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advised of the risks and benefits, of alternatives to blood transfusion including autologous transfusion (BCSH 1999), be given the opportunity to ask questions and have the right to refuse to receive it in accordance with local and national guidance (NMC 2008b, RCN 2006). One of the key objectives of the HSC 2007/001 Better Blood Transfusion was to improve information provided to patients and to ensure that those who are likely to receive a blood transfusion will be well informed of their choices. There are a number of information leaflets issued by the NHS Blood and Transplant Service for both patients and healthcare professionals.

The issue of consent for blood transfusion is currently being considered by the Advisory Committee on the Safety of Blood, Tissues and Organs (SaBTO). Patients have the right to refuse transfusion and to be treated with respect. Staff must be sensitive to individual patient needs, acknowledging their values, beliefs and cultural background and exploring alternative treatments if appropriate and available (Oldham et al. 2009). There is increasing public concern about blood transfusion safety and the need to accommodate some patients’ religious beliefs (John et al. 2008).

Jehovah’s Witnesses and blood transfusion

The role of blood in Jehovah’s Witnesses’ spiritual belief is based on scripture and followers are usually well informed on both their beliefs and their rights. Many Jehovah’s Witnesses carry information with them regarding any objection and therefore the need to ensure informed consent is very important. Staff caring for patients must ensure that decisions to consent to or refuse treatment are respected and recorded appropriately (McClelland 2007). Furthermore, in individual circumstances, practitioners should endeavour to consider non-blood or autologous methods as described previously, where appropriate (McClelland 2007).

Procedure guideline 8.14 Blood sampling: pretransfusion

Essential equipment

Antimicrobial skin cleanser – the recommended solution is 0.5% chlorhexidine in 70% alcohol

Needle/winged infusion device

Appropriate tubes for blood sample collection

Gauze

Hypoallergenic tape

Non-sterile, well-fitting gloves

Sharps container

Preprocedure

Action Rationale

1 Explain and discuss the procedure with the patient.

To ensure that the patient understands the procedure and gives their valid consent (NMC 2008b, C).

2 Take pretransfusion blood from one patient at a time.

To ensure that samples from different patients are not confused which can have fatal consequences and to minimize this risk (SHOT 2008, C).

3 Check all packaging before opening and preparing the equipment.

To ensure there has been no contamination and all equipment is in date. E

Procedure

4 Before taking the sample, ask the patient to state their first name, surname and date of birth. Cross-check these details against the blood request form.

To ensure that the sample obtained corresponds with the request (BCSH 2009, C).

5 Check these details against the patient’s identity wristband.

To ensure that the patient is positively identified before obtaining a blood sample (BCSH 2009, C).

6 Check the patient’s hospital number on the wristband against that on the blood request form.

To ensure that the sample obtained corresponds with the request (BCSH 2009, C).

7 Obtain the blood sample by direct venepuncture or via central venous access device, in the appropriate tube (see Chapter 11)

To ensure the correct procedure is followed and an adequate sample is obtained. E

Postprocedure

8 Hand-write the sample tube clearly and accurately, ensuring all names are spelled correctly. This should only be done once the sample has been successfully obtained and should be done at patient’s (bed)side.

(a) First name

(b) Surname

(c) Date of birth

(d) Gender

(e) Hospital identification number

(f) Ward or department

(g) Date

To ensure the sample is labelled with the correct patient details. BCSH guidelines do not recommend the use of addressograph (BCSH 1999, C). Blood tubes should never be completed in