Project for Making a Change in Nursing Practice Using Evidence-Based Practice

Pre-Medications

Current practices in the Blood Marrow Transplant Unit (BMTU) are to administer Tylenol and/or Benadryl as pre-medications prior to the administration of blood products before a transplant takes place. This paper will study whether such pre-medicating actions are detrimental to the patient due to the masking effects of the medicines and the occurrence(s) of mostly mild reactions to the blood transfusions that are normal occurrences before BMTU surgery. The paper will seek to discern whether the practice of pre-medicating patients is a viable practice or one that needs to be changed or terminated.

The purpose of the study is to determine whether a change can be made to improve the care of patients undergoing bone marrow transplants. The improvement could take a number of different forms; two of those forms include; first a fewer number of reactions to the blood transfusions that take place before and during the transplant, and second the masking effects of the pre-medications would no longer be present.

The importance of the study is that the change, while not necessarily saving any additional lives, could ensure that patients who are already facing a long and arduous process can alleviate a small portion of the pain and suffering during the process. The easing of pain and suffering may not seem such a large consequence, however there are a large number of patients who are facing this scenario that would likely beg to differ.

Current literature on the issue of pre-medication shows that it is not only in the BMTU where this practice takes place, it is also practiced in other medical situations as well.

The study will include a complete review of the literature to discern what other practices may be viable, or have been found wanting, in this scenario. The literature review is important because it can provide a direction to the study that will enhance the study's findings. An example would be a recent study that showed that "complications such as transfusion-transmitted infection and transfusion reactions remain drawbacks to the transfusion benefits gained by red blood cell (RBC) oxygen delivery and platelet (PLT) derived hemostasis" (Kennedy, Case, Hurd, Cruz, Pomper, 2008, p. 2285). If this study can assist in determining that pre-medications will lower transfusion reactions and infections, then the study will be of importance to the medical community.

Another study determined that "pre-treatments with intravenous clonidine suppressed the reflex cough induced by fentanyl" (Horng, Wong, Hsiao, Huh, Kuo, Cherng, Wu, 2007, p. 862). The study was conducted in response to a reflex cough that often develops after an intravenous bolus of fentanyl before surgery. A further study showed that it is not only medicine that can be used as a pre-treatment, but that music could be used as well. What the study determined was that "relaxing music decreases the level of anxiety in a pre-operative setting to a greater extent than orally administrated midazolam" (Bringman, Giesecke, Thorne, Bringman, 2009, p. 759). Other studies have also determined the effectiveness of pre-medication, and perhaps that is one of the reasons why the practice of administering Benadryl or Tylenol before bone marrow transplants continues to take place. Evidence of the ill effects of such actions make this study one of importance to the BMTU across the United States.

Methodology

Many of the consults that take place after investigations to a reaction to blood transfusions recommend that the practice of administering the medicines be discontinued because of the effects of doing so. What this study will seek to determine is whether the administration of Benadryl or Tylenol as a pre-medication is more harmful than beneficial in two specific aspects. Those aspects are the masking effects of the pre-medications and the mild reactions that can be produced by the pre-medications. The methodology used to determine the results will be quantitative in nature due to the fact that the study does not concern thoughts or feelings just physical reactions to the action of pre-medicating.