Blood must be checked by 2 RNs or RN and MD prior to transfusion. Noncrossmatched blood must have the ordering physicians signature on the blood slip.
Vitals are taken before transfusion The variances I have seen are vitals Q5mins for 15 mins then Q30 for duration of infusion, Q15 for first hour then hourly, to Q15 for 30 minutes then follow the orders for this patient (Q1, Q2, Q4) then follow with a post transfusion set of vitals.
If the nurse is not overwhelmed with work and can visually assess this patient throughout the transfusion and/or instructs the patient or patients family member of signs of reaction to watch for then the initial observance CONSTANTLY for the first 15 minutes should suffice. This is the time period when a reaction usually occurs.
A patient with previous reactions or a very unstable patient of course demands more intense monitoring.
You should probably suggest one of the more stringent protocols as the patients life will be the big consideration. This will allow for better nursing coverage justified by protocol.....If you need to take vitals Q5 and be at bedside for the first 15 minutes and return to bedside to assess this patient every 15 minutes this boosts the patient care hours and the hospital can justify the one or two more nurses for staffing on a unit that infuses blood often.
This is probably the work you do anyhow..but put it into the protocol and you get the staff to cover you for it.
If you need some documented occasions where not having proper staffing or not stringent enough guidelines and the patient suffered I am sure you can get them on the internet or from this site. These with successful lawsuits will convince the Nonmedical persons who run our facilities at this point in Health Care Reform that you need the protocols you are desiring.
Welcome to the Game