Incidence and reasons of patient’s injuries in hematology department
Natalya S. Nekrasova, Vera O. Sklyarova, Evgeniy A. Goncharov, Alexandr V. Kiselev
Raisa Gorbacheva Memorial Institute for Children Oncology, Hematology and Transplantation, First St. Petersburg State Pavlov Medical University, St. Petersburg, Russia
Summary
Introduction and aim
The purpose of this study was to reveal the most frequent causes of patient’s injuries at the Hematology Department and to propose measures aimed for reduction of their incidence.Patients and methods
We analyzed data from 12 patients who received chemotherapy or hematopoietic stem cell transplantation (HSCT) at the R. Gorbacheva Memorial Institute for Children Oncology, Hematology and Transplantation and were injured over 2014 to 2017. Median age of the injured patients was 39 (3 to 68) years old. Five patients were initially diagnosed with acute myeloid leukemia; 3, with acute lymphoblastic leukemia; 4, with other malignancies. 75% of these patients were subject to allogeneic HSCT. The injuries occurred, on average, 32 days after HSCT (3-283). Patient’s condition after injury was assessed by the falling risk scales: Morse scale (1989), The STRATIFY (1997), “Drug-associated scale of risk” (2012). In addition, we assessed influence of anemia and thrombocytopenia severity upon the injury incidence.Results
High and moderate falling risk was 91% according to STRATIFY scale (1997), and 92% (Morse scale, 1989), respectively. 50% of injured patients had severe anemic syndrome, 58% – severe thrombocytopenia. In 25% of all cases, the injury was drug-associated. Trauma manifestations included: head and face soft tissue contusion (67%, n=8); brain contusion and subdural hematoma (25%, n=3), spleen rupture in one case (8%). Mortality in injured patients was 33%, mostly due to posttraumatic hemorrhagic complications.Conclusions
Injuries in hematology department are an important problem and require special medical staff control. A proper prophylaxis of injury includes prediction of injury risks in patients by using appropriate scale and careful decisions on patient transfers to the ward surveillance. It is necessary to increase the number of nursing staff, in order to provide supervision and care for the patients with high and moderate risk of injury. We propose to implement an effective clinical protocol based on the project Patient safety first of all adopted in UK (2011), in order to reduce the injury incidence.Keywords
Hematopoietic stem cell transplantation, anemia, thrombocytopenia, falling risk, injuries, prevention measures.