Hemorrhage tops the list of preventable battlefield mortality with 14% of patients admitted to combat support hospitals transfused with one or more blood products (Cap et al., 2019). During the October 2018 and September 2019 period, 4,323 blood products were transfused in joint-theater hospitals. Yet, most Air Force (AF) nurses (86.5%) work in ambulatory care facilities or clinics and do not regularly administer blood products.
Major Savannah Jumpp identified a lack of standard AF simulation scenarios for basic blood product administration, as an Air Force Clinical Inquiry in Nursing Readiness (CINR) Fellow at the David Grant Medical Center. While simulation scenarios for massive transfusion were present, those relied only on a foundational competency in basic blood product administration.
After identifying a gap in readiness training for blood product administration, Major Jumpp formed a team with Clinical Nurse Scientists (CNSs), Readiness, Education & Training, an EBP Facilitator, and the CINR Fellowship Mentor to address the problem. With the support of the AF Nurse Corp Chief, the assistance of a TriService Nursing Research Program (TSNRP), and her local EBP Facilitator, she applied for a TSNRP EBP mini-grant to support the inquiry.
Major Jumpp used the PICO question: For active-duty nurses (P), how does hands-on learning (simulation) (I) compare to knowledge-based learning (computer-based training) (C) impact competency in blood product administration (O)? The literature review and appraisal revealed that the best evidence recommends blended education methods, such as combined lecture and simulation. The practice change added a live classroom lecture and blood administration hands-on simulation exercise to the existing required knowledge-based computer-based training. The pilot practice change was implemented with 32 participants and resulted in a 13% improvement in performance, a 7% improvement in self-competence, and a 90% rating in training program satisfaction.
In addition to the pilot practice change, Major Jumpp developed the “Blood Product Administration Simulation Training” toolkit complete with the simulation scenario, budget, curriculum, equipment list, workforce requirements, and the measurement instruments for knowledge, performance, self-competency, and satisfaction. The toolkit was posted on the Defense Health Agency (DHA) Launchpad Leading Practice website for Military Health System use and was incorporated in Defense Medical Modeling and Simulation training scenarios.
As a dissemination effort, the article, “Evidence‐Based Competency Training Program for Blood Product Administration” was published in Worldviews on Evidence‐Based Nursing in 2021. In January 2023, Douglas J. Floccare, MD, MPH, FACEP, the State Air Medical Director for Maryland Institute for Emergency Medical Services Systems and Medical Director for the Maryland State Police Aviation Command contacted Major Jumpp to learn more about and access the toolkit to train trooper flight paramedics. Maryland is the first state to carry whole blood aboard state police helicopters, offering the lifesaving intervention upon arrival. Training for the program was developed prior to the whole blood rollout in May 2023.
The 59th Medical Wing, Science and Technology Office of Research and Technology Applications developed an Intellectual Property (IP) Agreement, recognizing that the Blood Product Administration Simulation Training toolkit may not only be a useful product for the DoD but may benefit other government and external partners in the future. The IP Agreement allows toolkit sharing, tracking external interest in the product.
The Air Force (AF) Clinical Inquiry in Nursing Readiness (CINR) fellowship curriculum requires fellows to identify a high priority Nurse Corps readiness need and conduct an Evidence-Based Practice (EBP) initiative to address requirements locally and across the Air Force Medical Service. This military initiative will be adapted and implemented in non-military settings to improve patient outcomes too. The results of Major Jumpp’s CINR fellowship illustrate the life cycle for solving operational problems with scientific evidence and transitioning the knowledge product into practice and beyond.
