110408 blood transfusion single use pathway

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Worcestershire Acute Hospitals NHS Trust

Care Pathway for Blood Transfusion Single Use Page 1 of 6

CARE PATHWAY FOR BLOOD TRANSFUSION SINGLE USEFor use with all patients requiring blood transfusion, day case and in-patient, in all departments.

Guidelines referred to when developing this Care Pathway:1. Worcestershire Acute Hospitals NHS Trust, Policy & Guidelines for Blood Transfusion, November

2004.2. SHOT guidelines (Serious Hazards of Transfusion) 2000.3. British Committee for Standards in Haematology 1999.

Abbreviations used in Care Pathway

RN Registered Nurse Dr Doctor

Aux Auxilliary Nurse/HCSW T Any member of the above team

SHO Senior House Officer S Surgeon

A Anaesthetist AA Anaesthetic Assistant

St N Student Nurse

All users of this pathway must enter their specimen signature and initials below

PRINT NAME SIGNATURE INITIALS DESIGNATION

A multidisciplinary team has developed this Care Pathway. It is intended as a guide to care andtreatment, and an aid to documenting patient progress. The Care Pathway document is designed toreplace the conventional medical and nursing clinical record and be retained in the medical notes withinthis admission episode.

All healthcare professionals are of course free to exercise their own professional judgment when using

this Pathway. However any decision to deviate from the pathway should be documented and filed in thepatients notes.

Any comments regarding this Care Pathway should be sent to the Author, Hilary Morgan, BloodTransfusion Nurse Practitioner, 01905 763333 Ext: 30633

Approved by CEC and Issued: July 2005 Review: July 2008

Reviewed by Hilary Morgan, Blood Transfusion Nurse Practitioner and re-issued with minor amendmentsin July 2006 and October 2007

Please attach patient sticker here or record:

Name:.

Unit No:

D.O.B: ...

Male Female

Consultant: ... Ward: ..


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Unit Number:

Name: ... DOB: ..

Worcestershire Acute Hospitals NHS TrustCare Pathway for Blood Transfusion - Single Use Page 2 of 6

No.

De

signation

INTERVENTIONIf an intervention is not carried out for any reason, pleasetick No and document intervention number, reason and

action taken, in multidisciplinary progress notes (Page 6)

Y N Signature(Time /Date)

SECTION A - GROUP / CROSS MATCHING AND PRESCRIBING OF BLOOD1 Dr

orRN

Reason for transfusion: .

See WAHT Guidelines Protocol 1 of Blood Transfusion PolicyHb prior to transfusion: . g /dl

2 Dror

RN

Patient has received information re procedure, risks and benefits

Aware of reason for transfusion Written information leaflet given

Verbal explanation of procedure, risks and benefits given

3 DrorRN

Patient wristband in place and contains: surname, first name,gender, DOB, ID number

NB: If in pre-assessment clinic verbally check 3 items: name, IDnumber, DOB or address

4 Dror

RN

Request form fully completed

Ensure the following information is included: surname, first name,gender, DOB, ID number, location of patient, time and date, type ofblood product, diagnosis, reason for request and any specialarrangements.

5 Dror

RN

Sample tube labeled with above information plus date sampletaken and location of patient:

Tubes must be labeled by hand, after blood has been taken, byperson taking blood

Blood taken in Phlebotomy Clinic Yes / No6 Dr Blood prescribed on intravenous infusion sheet:

Ensure the following information is included: surname, first name,DOB, ID number, blood/blood components required, plus any specialrequirements e.g. irradiated, quantity and duration of transfusion.

7 Dr Any special instructions required documented:Diuretics must be prescribed on medicines chartBlood warmer CMV neg.Irradiated

SECTION B - COLLECTION & DELIVERY OF BLOOD- Blood Transfusion Must Be Commenced Within 30 Minutes of Arriving On Ward

1st

Unit

2nd

Unit

3rd

Unit

8 DrorRN

Blood requested / collected from blood bank:Information to be taken to lab: name, DOB, ID, location, typeand number of units. NB: Person collecting must have beentrained in procedure.Time requested:

1st

Unit 2nd

... 3rd

... 4th

...4

th

Unit

1st

Unit

2nd

Unit

3rdUnit

9 DrorRN

Correct blood delivered to ward / department andreceived by RN/Dr:

Time blood arrives on ward / department.

1st

Unit 2nd

... 3rd

... 4th

...4

th

Unit


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Unit Number:

Name: ... DOB: ..


No.

De

signation




SECTION C - PATIENT IDENTITY AND BLOOD UNIT CHECK- All patients undergoing blood transfusion, in ANY setting, MUST have an identification wristband in place- Blood unit and patient identity checks MUST always be done in the presence of the patient who is to receive the

transfusion- Patient identity and the blood unit MUST also be checked by a second person

1st

Unit

2nd

Unit

3rd

Unit

10 RN Unit of blood inspected / no abnormalities found:

Check for: leaks, haemolysis, unusual discolouration orturbidity, presence of large clots

4th

Unit1

st

Unit

2nd

Unit

3rd

Unit

11 RN Patient identity checked verbally with patient:

4th

Unit1

st

Unit2

nd

Unit3

rd

Unit

12 RN Surname, first name, date of birth and identificationnumber all identical on each of the below:

1. Wristband (N.B. A & E number can be used)

2. Blood bank slip3. Compatibility label4. Prescription

4th

Unit

1st

Unit

2nd

Unit

3rd

Unit

13 RN Blood group and blood unit number identical on each ofthe below:

1. Blood unit2. Blood bank slip

4th

Unit1

st

Unit

2

nd

Unit3

rd

Unit

14 RN Blood unit within expiry date

4th

Unit

- The blood bank slip AND the prescription chart MUST be signed by both persons carrying out thepatient and unit check, and the time and date of commencement of the unit entered.

- The blood bank slip to be kept with the patient during the transfusion- Sign and return traceability slip


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Unit Number:

Name: ... DOB: ..


No.

Designation




SECTION D TRANSFUSION PROCESS / MONITORING15 RN Patient informed of any possible adverse effects of procedure

and the importance of reporting these immediately to clinicalstaff:e.g. shivering, rash, flushing, shortness of breath or pain in extremitiesor loins.

- There is no minimum or maximum size of cannula for transfusion, size will depend on size of vein andspeed blood is to be transfused

-

Blood will be transfused through a sterile giving set designed for the procedure. Additional filters arenot required- Each giving set must only be used for a maximum of 12 hours

MONITORING OF TRANSFUSION TO BE RECORDED ON BLOOD OBSERVATIONS CHARTON PAGE 5

1st

Unit2

nd

Unit

3rd

Unit

16 RN Blood unit administered within 4 hours of leaving theblood fridge

4th

Unit

1stUnit

2nd

Unit

3rd

Unit

17 RN Blood unit transfused with no adverse effects:

NB: details of any adverse reactions MUST be documented inmultidisciplinary notes (page 6) together with any actionstaken and a reaction report form completed.

4th

Unit

SECTION E DISPOSAL OF BLOOD BAGS1

st

Unit

2nd

Unit

3rd

Unit

18 RN Blood bag disposed of as below:

1. Sealed with a suitably sized spigot or attached blue plug2. Placed in dated bag and stored in dirty utility room

NB: After 24 hours the pack can be disposed of as clinicalwaste

4th

Unit


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Unit Number:

Name: ... DOB: ..


Date

Time

Baseline

1st Unit

Sign and returntraceability slip

2nd Unit


3rd Unit


4th Unit


Completio

n

Please enterunit number

40

39

38

37

36

35

Temperature

BloodPressure

Pulse rate

Resps

170160150140

130120110

10090

8070605040

30

20100

240

220

200

180170160150

140130120110100

90807060504030

20100

BLOOD TRANSFUSION OBSERVATIONS CHART

1. Record temperature, pulse,respirations and blood pressure prior to start of the transfusion2. Record temperature, pulse respirations and blood pressure 15 minutes after each unit has commenced3. Record temperature, pulse respirations and blood pressure at the end of each unit4. Record observations when the transfusion has been completed

NB: These are the only recordings required UNLESS any adverse reactions occur


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Unit Number:

Name: ... DOB: ..


MULTI-DISCIPLINARY PROGRESS NOTESPlease use this sheet to document any additional communications required to ensure appropriate

care for patient.

NOSignature /Designation / Time /Date

110408 blood transfusion single use pathway

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