IMPROVING NURSING CLINICAL PRACTICE IN THE MANAGEMENT OF REFRACTORINESS TO PLATELET TRANSFUSION AMONG ONCOLOGIC/ HEMATOLOGIC PATIENTS

Mary Ray; Sherwin Balasia; Victoria Aquino

Platelet refractoriness is a clinical problem for patients with oncologic and hematologic disorders. It is the repeated suboptimal response to platelet transfusions after two sequential post-platelet increments of less than 10 x 109/L. Front-line nurses should be familiar with the causes of platelet transfusion refractoriness, its assessment, and management to improve patient's clinical outcomes. The goal is to improve clinical nursing practice in managing platelet refractoriness by educating nurses on the non-immune-mediated and immune-mediated factors and discussing the steps of interventions. An algorithm of strategies and countermeasures recommended by evidence-based research articles on identifying the causes of platelet refractoriness will be shown and discussed with staff nurses, and the type of platelet unit to be given-platelet crossmatching or HL A matching for immune-mediated causes. A literature review was conducted through the ONS and Medscape databases. The words: "cancer," "patient," "platelet transfusion," "post platelet count," and "refractoriness" were used to generate articles. The articles were analyzed for variables causing platelet refractoriness and recommended care plans. Retrospective data collection from 15 thrombocytopenic patients with 100+ transfusion platelet events (post-chemo treatment, post-autologous stem cell transplant, post-allogeneic stem cell transplant, and chronic thrombocytopenia related to aplastic anemia) were used to identify the rates of the variables that might influence platelet refractoriness. An in-service was presented to the nursing staff with an evaluation algorithm and interventions during suspected refractory. A survey was captured to grade improvements in the nurses' understanding of platelet refractoriness. The retrospective study showed the highest non-immune related variables were sepsis/infection, current medication, and active bleeding. A case study of a sample patient showed once their non-immune clinical condition is resolved, their platelet refractoriness recovers. Nurses given education on platelet refractoriness offered positive feedback on the surveys. Nurses feel more empowered by the knowledge. Nurses feel confident in asking for platelet antibody tests for suspected immune-mediated factors. This project aims to improve front-line nurses' clinical practice through effective collaboration with physicians and transfusion services. The intention is to empower front-line infusion nurses with knowledge to promote a standard guide of practice that helps nurses to effectively respond when post-platelet increments are suboptimal so they can properly advocate for their patients if further interventions are appropriate.

IMPROVING NURSING CLINICAL PRACTICE IN THE MANAGEMENT OF REFRACTORINESS TO PLATELET TRANSFUSION AMONG ONCOLOGIC/ HEMATOLOGIC PATIENTS

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