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.
I'm sure that it was especially since it was the first time the Rapid Response Team was activated. I work on Monday and plan to ask my Nurse Manager about it. I'll let you know.
Is it written anywhere that you notify the lab or the pathologist for investigation of transfusion reactions? In many hospitals it is required. If the pathologist is clued into the situation, sometimes they can light a fire under the pt's attending.
Is it written anywhere that you notify the lab or the pathologist for investigation of transfusion reactions? In many hospitals it is required. If the pathologist is clued into the situation, sometimes they can light a fire under the pt's attending.
Oh yes of course! The blood is sent straight to the lab for an investigation.
Was taking care of a 16 year old MVA yesterday. Poor girl was in horrible shape (ejected through sunroof!)
Surgeon insisted that she be taken down to X-ray. I was adamant that she NOT be moved (at the very least untill Neuro had come taken a look. Not to mention put her on a better cervical collar) - I could plainly see she was in no position to get out of bed - much less travel down to the basement for x-ray.
I brought it up with clinical instrcutor. She told me to inform the nurse. I did. She called a confrence of the pediatrician and the surgeon.
No avail. She was deemed 'fit' to go down for an xray.
It was an ordeal - she was puking all the way down there (but since her jaw was wired she found it difficult to spit her puke out). She puked all the way back up after xray refused to move her out of the chair --- they didn't want to be responsible for her if she fell.
So, after all that pain and struggle - we're back where we started, in bed and her pain level now an 8 (back up from the 2 it was following medication), feeling like dirt.
Atleast the whole thing made them rush neuro up there and as I was leaving the floor they were assesing her spine.
I was madder than heck. The whole episode was so pointless and avoidable! I made sure I wrote a nice lengthy nursing note for that stupid incident.
:yeahthat: TE=EricEnfermero]Is it written anywhere that you notify the lab or the pathologist for investigation of transfusion reactions? In many hospitals it is required. If the pathologist is clued into the situation, sometimes they can light a fire under the pt's attending.
to Dutchgirl, did the Tylenol and Benadryl administration had doctor's order already or we can just give it and have and order after administration since it was an emergency???
Specializes in ER, Occupational Health, Cardiology.
I am proud that your Nurse had the sense to stand up for the patient, and come to you with that absurd order, instead of blindly following it. I am also proud of you for supporting your Nurse, and of your DON and your ERT for the support that they provided both of you. In the end, you two are validated, but the patient was the ultimate winner. Good job!
Specializes in Day Surgery, Agency, Cath Lab, LTC/Psych.
Wow. Can you imagine the ramifications of giving the entire unit with that severe of a reaction? Scary, scary, scary. Kudos to you and the primary for doing the right thing.
DutchgirlRN, ASN, RN
3,932 Posts
I'm sure that it was especially since it was the first time the Rapid Response Team was activated. I work on Monday and plan to ask my Nurse Manager about it. I'll let you know.