Anesthesia — Foundation of Discipline

F7 Assessing the indications for transfusion of blood products and managing side effects and complications

Key Features:
- The observation of this EPA should be started in Foundations, and may be completed
in Core.
- Assessment and management of complications and side effects may be evaluated
through discussion, OSCE, or high fidelity simulation, as well discussion around actual clinical situations by asking resident’s about indications, side effects, and complications when blood products are used.
- This EPA covers the more commonly used blood products: red blood cells (RBCs), frozen plasma (FP), platelets, cryoprecipitate, and prothrombin complex concentrate (PCC). Other products used less commonly, such as activated Factor VII or fibrinogen, are more appropriately covered in the relevant Core EPAs.
- This EPA can be observed in the operating room or in other environments (e.g. emergency room, critical care, ward).
Relation with other EPAs: The skills learned in this EPA in Foundation leads to the following situations that are linked to EPA’s in Core: «assessing and managing patients with significant hematological disorders», «managing patients with major polytraumatic injury, with or without massive transfusion protocol», «managing the obstetric patient with hemorrhage», «managing blood transfusion or conservation strategies in cardiac surgery» «managing hemorrhage during aortic surgery» and «managing Jehovah Witness patients».

Form

F1: Observation

Milestones

• ME 1.3. Apply knowledge of physiology and pathophysiology of blood loss

• ME 2.2. Recognize signs and symptoms of acute hemorrhage and predict volume of blood loss

• ME 2.4. Develop strategies for perioperative management to minimize blood loss

• ME 1.3. Apply best evidence and guidelines for the transfusion of blood

• ME 3.2. Obtain and properly document informed consent for administration of blood
  products

• ME 3.2. Describe the indications, contraindications and risks for crystalloid and/or colloid fluid administration and the replacement of blood products such as: RBC, frozen plasma (FP), prothrombin complex concentration (PCC), platelets, cryoprecipitate

• COM 4.1. Explore the patient preferences and cultural practices regarding blood products when developing care plans

• COM 5.1. Document information about fluid and blood products administered and the response of the patient

• COL 1.3. Seek out and respond to input from the surgical team when fluid resuscitating a critically ill patient

• L 2.1. Allocate health care resources for optimal patient care

• L 2.2. Consider costs of blood products when choosing care options

• L 1.1. Improve clinical practice by applying a process of continuous quality
  improvement to the perioperative optimization of anemia

• S 3.4. Incorporate evidence-based medicine into clinical practice

• P 3.1. Adhere to ABO blood compatibility and blood product administration
  guidelines

Context Variables

• Location (single-choice)
  • OR
  • ICU
  • PACU
  • ward
  • other location
• Blood product type and amount (free-text)

Requirements

• The Specialty Committee has not provided guidance for the entrustment of this EPA. Entrustment decisions are left to discretion of the Competence Committee