Blood Transfusion Reaction...Doctor order to go ahead with transfusion anyway...!

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Specializes in OB, M/S, HH, Medical Imaging RN.

Yesterday I worked charge and one of the patients needed a unit of blood before going home. The nurse started the blood and within the first 15 minutes the patient's temp jumped to 100.7, the pt. complained about CP, her BP shot up to something like 220/120. The nurse immediately stopped the transfusion. Opened the NS and gave her Tylenol and Benadryl and then called the doctor. The doctor said "I don't care, give the rest of it anyway, I want this pt out of the hospital today". She came to me and said "I'm not doing it". I told her you are correct and anytime you feel uncomfortable you have every right to refuse to follow an order. (She was afraid of the reprecussion of not following his orders). We activated our emergency response system. The Hospitalist, RT, Lab, CCU Charge and Sup comes to the floor. Kinda like a code but knowing it's not an emergency. Super idea if your hospital doesn't have one! Anyway.....The doctor ordered a bunch of labs, the lab drew them stat, RT did a stat EKG, the patient broke out in a horrible itchy rash, CCU Charge went back to CCU and the Sup talked to the patient. The nurse said to me. Should I call the doctor who ordered the blood to tell him what we did? I said "no, we actived our system and those are valid legal orders and evidently he doesn't give a flip anyway". The Sup agreed. We said he'll find out later when he calls to see if the pt is gone as ordered and will also realize his mistake when he gets called to administration. I can't believe the blantent disreguard this doctor had for his patient.

the nurse's notes should be interesting, yes? those alone will implicate doctor dearest.:madface:

BAD Doctor...no bagel! My hospital has just put together an emergency response team for non-code situations. I think it is a great idea. It should keep situations from getting worse and can be a great backup for nurses that question wacky orders.

Specializes in OB, M/S, HH, Medical Imaging RN.
the nurse's notes should be interesting, yes? those alone will implicate doctor dearest.:madface:

Yes, I read them and she did a wonderful thorough job with her charting!

Specializes in OB, M/S, HH, Medical Imaging RN.
BAD Doctor...no bagel! My hospital has just put together an emergency response team for non-code situations. I think it is a great idea. It should keep situations from getting worse and can be a great backup for nurses that question wacky orders.

We had just put it together also and this was the first time it was activated. I think it's a great idea also.

I had a situation with a doctor several years ago, which almost cost the patient her life, and if we had had the Rapid ResponseTeam back then it would have been an answer to prayer. However the doctor did get repremanded by administration. They stood behind me.

Reminds me of a pt I had in a junctional rhythm once. PMD came in to admit him and ordered a lidocaine protocol. I questioned it and he insisted. I went to my charge. She went to the ER doc. He talked to the PMD, who still insisted. I refused to start it and called report to the ICU. ICU nurse said " He wants what?????" PMD complained to nursing director that none of us would follow his orders. No idea what N.D. said but when he came out he was awfully quiet........

Good Job Dutch!

Specializes in ORTHOPAEDICS-CERTIFIED SINCE 89.

"I want her out of here today"? What arrogance. I guess a pine box would have been one means to that end.

I'm not hospital savvy anymore but that rapid response team sounds like a wonderful concept!!!! Thanks for the heads up.

Specializes in tele, stepdown/PCU, med/surg.

Rapid Response Teams are so cool. We have them at our hospital and I truly believe they save lives and prevent codes.

for this type of situation if you have an escalation policy or whatever similar activate it. the doctor can be terminated for not responding to the situation.

Was this situation referred to Risk Management?

What a complete a$$!!!

I remember when I worked as a CNA at a local hospital, I was on my third semester of nursing school and the charge nurse kept trying to make me go beyond my capabilities legally... one time she had me stay in a patient's room to monitor them while they were receiving blood... he started having a huge reaction, and I paged her thru the room intercom (Temp 102.2, BP 220/150, resp 32 or something) and she responded back over the intercom telling me to stop transfusing, open saline, and call the doc!!! I told her I was doing no such thing (I WAS A CNA!) and she huffed into the room to do it, ordered me out, and wrote me up. I went to the hospital administrator about it, and she called that nurse in immediately and stripped her of charge duties.

Never be afraid to stand up for what you KNOW is right- noone will stand up for YOU when your license is taken away!

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