Utilization of intra-operative blood salvage in management of women with acute ruptured ectopic pregnancies in Mulago Hospital

Abstract

Background: Intra-operative blood salvage is a scientific technique known to reduce the need for an allogenic transfusion and associated risks of infectious and non-infectious complications and time required to acquire blood in situations of emergency surgeries like acute ruptured ectopic pregnancies. Despite the known benefits of intra-operative blood salvage, the techniques is not utilized or taught in Mulago National referral hospital. Detailed insight into the issues leading to failure of intra-operative blood transfusion (IBS) utilization was lacking in Mulago. To encourage the initiation and utilization of IBS, tailored recommendations aimed at barriers that hinder its practice were made. Main objective: The study was aimed at exploring relevant barriers and facilitators that influence the implementation of intra-operative blood salvage in the management of acute ruptureda qu ectopic pregnancies. Methods: This was alitative descriptive study carried in Mulago National Referral Hospital. Twelve respondents were selected using maximum variation purposive sampling. Researcher administered in-depth interviews were conducted using an interview guide. The questions asked focused on the personal experience and theoretical prompts were informed by the Theoretical Domains Framework (e.g., knowledge, beliefs, etc.). The responses were all audio-taped and recorded and other remarks recorded in a note book. We transcribed the interview recordings into verbatim. We analyzed data using the qualitative software QSR Nvivo 10. The coding scheme was drawn up using a combination of pre-defined areas of analysis based on the objectives of study. Finally recommendations were developed based on the barriers established.

Results: Utilization of IBS in Mulago National Referral Hospital was hindered majorly by deficiency of knowledge and skills. Other barriers included beliefs about quality and theoretical risks, lack of equipments, sterility of the environment, lack of specific IBS goals and motivation as well as complexity of the technique. While presence of multiple disciplines, students willingness to learn and practice, visiting professionals, some skilled and knowledgeable senior consultants, scarcity of blood, positive experiences from those who have ever practiced or are practicing IBS, the national status of Mulago and increased information flow were mentioned as facilitators.

Conclusion: This study identified a number of barriers of intra-operative blood transfusion in Mulago National referral hospital. At professional level lack of knowledge came out as the major barrier in addition to lack of skills, lack of evidence and belief about transfusion risks. While at the organizational level, lack of resources, lack of guidelines and un-conducive environment were identified. Presence of multi-disciplinary groups of professional, visiting teams, students and patients, were facilitators established by the study.

Recommendation: Possible ways that may lead to utilization of intra-operative blood transfusion in Mulago National Referral Hospital include; Education and training (CME, Morning meetings, class training, on job orientation), autologous blood group team to advocate, train and mentor other staff and establishing demand (Advocacy and development of guidance, protocols or AIC materials, inventory into the resources availability and the possibility of procurement. Finally, feasibility and or implementation studies about intra-operative blood transfusion may be done.