First Major Mistake, Pt didn't get blood, I'm so Afraid

[ICURNVUS]

I am a registered nurse that has always worked intensive care. I recently took a job on a Nephrology unit at a large Medical facility in my area. This morning I received a call from the clinical nurse manager asking questions about a patient receiving a blood transfusion in hemodialysis. And yesterday I worked day shift and I normally a night shift nurse. When I initially took report the patient in question was already in hemodialysis. The off-going nurse let me know that no nurse nor the ICU Rover nurse was able to obtain blood from the patient nor get IV access on the patient. The nurse sent down orders for the dialysis nurses to obtain a blood sample on the patient and she told me that hopefully the patient would be there long enough to also receive the blood in the hemodialysis unit before coming back to the floor. I had six patients two going to procedures two going to procedure the following day having to obtain consent right site forms blood consents etcetera. One discharge, on admission from cath lab.This patient arrives back from dialysis and in report the nurse did not make mention that the patient received blood in the hemodialysis unit nor did she mention the Hgb result from that morning,she told me that she pulled off 2.8 kg they were trying to pull off 3 kgs but the patients blood pressure dropped to 80 over 70 and she also mentioned that the patient was a little groggy because she had just had pain medicine which I found out later was not correct she had had the pain medicine at 7:54 a.m. that morning and that just wasn't true. So anyway patient came back I assessed her she was alert and oriented pretty much but just in a great deal of pain her husband asked what her hemoglobin was so I told him that I would need to go and check so I had to pull the patient over and I looked in at 7:44 a.m. that morning the patient's hemoglobin was 6.4. So I went back in the patient's room and she told me that she got two units of blood downstairs in hemodialysis and her husband wanted to know what what was her hemoglobin since she got the blood in hemodialysis. The patient was alert and oriented so I went and that is when I realized that's why they didn't get the blood that morning because she was a very hard stick , no IV etc. So our orders say that we get a hemoglobin 4 hours after blood is administered so she came back around 12 so I said between 4 and 5 I would have taken another sample got very busy throughout the day . I saw in her orders it was saying for her to have blood transfused 2 units also saying that blood product was ready but the time at which it was entered in the computer was so much earlier in the day while she was in dialysis I was going off of what the patient told me and what the previous nurse said and the fact that she had no iv access and it was reported to Hemo that the floor was unable to obtain either.I guess Long story short I found out this morning that the patient did not get blood in hemodialysis and was having to be sent down to hemodialysis this morning just to have blood transfused. I am absolutely mortified I feel defeated and this is the first time that I have had what I consider a major medical mistake that I've made. I know that I should have called hemo about the blood being given in Dialysis.back to verify that the patient received blood but I did not I went off of what the patient since she was alert and oriented and had been receiving dialysis for years. That in addition to the nurses report that morning and the fact that the patient had no IV access I made a very wrong assumption and it caused the patient to have an unnecessary procedure in hemodialysis this morning. I'm worried about my job now and I just don't know what to do as I wait for the influx of calls from hospital admin today.

[Chisca, RN]

So in your facility only dialysis units can give blood? No IV access is a MD problem and should have been dealt with earlier in course of stay. Don't see how you are at fault.

[ICURNVUS]

Thanks for your reply I was told it was my fault because when my patient came back I should have given en the blood because it was on her profile to give or I should have called Hemo instead of taking the patient's word. I understand I just was out of my element on day shift and had worked 16 hra the previous day. I made a mistake and I learned from it. I was terminated. The dialysis nurse never even mentioned the order to transfused nor the hgb she got that morning nor that there was blood product in the lab that she ordered. My question was how was I to give the blood when no one could get an IV on the floor. We can give blood on the floor of course but The MD solution to our inability to obtain access or get labs was do it in HD. Obviously they never got an IV on the floor bc they sent her back to HD the next day just for the transfusion. I'm just disheartened.

[Chisca, RN]

It is a blessing you were fired because it sounds toxic where you were working. I am quite aware of my patients lab work and this dialysis knew the labs. I am also aware of any IV access or lack thereof. What happens where i work is the dialysis nurse calls the nephrologist to extend the treatment time so the blood can be given. You were left holding the bag that the dialysis nurse created by their negligence. Handoff from dialysis nurse should have covered lack of transfusion and you should have called whoever ordered the transfusion and informed them of no IV access. Not your fault and if anyone should have been fired it was the dialysis nurse. Hang in there, it will get better. One door closes and another will open.

[ICURNVUS]

I have tears reading this. I thank you so much. I'm so hurt I called all day inquiring about my patient from the previous shift to make sure she was ok. I have never been fired in my 10 years and take my job so seriously. I would never intentionally cause harm to anyone. Thanks again.

[Chisca, RN]

And would they have blamed you if you fluid overloaded the patient by giving a volume expander with no way to remove the fluid? ALWAYS safer for blood to be administered during dialysis treatment to pull excess fluid. There was a delay in getting the patient blood but they were stable enough to tranfuse the next day. No harm done. Except to you.

[Megan1977, MSN, EdD, RN]

On 10/26/2019 at 11:14 AM, Chisca said:

It is a blessing you were fired because it sounds toxic where you were working. I am quite aware of my patients lab work and this dialysis knew the labs. I am also aware of any IV access or lack thereof. What happens where i work is the dialysis nurse calls the nephrologist to extend the treatment time so the blood can be given. You were left holding the bag that the dialysis nurse created by their negligence. Handoff from dialysis nurse should have covered lack of transfusion and you should have called whoever ordered the transfusion and informed them of no IV access. Not your fault and if anyone should have been fired it was the dialysis nurse. Hang in there, it will get better. One door closes and another will open.

Sorry I am late to this discussion but 100% what Chisca said ^^^. I am a dialysis nurse and am very aware of my lab values. So easy to give the blood while in dialysis. Also the MD needed to order a PICC line or some other form of access for IV fluids and medications. Dialysis access is a life line and to be used for dialysis only.