The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [281]
Although there is little evidence to support the efficacy for set procedures to manage this risk, current professional opinion has been provided by the British Committee for Standards in Haematology (BCSH) in collaboration with the Royal College of Nursing (RCN) and the Royal College of Surgeons of England (RCS) (BCSH 1999, Gray and Illingworth 2005). As a result of this guidance, every hospital should have a policy in place for the administration of blood and blood components including identification of the patient, blood sampling, special blood requirement requests, processing of blood samples, the storage, collection and transportation of blood products, administration of blood products and the care and monitoring of the transfused patient. Furthermore, hospitals are also required to manage and report any adverse events or near misses, with a statutory requirement to hold a record of every step of the transfusion process including the final fate of each blood product for 30 years (James 2005). Only staff authorized to do so should be involved at any stage in the transfusion process.
Nurses in the UK are normally the healthcare professionals ultimately responsible for the bedside check and arguably have the final opportunity to prevent errors occurring when patients receive blood transfusions (Wilkinson and Wilkinson 2001). Errors in the requesting, collection and administration of blood components (red cells, platelets and plasma concentrates) lead to significant risks for patients. Since its launch in 1996, the Serious Hazards of Transfusion (SHOT) scheme has continually shown that ‘wrong blood into patient’ episodes are a frequently reported transfusion hazard. These wrong blood incidents are mainly due to human error arising from misidentification of the patient during blood sampling, blood component collection and delivery or administration which can lead to life-threatening haemolytic transfusion reactions and other significant morbidity (BCSH 2009).
The National Comparative Audits (NCA) of bedside transfusion practice in England and North Wales (2003, 2005 and 2009) show that patients continue to be placed at risk of avoidable complications of transfusion through misidentification and inadequate monitoring of the patient.
Rationale
Blood transfusion is an essential part of modern medicine and healthcare. However, it should be prescribed only to treat conditions associated with significant morbidity or mortality that cannot be prevented or managed by other means (WHO 2005).
Recent publications and legislation have created greater awareness of the need to continue to improve transfusion practice in many ways. Blood and blood products are no longer regarded as safe unlimited resources. There are risks inherent in transfusion practice and therefore unnecessary exposure to blood products should be avoided. This is of particular importance for patients who may only have one transfusion in their lifetime, such as surgical patients. Therefore, these patients should only receive a transfusion when it is absolutely necessary. Furthermore, the appropriate use of products is essential for the conservation of blood supplies. Regularly updated guidance on the safe appropriate use of blood and blood products is now available online at www.transfusionguidelines.org.uk and these should be consulted in collaboration with local hospital and blood transfusion service guidelines.
Indications
Anaemia is defined as a haemoglobin concentration in blood that is below the expected value, when age, gender, pregnancy and certain environmental factors, such as altitude, are taken into consideration. In general, anaemia is a consequence of one or more of the following generic causes:
increased loss of red blood cells
decreased production of red blood cells
increased destruction of red blood cells
increased demand of red blood cells
increased production of abnormal red blood cells,
which may be due to nutritional deficits, blood