Best Nursing Practices when Transfusing Blood Products - Research Paper Example

OUTLINE Introduction Scope of Nursing care Medical Errors Six Rights for Nurses Administering Medications Pragmatic advices for best blood product administration Nursing role prior to administration of blood products Consent for transfusion Administration of the blood components Monitoring of patient after blood transfusion Supporting Roles Conclusion References Introduction In the world millions of people receive blood transfusions annually as either life-sustaining or life-saving treatment. The blood products are administered in various conditions such as acute trauma, intra operative blood loss, compromised blood-cell production secondary to disease or any blood disorder related treatments (Bielefeldt and DeWitt, 2009). The nurse has indispensable role to play in health care setting alone and along with the other health care professionals being at the front line of patient care. As the global environment is changing at fast pace, the nursing profession has undergone many transformations in order to achieve continuous quality improvement in terms of positive clinical outcome. It is imperative to ensure the safe and effective delivery of blood transfusion products along with the safety of the blood product itself. It is necessary to have the information and knowledge about the potential risk and side effects while transfusing blood components. Scope of nursing care Nursing is a profession of the highest realm with unconditional love for mankind. Professionals are expected to show a degree of special attainment, altruism, and self-sacrifice in their dealings with the rest of the community and in return receive privileges both in the workplace and at large. Nurses work in multidisciplinary professional teams with doctors and therapists. Teamwork in nursing practice refers to interdisciplinary practice or collaboration defined as a joint decision-making and communication process with the goal of satisfying the needs of the patient. This includes respecting the unique abilities of each professional involved in the care. Nurses should be equipped with the all the needed information to complete all the tasks to work with the patients, families and colleagues in a safe, efficient manner. To deal effectively with the issues of patients nurse should have multiple skills. The attitude of the nurse affects their daily judgments, decisions, and efficiency. It is necessary to synthesize the required attitude, patient-focused systematic approach and purposeful clinical learning to deliver the needed result. Nurses should have ability to react quickly and take instant decision when needed. They should have capability to think laterally and work under tension. These qualities are needed for handling patients who are in crisis. Nurses are continuously physically and mentally challenged. They should able to handle every tough situation with focus, strength, stamina and heightened alertness. Professional education programs and curricula require that support best nursing practice in a variety of clinical settings. These programs should emphasize on the blood management and transfusion safety. The use of informatics to promote collaboration in patient care planning and implementation should be part of continuing education program. The nurses contributions through suggestions and concerns should be considered as one of the solution providers in health care delivery. Six Rights for Nurses Administering Medications The consequences of medical mishaps are fatal. FDA has estimated that in the United States alone, in a year 414 blood transfusion mishaps happen (Dubin, 2010). The increased awareness of medical errors in health care management has triggered many aspects of research on prevention of medical errors. These mistakes could be avoided through positive medical communication among healthcare providers and the patient. “Six Rights for Nurses Administering Medications" can play an important role in establishing and strengthening healthcare setting by prevention of medication errors. The checklist of six rights is briefed as follows for best nursing practice (Cook, 2010). 1. The nurse should demand for a complete and clearly written order from a physician having all the specific and required parameters mentioned about the drug, dose, route and frequency. 2. The nurse has the right to recheck the correct amount of dispensed drug by the pharmacist, and in case of error notify to the respected person and take corrective measures. 3. The nurse has the right to have access to all updated knowledge about drug information which is available through the hospital formulary, a physician’s desk reference and a current nursing drug reference book. This would help them to deliver medications with the safest method. 4. The nurses have to claim for apt structured policies to administer medications safely. This would assist the nurses to follow professional standards, or otherwise might face litigation if not properly followed. The Nursing and Midwifery Council (NMC) is a governing body accountable to formulate professional guidelines for registered nurses, midwives and specialist community public health nurses (NMC, 2008). 5. Nurses should be assertive in building the healthy drug delivery system. Nurse and physician both have different level of knowledge, experience, skills, or perspectives. Physician’s treatment strategy is based on the perception after diagnosis of patient, but from the nurse’s point of view any disease is a life experience. Constructive suggestions in a positive atmosphere have capacity to solve most of the problems. 6.  The nurses have the authority to stop, think, and be vigilant while administering medications. The nurses should insist their rights to protect the public from undesired incidences. Pragmatic advices for best blood product administration This life saving intervention can become hazardous if proper implementation procedures are not followed. Therefore, it is critical to identify and evaluate issues related to the execution of transfusion of blood components to avoid negative patient outcomes. The areas which are most vulnerable in the blood transfusion medication and are important to look at include sample collection, and matching; checking sample prior to administration, and transfusion procedure, and observing the patient to diagnose adverse reactions. The framework regarding the best blood products transfusion practices for nurses and midwives has been well documented by Green and Pirie (2009). The nurse should be trained in various areas such as information about the blood therapy, ordering of blood products, rate of transfusion, I.V. checking, transfusion reactions, patient ID, bedside checking etc. Nursing role prior to administration of blood products It is a responsibility of the nurse or midewife to notify the patient or guardian about the need as well as pros and cons of blood component therapy (Green and Pirie, 2009). The information leaflet about the blood product treatment should be given to the person undergoing transfusion. The nurse should able to answer the queries of the patient/guardian regarding transfusion before obtaining a valid consent from them. The case study should include the explanations and rationale about the requirement of transfusion for that specific person. The critically ill persons who are not in a position to give consent, or who does not want to give permission for transfusion should be properly addressed with institutional policies. It is also necessary to educate the transfusion recipient to make him aware about the signs and symptoms of reactions after blood transfusion so that he can call for the assistance. The Advisory Committee on the Safety of Blood, Tissues and Organs is evaluating the matter related the consent for blood transfusion (Green and Pirie, 2009). The typing and cross matching of pre-transfusion blood samples is the first crucial step in the blood product intervention. It is the responsibility of the nurse to reexamine the suitability of the blood component therapy for a particular patient. The transfusion order and patient’s valid consent should be verified. The nurse should note the correct physical assessment of the patient so that she could able to distinguish any changes or signs after or during the transfusion process. The patient should be made aware about how he can avail the help in case of encountered adverse reactions. It is necessary to gather all the necessary tools for administering blood component, and managing adverse reaction such as an additional free I.V. line for normal saline solution, oxygen, suction, and a hypersensitivity kit. The nurse should have detailed knowledge about the particular blood product to be transfused, and the rate of administration depending upon the status of the patient. The nurse should be well equipped with the information about on duty physician and a blood bank person to tackle emergency appropriately. The blood product, and the recipient’s identity should be reconfirmed by the nurse before starting the transfusion process. The nurse should confirm with physician about the necessity of premedication to avoid immunologic transfusion reactions for a particular patient before stating the transfusion (Henneman et al., 2008). The blood product should be infused with normal saline, and filtration accessories. Administration of the blood components The time line for the transfusion of blood component from the advent of product from the blood bank till the complete infusion should be strictly followed in order to prohibit complications resulting from microbial contamination. The infusion should be started within 30 minute of arrival of the product from the blood bank. Monitoring of patient after blood transfusion Standardized monitoring policies are decided by the organization, and it is a duty of a nurse to adhere to these regulations. It is the best protocol to observe the patient’s sign prior-, during-, and post transfusion, and document vital signs. The nurse should be alert while monitoring post transfusion patient, and should take immediate actions such as intervening if necessary, and informing to doctor, and blood bank. The nurses should be vigilant to notice the physical and clinical manifestations such as fever or chills, flank pain, vital sign changes, nausea, headache, urticaria, dyspnea, and broncho spasm (Bielefeldt and DeWitt, 2009). If a nurse encounters any adverse transfusion event, the transfusion should be stopped at the earliest, and normal saline solution should be dispensed through I. V. The signs and symptoms are handled according to the standardized protocol. The transfusion process should be recommenced if necessary after acquiring order from the physician. The nurse should document the signs, and symptoms shown by the patient, other relevant findings and intervention strategy adopted by them. Supporting Roles In order to furnish a best standard of practice and care every time, the nurse and midwife should extend their role in many ways. The healthcare team including nurse and midwife should encourage for the development of local clinical policies for blood transfusion. These policies should follow national guidelines and should be evidence based. It is a responsibility of nurse to recheck the set out algorithms. It is a duty of a nurse to ensure that every case is completely documented. The record keeping should be audited at regular intervals. Conclusion The blood transfusion strategies should be properly designed, implemented, and tested in order to reduce unwanted bedside incidences and achieve best clinical outcome. Right blood for right patient at right time is the foundation for the safe administration of red blood cells and plasma components. Special precautions need to be taken to ensure safe blood component therapy. Multimodal approaches must be adopted to stick to the standard set out for safety. The nurse should be prepared for managing anticipated adverse reactions which would be reflected into enhanced clinical outcome. Training about the appropriate use of technology to the nursing staff, professional guidelines, best practice and best accessible clinical information are the cornerstones in order to mitigate errors during blood transfusion. References Bielefeldt, Sabrina and DeWitt, Justine.(February 2009).The rules of transfusion: Best practices for blood product administration. 2009; 4(2). From: http://www.americannursetoday.com/article.aspx?id=6490&fid=6462 Green, Jan and Pirie, Liz (September 2009). A Framework to Support Nurses and Midwives Making the Clinical Decision and Providing the Written Instruction. http://www.transfusionguidelines.org.uk/docs/pdfs/BTFramework-final010909.pdf Henneman, EA; Cobleigh, R; Avrunin GS (October 2008). Designing Property Specifications to Improve the Safety of the Blood Transfusion Process. Transfusion Medicine Reviews. 2008;22 (4): 291-299. From: http://www.cs.umass.edu/~rcobleig/TMR2008.pdf Dubin Cindy H (July 2010) Technology, Vigilance, and Blood Transfusions. P & T, 2010; 35(7):374-376. Cook, Michelle Colleran. Nurses Six Rights for Safe Medication Administration. . Massachusetts Nurses Association. http://www.massnurses.org/nursing-resources/nursing-practice/articles/six-rights Nursing and Midwifery Council (2008) Standards of conduct, performance and ethics for nurses and midwives NMC, London. Read More