Millions of blood products are transfused each year in the United States–the majority of which are administered by nurses with little formal training in transfusion therapy. While health care resources and the public have focused on the safety of the blood product itself, the safety of the transfusion process has received minimal attention.
Transfusions are one of the most hazardous procedures performed by nurses in which complacency, cavalier attitudes, and lack of competence can result in poor patient outcomes. In spite of this, hospitals often meet only the minimal regulatory requirements for nursing education and oversight related to blood component administration. Typically, computer-based training programs, that require little or no skills proficiency, are utilized to fulfill these regulatory mandates. Due, in part, to this knowledge and proficiency gap, a number of regulatory, safety, and quality gaps in the transfusion process have been uncovered in nursing practice audits. A recent multi-center audit of 1602 transfusion administration records was presented at the 2009 AABB Annual Meeting in New Orleans. The results of the audit were alarming and identified specific gaps related to the informed consent process, dual identification prior to transfusion, patient monitoring, and management of adverse events to transfusion. Although blood management programs typically focus on physician blood management practices, nursing practices must also be optimized to improve transfusion safety. Mechanisms to accomplish this must be multimodal and multidisciplinary. Various best practices that have been observed nationally are highlighted below:
- Broad and diverse nursing representation on the Blood Utilization Committee or Blood Management Committee (this must include front line staff nurses).
- Nursing involvement in developing blood management and transfusion safety task forces. These multidisciplinary teams should be established around safety, quality and economic blood management-related opportunities.
- Nursing staff involvement in audits of transfusion documentation and direct observation of blood administration. This is best performed as a peer review process by objective, knowledgeable nursing colleagues (not direct co-workers) and presented to the nursing staff as a “teaching opportunity” and not a “pass/ fail” audit.
- Establish unit-based nursing blood management champions. This is similar to the model employed for wound care, patient safety and infection control champions.
- Nursing education and training models should utilize a multimodal skills-based approach to underscore the importance of properly following nationally-established best practice blood administration procedures.
As health care continues to evolve and progress in the 21st century, team-based patient management will be an essential component for providing high quality medical care. Communication and teamwork with nursing staff remains essential. With over 3 million licensed nurses in the United States, nurses are the single largest group of healthcare constituents in the country. However, considering the educational gaps that exist relating to blood management, nurses must be given the tools to understand the “why” before the “how”. As patient advocates and students of science, educated and engaged nurses can have a significant role in promoting evidence based practices and optimizing the safety of the transfusion process.