Authors (including presenting author) :
Wong CH (1), Law NW (1), Mok YT (1)
Affiliation :
(1) Department of Anaesthesiology and Perioperative Medicine, Hong Kong Children’s Hospital
Introduction :
Monitor patient blood loss is one of the major responsibilities of theatre nurses in providing safe patient care and clinical information for anaesthetists to determine fluid and blood products replacement.
Traditionally, circulating nurse use paper form to calculate blood loss by adding blood clots, blood soaked in gauzes and suctioned out in canisters then minus total volume of irrigation fluids manually to estimate patient’s blood loss intraoperatively.
As pediatric patients have higher blood loss to total blood volume ratio, every gauze was weighted immediately to obtain accurate and real time intraoperative blood loss for treatment decision. For major operation with excessive blood loss, manual calculation could be repeated more than 50 times. It is time consuming and leads to miscalculation errors.
With the implementation of electronic nursing documentation in operating theatre in HKCH, formulated electronic blood loss calculator was designed to operate in electronic devices to enhance intra-operative blood loss monitoring.
Objectives :
To eliminate calculating errors in intraoperative blood loss calculation To redirect nurses’ time used for calculation to patient care
Methodology :
A pre-questionnaire was distributed to nurses to understand their clinical needs, usual practices and difficulties in calculating intraoperative blood loss.
To use the calculator, nurse only have to input total weight and amount of gauze being weighted, then intraoperative blood loss will be calculated automatically. Besides, blood loss in suction apparatus are calculated by entering fluid volume in suction canisters and fluid volume irrigated to wound.
All blood loss information will be updated real time for timely clinical judgment.
After 2 months, a mid-term evaluation with individual interviews and clinical observations was conducted to gather comments and review nurses’ perception on the tool. Several modifications were made, including layout redesign to smooth out the procedure and adding instructions inside the tool.
Result & Outcome :
15 nurses were interviewed. Over 95% of participants calculated blood loss on paper form and only 27% of participants agrees that calculations on paper form is an effective way to calculate intraoperative blood loss in pre-questionnaire.
After launching of electronic blood loss calculation, 45% of participants agrees that it is an effective way to calculate blood loss without calculation error. The mean satisfaction score for new system is 3.5 out of 5.
