We are revising our blood component administration policy to flow along with our RBC administration policy.  I cannot find the original source for our current administration rates for FFP, platelets or cryoprecipitate.  Looking for a reference/best practice for administration guidelines for blood components.

We do not recommend infusion rates.  That is the purvue of the ordering MD (anyplace I have ever been).

The only thing I tell nursing is to infuse plts as quickly as prudence dictates.

With our current multi-facility EMR, there was no rate built with the component orders.  It was decided each facility would have 'recommendations' of a time frame or as the physician orders. 

You're mainly going to receive input on the laboratory side of things, not so much the nursing administrative side. There's really only guidelines on the timing of the start of transfusion post-issue from the Blood Bank, and that's really just for temperature acceptability & storage conditions...

We have not had infusion rates defined, but our Pathologist over Blood Bank has added these for a recent revision due to the fact that we have had a couple of patients with TACO.  She wanted to help the nurses be aware of what was going on with the patient before they ran the blood in within 30 minutes!  Apparently our computer system doesn't have the ability to have pop-up boxes with certain diagnosis codes that would automatically alert the nurses to these situations.

I haven't seen anything defined in writing and was concerned that I was overlooking something.   Our goal is to give them some general guidance and remind them about TACO.  That's what the newer nurses are looking for. 

Nursing policy for blood administration should include those type of guidelines, They have references available for infusion rate, etc. The medical director of blood bank should (ideally) then review all of those polices to make sure that what they have included is good practice. In other words, a collaborative procedure. We struggle with getting blood/blood product nursing policies reviewed when written. There is a constant rotation of new nursing admin staff writing policies who never seem to know that our medical director should review those new policies and they don't understand what the lab has to do with administration. I just tell them it's an FDA requirement and TJC expects those requirements to be followed.

Our nursing policies are accessible on-line so I search periodically for blood related policies to see if anything has been added. I put all of those policies in my SOP manual under blood administration. When I do biannual review, I check to see if the policy has been revised so I can upload a new version if necessary. I usually check at least annually as well. The policy format used by my facility assigns 'ownership', which is the VP of nursing, 'authorship' and also includes a line which indicates people who must review the policy. TJC requires policy review every 3 years, so that's why I include those policies in my manuals - to make sure they are reviewed often enough for CAP requirements. If I find a policy that does not have the medical director's name on it as a required reviewer, I reach out to the 'author' or the 'owner' to see about getting it added. I've also made a point of knowing who is responsible for the facility policy manuals and who is responsible for the Joint Commission compliance book. I have those 2 ladies on speed dial and they are very helpful.  It can be painfully slow to deal with all the committees/councils that direct nursing policy. I tell myself that persistence and patience is key (and patience is not necessarily one of my virtues!).

 

Standard 62. Transfusion therapy. Infusion therapy standards of practice. (2016). Journal of Infusion Nursing, 39, S135–S137. (Level VII) and

AABB. (2012). Primer of blood administration. Bethesda, MD: AABB. (Level VII)  

these are the references that our blood administration policy lists.