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Written by: Mediware Consulting and Analytics on Tuesday, May 10, 2011 Posted in: Blood Management

In honor of National Nurses Week Strategic Healthcare Group would like to recognize nursing’s vital role in blood management and transfusion safety.

There are nearly 3.1 million registered nurses in the United States1 and approximately 30 million blood components transfused each year. With this huge demand for nursing care of transfusion recipients, it is no surprise that an emerging role in nursing is the Transfusion Safety Officer (TSO).2

A TSO serves as liaison within the hospital environment to ensure that blood management and transfusion related activities are conducted in the safest possible manner and meet or exceed existing evidence based standards of practice. Nationwide, there are less than 30 nurses in the role of TSO. These nursing professionals understand that blood administration is the most dangerous procedure nurses perform at the bedside and they are dedicated to improving the quality of blood management and the safety of transfusion administration.

The theme for this year’s National Nurses Week is “Nurses Trusted to Care.” Nursing is a profession in which we practice both the art and science of patient care; patients trust us to compassionately deliver evidence based nursing with the goal of helping without harming. Until recent years, the healthcare community considered blood to be a benign substance given to patients to help them feel better. “The medical community often uses blood as if it were a medication to treat both acute and chronic anemia; however, a transfusion of blood actually is much more akin to an organ transplant. As with organ transplantation, immune system modulation disruptions by transfusion are well-known.”5 Existing and emerging evidence compels nurses to recognize and understand that a blood transfusion is a cellular transplant, which may cause more harm than good.

Blood products should be administered with the same regard and caution as high risk medications.3 Indeed, many of the established transfusion administration safety standards have been applied to improve the safety of high alert/high risk medication administration: double check: 1) the right patient, 2) the right medication – treatment, 3) the right dose, 4) the right time, and 5) the right indication. Just as nurses must know the five rights of medication administration, nurses who administer blood products must know the clinical indication, appropriate dose, expected benefit and the risks of transfusion therapy for the patient receiving the transfusion.

The elimination of transfusion errors remains number one on The Joint Commission’s list of National Patient Safety Goals. Further, the College of American Pathology (CAP) has reported that the most common transfusion safety violations among healthcare systems involve transfusion reaction recognition and annual education in the recognition of transfusion reactions.3 “There is no doubt that nurses must be able to recognize and act on early signs of an adverse event, and that it is dangerous to fail to respond to signs and symptoms of an adverse event.”4 The transfusing nurse is responsible for diligent patient monitoring and assessment throughout the infusion of blood products because “transfusion related complications are serious risks of blood administration and major contributors to transfusion associated morbidity and mortality.”5

The role of the transfusion nurse includes advocating for patients to receive blood products based upon scientific evidence. It is incumbent upon nurses to carefully consider each and every potential transfusion exposure, cognitively review the medical decision and the order to transfuse, and correlate the need for transfusion with the patient’s lab results and clinical status. Nurses must be knowledgeable about the risks associated with transfusion therapy and diligent about assessing patients for signs and symptoms of a transfusion adverse event. Nurses must employ both art and science to ensure effective blood management and optimal transfusion safety.

Selected References and End Note
  1. American Nurses Association (ANA) 2010 Annual Report.
  2. We recognize that some TSO’s are members of professions other than nursing; however this article focuses on nursing’s role in transfusion.
  3.  Sazama K. Practice parameter for the recognition, management and prevention of adverse consequences of blood transfusion. College of American Pathologists. Arch Path Lab Med 2000 Jan;124(1)61.
  4.  Oldham J. Right patient, right blood, right care: safe transfusion practice. Br J Nurs 2009 Mar; 12-25;18(5):312.
  5.  Klien H. Allogeneic transfusion risks in the surgical patient. Am J Surg 1995 Dec; 170(6A Suppl):21S.
  6.  Katz E. Blood transfusion: friend or foe. AACN Adv Clin Care. 2009 Apr-Jun; 20(2):155.