Motivators and Challenges in Implementing Restrictive Red Blood Cell Transfusion in Intensive Care Unit Kelantan
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Abstract
Introduction: The overuse of red blood cell (RBC) transfusions is a rising concern. Restrictive transfusion is effective in reducing unnecessary transfusions. This study aimed to identify the motivators, challenges, and factors associat ed with challenges in implementing restrictive RBC transfusion in the intensive care unit in Kelantan. Methods: A cross-sectional study was conducted using a validated questionnaire, involving clinicians from the Department of Anaesthesiology at Hospital University Sains Malaysia and Hospital Raja Perempuan Zainab II in Kelantan from 1st November 2022 until 30th April 2023. Sample size was calculated using the single proportion formula. Results: The median scores of the motivators and challenges were used as cut-off points for agreement. Out of 99 participants, 54 had high agreement with the motivators (median score = 37.0), including knowledge, professionalism, beliefs about consequences, and capabilities. 52 participants showed high agreement with challenges (median score = 14.0), particularly social conflict and patient outcome expectancy. Logistic regression revealed that medical officers and master’s students had significantly higher agreement with challenges compared to specialists or consultants (AOR 13.17, 95% CI:1.901-91.233, p=0.009 for medical officers and AOR 6.60, 95% CI:1.091-39.932, p=0.040 for master’s students). Those with 10-14 years of practice were more likely to report high agreement with challenges compared to those with over 15 years of experience (AOR 12.46, 95% CI: 1.011–153.494, p=0.049). Conclusion: Less experienced clinicians and those in non-specialist roles perceived greater challenges in adopting restrictive transfusion practices. To enhance implementation, early training, interdisciplinary workshops, standardised proto cols, and reduced staff workload are recommended.
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