Date of Award
Summer 2026
Abstract
Abstract
Background: Massive Transfusion Protocol (MTP) activations are low-frequency, high-acuity events in the post-anesthesia care unit (PACU) setting. These events necessitate the rapid formation of codes teams, interdisciplinary communication amongst unfamiliar providers, critical decision-making, high-volume rapid blood transfusions, and critical laboratory marker monitoring.
Local Problem: Due to the infrequent nature of hemorrhagic events in the PACU, nurses may have limited experience participating in these protocols at their institutions, resulting in potential for documentation errors from retrospective back charting, decreased confidence regarding blood product sequencing and laboratory draw timing, and increased cognitive workload overall. This quality improvement (QI) project implemented a Massive Transfusion Protocol Board as an addition to the code cart deployed during MTP activations in a local PACU. This large-scale visual cognitive aid serves all nursing staff present at a code to jointly reference for protocol adherence, resuscitation team communication and situational awareness, and rapid documentation throughout the transfusion processes. The accessibility of the tool seeks to improve nurse perceptions of preparedness and confidence going into these complex events.
Methods: The intervention consisted of a large reusable dry-erase whiteboard displaying the institution’s specific MTP protocol workflow in sequential list format. It contains designated areas for checking off completed steps and prompts nursing staff to record the time of each unit’s administration, unit lot number, as well as laboratory draw intervals.
Primary outcome measures included the change in nurses’ self-reported confidence levels approaching multiple identified barriers and challenges of MTP activations, including both skills responsibilities and emotional cognitive burden. Domains measured within the pre- and post-implementation surveys included MTP progression clarity, situational awareness, preparation confidence, interdisciplinary communication and role clarity, documentation, and accessibility of MTP resources.
Results: This initiative demonstrated that the MTP board was perceived by frontline nursing staff in a PACU as a valuable cognitive aid tool for hemorrhagic emergencies in categories consisting of preparedness and situational awareness, team communication, documentation, and accessibility. Implementation of the MTP Board was associated with increased nurse confidence and perceived readiness across all domains. Mean, median, and top-box analysis values, as well as Mann-Whitney U-scores, all indicated statistically significant improvements in the measured categories comparing pre implementation versus post-implementation survey results.
Conclusion: The results from this low-cost intervention support the use of standardized cognitive aids during low-frequency critical care events and contributes to staff well-being through reduction of stress and mental workload. Future QI initiatives should evaluate performance outcomes of the use of the MTP Board during hemorrhagic events through measures such as patient safety outcomes, protocol adherence, documentation accuracy, and the impact on nurse burnout and resilience.
Document Type
Master's Thesis
First Advisor
Dr. Elizabeth Evans, DNP, RN, CNL
College or School
CHHS
Department or Program
Direct Entry Masters Nursing
Degree Name
Master of Science
Recommended Citation
Farrell, Jenna L., "A Quality Improvement Initiative: Implementing an Effective Massive Transfusion Protocol Cognitive Aid Tool Within an Operating Room & Post-Anesthesia Care Unit Setting" (2026). Master's Theses and Capstones. 2120.
https://scholars.unh.edu/thesis/2120