Guidelines for the Administration of Blood and Blood
Components
District General Hospital Trincomalee
SUMMARY OF KEY RECOMMENDATIONS
Decision of transfusions.
The rationale for transfusion should be based on clinical and laboratory assessment and the specific components to be transfused should be documented in the patient's clinical record.
Patient Consent
Informed consent, either verbal or written, should be obtained (wherever possible) and documented in the patient's clinical note
Prescriptions
Decision of transfusion with justification and expected outcome should be legibly written in BHT/Clinic note with type of blood component, volume / number of units to be transfused, date of transfusion, special transfusion requirements and any special instruction
Requests for transfusions
REQUEST FORMS FOR RED CELL PRODUCTS and REQUEST FOR PLATELETS AND PLASMA COMPONENTS issued by National Blood Transfusion service should be filled completely and legible
Pre-transfusion patient Identification & sample collections
All patients having a blood sample taken must be positively identifies
The collection of the blood sample from the patient and the subsequent labelling of the sample tubes should be performed as one continuous, uninterrupted event at the patient's (bed) side, involving one patient and one member of staff only. Collection date, time and the name of the sample collector should be legibly written and signed on the request form and the sample labe
Identifying the responsibility of blood and component acceptance by nursing officers
Blood is been considered and a drug, if at all a very dangerous drug as serious adverse reactions can occur if given to the wrong patient. As a preventive measure of such errors occurring, every step in the transfusion process has to be double checked by two responsible persons,
When the blood product is received at the ward or unit, the product has to be received by the nursing officer in the unit, as blood is also considered as a drug. However, a medical officer has to counter sign and monitor the patient at the bed side of the patient just before the transfusion
It was brought to my notice that the issue seal depicted below that has been in place and used by the blood bank mentions Medical officer (M/O) instead of Nursing Office (N/O) in the seal.
I therefore, would like to bring this to your notice and inform all the Nursing Office's at DGH
Trincomalee through the Matron's office that in the future all blood and blood products needs
to be received by a NO to assist the Medical officer to start the transfusion by assuring and assisting in the double check
Pre-collection considerations
Receipt in the clinical area
When the blood component is delivered to the clinical area, an appropriately competent member of staff should check that the correct blood has been delivered.
Administration Check
All patients receiving a transfusion must be positively identified and the final
administration check should always be conducted next to the patient. Match the patient with documents and the component to be transfused as follows:
Patient BHT/Clinic hot compatibility report compatibility label component label
Once all checks have been successfully completed, the transfusion should be started immediately, if there is any discrepancy, the blood bank should be informed and the component must not be transfused until there has been an investigation and any discrepancies resolved.
Blood Component Checks
Check the integrity and any unusual appearance of the component
The unique component donation number and the date start and stop time of all blood components administered and the name of the person administering the component should be recorded in the second part of the component issue stamp in patients' clinical notes.
Monitoring the patient
Minimum monitoring of the patient should include
> Pulse rate,
> Blood pressure,
> Temperature
> Respiratory rate.
Observations should be undertaken and documented for every unit transfused.
> Prior to transfusion
>At 15 min after the start of each component
> Post transfusion
Development of signs and symptoms suggesting a transfusion reaction should prompt more frequent observations, dictated by the clinical situation. Reporting of all transfusion reactions and near misses to the blood bank's haemovigilance system is been mandatory.
Before collecting the blood component, ensure appropriate and patent intravenous access. Only one unit for each patient at a time is to be requested and collected, unless rapid transfusion of large quantities is needed