Transfusion policy OMG!

[Jennifer88]

I have a scenario I'd like to share and get some opinions. I was reviewing Nursing transfusion documentation and discovered a patient with no vitals documented at the 2 hour mark. I submitted a request for missing information to the Nurse Manager. She in turn spoke with the nurse performing the transfusion. This is the message I got back: She knew the vitals check was due, but the patient was not in his room. She went outside to look for him because he went out to smoke frequently. She could not find him. When he returned to his room, he told her he had been out in his car smoking and listening to music. He did not tell anyone he was going out and no one checked on him until the 2 hour vitals were due. Keep in mind that this guy is wearing a hospital gown and wheeling an IV pole with a pump and unit of blood attached in the parking lot of a small county hospital, in August, during 95 degree heat, with no medical personnel present. I guess my question is, what policy do you have in place regarding things like this? And does this really happen anywhere else?? My BB techs, Medical Director, and I are the only ones that think this is a problem. I know we can't physically force a patient to stay in bed. My suggestion is to talk him into waiting, but if not the transfusion must be ended. I feel pretty stupid to even post this. I have it on the agenda for the next transfusion committe meeting. I want to be armed with information before I go in.

Thanks!

[Eagle Eye]

No question is a stupid question. There is a post somwhere on this forum with similar case...

[Malcolm Needs ☆]

No question is a stupid question.

I almost agree aakupaku, but not quite!

I think there is such a thing as a stupid question.

I would say a stupid question is the one that you never ask (not you personally; I don't mean that), when you don't know the answer, but you are too embarrassed to ask, because you think everyone else knows the answer, and you don't want to look a fool in front of your peers.

I use to be like that at conferences, symposia and scientific meetings, but many of my mentors (and I've had some superb mentors over the years; far too many to name, but all fantastic in their own way) taught me that the only person that was harming was me. They were absolutely correct, and now I am quite happy to ask questions, even if everyone else knows the answer, and if the audience laughs at me, or thinks I'm an idiot - so be it (I am anyway!!!!!!!!!!).

[Bill]

Been there, done that! We had a patient that did exactly the same everrytime he came in for a transfusion (about every 3 weeks for >2 years). No matter what was said to him, he would go outside for a cigarette(s) as soon as 1 hour vitals were done. Usually, he would come back just in time for 2 hr vitals. Like you said, you can't tie them to the bed. On a more serious note--if you have this type patient, use a bed check to at least let you know he has left the bed.

[R1R2]

We have no policy in place that states a patient can't walk around with blood hanging. The transfusionist does instruct the patient on signs and symptoms of a transfusion reaction and that the patient should inform the transfusionist if necessary. I am not too concerned about this. If this problem only applies to one patient instruct him to stay put and document the conversation. You can only do so much.

[Deny Morlino]

I partially agree and partially disagree. While it is true we can't "tie a patient to a bed" I am forced to question how desperate was the need for the transfusion if the patient was able to walk out to his car for a smoke break. From a liability point of view the possibilities boggle the mind!! Any number of issues may have suddenly arisen during the transfusion!

Because of the frequency of blood transfusions we are ALL numb to the seriousness of the process. I remind all of my students and any new nurse that a transfusion should be treated as the equivilant of an organ transplant. With that mindset, a patient should be limited in their travels during and immediately after a transfusion FOR THEIR SAFETY. Healthcare needs to be a partnership between the patient and the caregiver(s). If the patient cannot abide by some restrictions during such an important process (transfusion), then the transfusion would not occur and I would pull the physician in to discuss the issue with the patient. I would involve the Risk Management group in the discussion prior to waiting for the transfusion committee meeting. Be prepared for risk management to throw a fit about the liability (as well they should). Keep in mind our job is to try to heal patients with the procedures we perform. The patient's safety during these procedures should be a priority. OK, off of my soap box now.

[rravkin@aol.com]

How do chemotherapy transfusionists keep their patients seated for 3 to 4 hours at a time?? I think maybe we can apply the same practices here. It is an incredible safety issue for all involved.

[Liz]

Number one: the nurse (transfusionist) explains prior to the transfusion that the patient must stay in bed etc all the info is explained each and every time.

Number 2 we have a nursing unit that asks the patient not to walk around if he or she is sen in the corridor.

NUMBER # we have security guards at all entrances of the medical center!!!! No one gets out like that.

What if a child is being abducted, or a mom is leaving a newborn and running away. What if i decide to take someones laptop.. ok enough i'll stop. But for the safety of patients we have security watching exits. no one can walk out against orders.

[Liz]

PS: It s a written policy under patient safety, under transfusion under whatever else you think is necessary.

For one day patients coming for chemo, blood etc.. they also get the same explanation.

Patients "normally" do not want to get up, but one does get exceptions.

[Liz]

I partially agree and partially disagree. While it is true we can't "tie a patient to a bed" I am forced to question how desperate was the need for the transfusion if the patient was able to walk out to his car for a smoke break. From a liability point of view the possibilities boggle the mind!! Any number of issues may have suddenly arisen during the transfusion!

Because of the frequency of blood transfusions we are ALL numb to the seriousness of the process. I remind all of my students and any new nurse that a transfusion should be treated as the equivilant of an organ transplant. With that mindset, a patient should be limited in their travels during and immediately after a transfusion FOR THEIR SAFETY. Healthcare needs to be a partnership between the patient and the caregiver(s). If the patient cannot abide by some restrictions during such an important process (transfusion), then the transfusion would not occur and I would pull the physician in to discuss the issue with the patient. I would involve the Risk Management group in the discussion prior to waiting for the transfusion committee meeting. Be prepared for risk management to throw a fit about the liability (as well they should). Keep in mind our job is to try to heal patients with the procedures we perform. The patient's safety during these procedures should be a priority. OK, off of my soap box now.

I agree Deny. Goodness.

It is a transplant of someone's blood! of course!

and if they cannot abide to rules for their own safety then you cannot transfusion.

What about the consent.

OMG in the car, heat, outside, smoking, NO ONE (paramedic) SPOT CHecking???

Ok i shall go to my room now.

[Mabel Adams]

Although most serious transfusion reactions would have made themselves known by the 1 hour vitals, TRALI could show up later. Once they feel short of breath (and they ARE sick enough to need transfusion we presume) will they be able to get themselves back inside for medical help? What if they fall because they are having a reaction while trying to get back to get some help. Every hospital has to look at falls and fall risk. The Quality people that track falls might help you get some traction.

[BankerGirl]

I agree with the previous posts that this is a serious safety issue and needs to be addressed. I do not believe that we have this in official policy, but we had one patient who was found by staff members smoking on the main street through downtown while receiving blood. The nurses spoke to him and as far as I know, it has not happened since, although he is still hard to keep track of at other times.

[SMILLER]

I agree with all here. Yikes! And, Yikes! again!

Have someone from Risk Management go with you to that transfusion committee meeting.

Scott

[Pavel Dmitrievich]

There are so many issues attached to this event that my head is spinning. The liability issues alone are very worrying. I don't believe that I have worked anyplace where this event would have occurred more than once without very serious consequences.

[MEG]

No, I have never heard of this in my 20 years!!! My jaw is hanging open. Yes, it is a problem. You are required to one document vitals, and two monitor the patient through out the transfusion. I think that you will have to explain to the Dr., nurses and patient that he is receiving an FDA regulated drug(if you think about it is actually a liquid organ transplant) when he signs the consent for transfusion that is consenting to stay put until 1 hour post transfusion. If he is not willing to do so that is refusal of treatment. Remember, if anything goes bad during this transfusion your facility is responsible!!!!! I have done an FDA Fatality report and they are not fun. To be honest, I don't know how you would explain this. Your state Health Department can be called in as well and they can and will shut you down. Not only that but you risk losing any certifications you carry. I am truly mortified and speechless. I hope this helps, I wish you luck.:eek:

[Mabel Adams]

Just think about the newspaper article if anything happened. Would the average citizen reading the story feel that the hospital dropped the ball or that the patient was being reasonable?