wanted face-to-face learning, but simulated training was not favoured.

“The study confirms the need for improved education and training to ensure best transfusion practice and patient outcomes in both undergraduate and early career settings,” the authors concluded.

“Online eLearning should not be viewed as adequate transfusion education alone and should be part of a blended learning platform.”

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