Implementation of the Recommendations for RBC Transfusions for Critically Ill Children From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative.
Implementation of the Recommendations for RBC Transfusions for Critically Ill Children From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative.
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实施儿科重症护理输血和贫血专业知识倡议中的危重儿童红细胞输血建议。
DOI：
10.1097/pcc.0000000000001592
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发表时间：
2018
期刊：
影响因子：
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通讯作者：
PediatricCriticalCareBloodResearchNetwork(BloodNet),andthePedi
中科院分区：
文献类型：
--
作者：
Steffen,KatherineM;Bateman,ScotT;Valentine,StaceyL;Small,Sara;Spinella,PhilipC;Doctor,Allan;PediatricCriticalCareTransfusionandAnemiaExpertiseInitiative(TAXI);PediatricCriticalCareBloodResearchNetwork(BloodNet),andthePedi
Objectives：To provide context for implementation of the Pediatric Critical Care Transfusion and Anemia Expertise Initiative recommendations for RBC transfusions，including a review of previous research related to implementation of transfusion guidelines，efforts to facilitate implementation through Transfusion and Anemia Expertise Initiative，and to provide a framework for recommendations.Design：回顾现有的临床文献，并描述一种基于实施科学原则的综合实施方法。先前使用输血指南的努力包括使用提供者教育、当地指南、视觉辅助、前瞻性和回顾性审计和反馈以及计算机化决策支持工具;然而，没有一种方法被确定为在儿科重症监护环境中实施的最佳方法。证据围绕供应商的信念和输血决策点需要额外的供应商的教育，强调限制输血的重要性，并制定建议，如输血和贫血专业知识倡议指南，可应用于特定的临床conditions.Conclusions：输血和贫血专业知识倡议指南将被广泛传播;然而，需要协调一致的执行工作，以影响实践。建议采用一种方法，鼓励广泛的多专业利益相关者参与，就实施的指南达成正式协议，选择实用可行的策略，并在整个实施过程中积极监测临床实践和结果。提出了正式的第二阶段输血和贫血专业知识倡议-血液使用的持续评估，以加强建议的实施，跟踪对实践和患者结局的吸收和影响，并确保在制定时将新的临床证据整合到现有指南中。
Objectives:To provide context for the implementation of the Pediatric Critical Care Transfusion and Anemia Expertise Initiative recommendations for RBC transfusions including a review of prior research related to implementation of transfusion guidelines, efforts to facilitate implementation through Transfusion and Anemia Expertise Initiative, and to provide a framework for recommendation implementation.Design:Review of existing clinical literature and description of a comprehensive approach to implementation based on Implementation Science principles.Results:The Transfusion and Anemia Expertise Initiative recommendations on RBC transfusions are based on clinical evidence and aim to limit unnecessary and potentially harmful transfusions. Prior efforts to use transfusion guidelines include use of provider education, local guidelines, visual aids, prospective and retrospective audit and feedback as well as computerized decision support tools; however, no single approach has been identified as optimal for implementation in pediatric critical care settings. Evidence around provider beliefs and transfusion decision-making point to the need for additional provider education, emphasizing the importance of limiting transfusions, and the development of recommendations, such as the Transfusion and Anemia Expertise Initiative guidelines, that can be applied to specific clinical conditions.Conclusions:The Transfusion and Anemia Expertise Initiative guidelines will be broadly disseminated; however, coordinated implementation efforts will be required to impact practice. An approach that encourages involvement of a wide range of multiprofessional stakeholders, formal agreement on the implemented guidelines, selection of strategies that are practical and feasible, and active monitoring of clinical practice and outcomes throughout implementation is recommended. A formal second stage Transfusion and Anemia Expertise Initiative-Continuous Assessment of Blood-use is proposed to enhance implementation of the recommendations, follow uptake and impact on practice and patient outcomes, and ensure integration of new clinical evidence into the existing guideline as it is developed.