Manager mad RN followed policy and procedure!

[elfinM]

There is a manager who wanted an RN to overlook policy and procedure, and got mad when other RN's voiced their opposition to this request. Who is wrong here, the manager or staff RN's. Situation was pt on floor gi bleed in need of multi unit of blood. pt had unit hanging and was taken to gi lab, blood sent in hospital is done by secured tube system. manager wanted RN to send the blood to gi lab after receiving it on the floor. Problem is it can not be securely sent from floor to another unit, so blood would be in tube system "unattended". Two staff RN's voiced their opposition to this request. "Newer" RN, said "he told me to send it and he would take the heat for it". "New" RN decided that her co-workers were correct and then had the blood hand delivered to the gi lab to be hung. Mananger had charge RN "council the two RN's that voiced their opinon. Who is in the wrong here? Isn't pt safety the number one goal. Manager stated "pt needed blood right then and it was best to not have followed the policy and procedure". Just asking.

[maelstrom143]

The nurses who voiced an objection to tubing the blood unsecured were correct and the mgr wanting to overlook protocol would be the one in hot water if push comes to shove. Neither the nurse following protocol nor those supporting her should have been called to account for doing the right thing. It is not personal, it is just the right thing and the manager should know this, otherwise why did he/she become manager?

We use tube systems and have a lock whereby we must unlock the system when it alerts us to the arrival of blood. If it has to be taken elsewhere after its arrival on the floor, the blood would have to be manually taken and handed off or hung as needed.

No one can practice under another nurse's license and saying, "I will take the heat for it" will not cover the nurse if an issue arises.

Your manager was wrong.

[nrsnic, BSN, RN]

When I was a phlebotomist I recall refusing to give blood to a room full of nurses, two ER docs, and the ICU charge. The reason was that the patient's blood ID band had been cut off, as well as his ACTUAL ID band, and had been tossed onto the counter amongst a messy pile of paperwork. It didn't matter that half the people there "absolutely knew" that the person in bed was, in fact, the right person...it is an absolute no-no to give blood to someone without ID bands. Especially since this person had just been transferred from OR.

Whew, just thinking about it gives me hives. The two doctors and the charge nurse were in my face screaming! Luckily my blood bank manager overheard that. Not only did my manager back me up, I was told some time later that I absolutely did the right thing by the nurse manager for ICU. It wasn't my fault that there was an oversight, but it was my duty to make sure that we got back on the policy/procedure track. The patient didn't suffer for it. We can give uncrossmatched blood in an emergency, which is what they did. WHILE the docs and charge were yelling at me, I calmly redrew the patient so he could have blood crossmatched again.

I won't say that I have never broken a policy or procedure, but blood products and all the procedures surrounding it are too important and scary to screw up.

[psu_213, BSN, RN]

We get our blood 'tubed' to us (in the ED) from the blood bank. Each unit has the unit number and the blood type on a sticker on the bag of blood. Attached to the bag is a paper that has the pt name, the unit number, MRN, DOB, blood type, etc. I don't know the procedure if we receive a unit of blood that needs to be transported elsewhere (for instance, a unit of blood that was received on a pt that has since be transported to the floor). As for the OP, I have no idea why the NM did not want to follow the written procedure.

[Rob72, ASN, RN]

Oh, let's see, we have a JCAHO violation, and a violation of practices recommended/mandated by the AABB.

http://www.aabb.org/Pages/Homepage.aspx Something about the Six Rs of Administration, I believe...hmmmm

"Never attribute to evil what may readily be explained by average stupidity.":rolleyes:

[Penguin67]

OK, I have read the issue and all of the responses. I am left asking, "Why would you ever put a unit of blood into a tube system?" Everywhere that I ever worked, blood was never to be tubed, as it could potentially break and contaminate the entire tube system. I understand that your tube system is new, and perhaps this should ba policy where you work. Just my two cents here.

[ChristineN, BSN, RN]

Everywhere I have worked blood has been sent to the floor through the tube system. Generally the blood is in a plastic bag as well as a padded tube to decrease the chance of explosion (and I've never heard/seen a unit explode). The unit is checked by the blood bank and time stamped and sent to the floor for 2 RN's to check.

My issue with the OP's story is why was the blood sent to the floor if the nurse wasn't ready for it? If there was another unit still infusing then she was not ready for her 2nd unit. At my hospital the policy is that blood is only good at room temperature for 30 min, so the blood bank does not tube blood until the RN says she is ready. In this situation, I would have told the blood bank to send it to the OR when they were ready for it.

[psu_213, BSN, RN]

OK, I have read the issue and all of the responses. I am left asking, "Why would you ever put a unit of blood into a tube system?" Everywhere that I ever worked, blood was never to be tubed, as it could potentially break and contaminate the entire tube system. I understand that your tube system is new, and perhaps this should ba policy where you work. Just my two cents here.

What about any blood samples/blood cxs. (stool samples?) If they broke they would contaminate the system. I think the real argument in this regard is that if something happened to the tube system, what if a unit of blood was in transit and got stuck along its journey when the system broke for some other reason?

[Rob72, ASN, RN]

What about any blood samples/blood cxs. (stool samples?) If they broke they would contaminate the system. I think the real argument in this regard is that if something happened to the tube system, what if a unit of blood was in transit and got stuck along its journey when the system broke for some other reason?

As with most "cost containment" policies, a statistician crunched the numbers, and advised Legal that it was a statistically valid choice. Don't need all those $$ phlebs, techs, or aides, if you can have a tube system. IIRC, it "saves" something like 5-10 FTEs/annum, on average.

If you suspect you blood is taking a tad too long, call, or have someone else call the BB. Its then old fashioned leg work.

[Lab Scientist]

That stinks that a manager would discipline someone for simply speaking up about a breach in the rules. That manager should be reported to his/her manager for breaking the rules.

[jadelpn, LPN, EMT-B]

I always thought blood followed patient. If the patient was in the GI lab, the primary nurse should have told 2 RN's transporting patient that the blood would come to them in the GI lab, and notified blood bank of same. I also thought that the blood bank needed to verify cross/match with bracelet, 2 RN's needed to verify (which the 2 RN's in GI lab could have done and hung). If the blood came to the floor, and the RN swiped for it, the RN is then responsible for it. And it needs to be hung in a timely manner once you get it, and the immediate need would suggest it going directly to where the patient is. Since the tubing is new to the facility, now is the perfect time to get an updated blood policy in place. And anyone who says to me "you do it this way and I will take the heat" will NOT be the one who holds any credibility in a court situation or when I lose my license to a poor outcome--pure hear-say. I don't like to take responsibility for a critical patient's blood, which could be a matter of life and death, when I can't see it through to the patient myself, no matter if my NM gets pis** about it or not. I would present it to your CNO as a potential loophole that needs a policy revision, more in line with JHACO standards.

[sauconyrunner]

What a cluster!!! At our facility we have to get blood in person. Pretty much everywhere I have worked. THing about tube systems, regardless of policy- things get stuck in it. things go to the wrong place...etc etc. THings arrive in a tube system and sometimes sit...especially if someone isn't waiting for it.

Yes, New and newer RN were correct in hand delivering. OMG. I agree, if you have a way to ask about updating policy, this is the time to do it.

[Morainey, BSN, RN]

Situation was pt on floor gi bleed in need of multi unit of blood.

I read too quickly and thought you meant the patient was literally on the floor. I was going to say, well someone better pick them up! Ah hahaha. Yes I am easily amused.