Nurses have known and upheld the five rights of medication administration for decades. The Transfusion Medicine community quickly and readily adapted these rights to another high volume, high risk hospital procedure: transfusion administration. Recently, the five medication administration rights have been expanded to eight, all of which apply to blood product transfusion: right product; right patient; right dose; right time; right reason; right site; right documentation and right response.1
Just as medication safety is improved by additional rights, transfusion administration safety is enhanced when physicians, nurses and Medical Technologists know and apply the 8 rights of transfusion administration for every blood product:
1. Right product
- Is the appropriate product being utilized for the clinical presentation?
- Does the type of product identified on the label match the product ordered? E.g. if the order states irradiated pRBCs, does the product label state irradiated product?
2. Right patient
- Match the recipient’s name on the order with the name on the patient’s armband;
- Use two identifiers and when possible have the patient say his name and date-of-birth out loud.
3. Right dose
- What is the patient’s fluid volume status? Is the patient at risk for Transfusion Associated Circulatory Overload (TACO)?
- Are two units of pRBC’s ordered for an anemic patient when one will do?
4. Right time
- Confirm that the product will be started within 30 minutes of the time dispensed from blood bank and completed within four hours.
- Is the product being given within the timeframe to maximize therapeutic effect
5. Right reason
- What is the physician’s clinical indication for the transfusion (not just a lab result)?
- What clinical sign in addition to a lab value supports the transfusion indication?
6. Right site
- Confirm that the patient has a patent IV and that only Normal Saline is given through the IV that the blood product is administered through.
7. Right documentation
- Physician documentation of an appropriate indication
- Transfusion consent documented prior to product administration
- Document the dual identification process
- Document vital signs before start, 15 minutes after start, hourly, and at stop time
- Document start and stop times
- Document any changes in patient condition as noted by the nursing and physician assessment
8. Right response
- Based on the indication for the transfusion, did the transfusion have the desired clinical effect, e.g. oxygen carrying capacity, reduced bleeding, and lab evidence?
All of these “rights” serve to focus our thinking around transfusion therapy and patient-centered blood management. Transfusing healthcare providers should embrace these transfusion administration rights and utilize them in everyday clinical practice. Each and every time we contemplate a transfusion for any patient, we should stop to consider, not only the risks and benefits, but also the “Eight Rights,” individually. If we cannot justify and complete all of them, we will be failing in our efforts to provide continuous quality and safe transfusion practice.
- Nursing Drug Handbook, 2012, Lippincott Williams & Wilkins: Philadelphia, PA.