who can check blood

Nurses Safety

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Our hospital recently changed our policy on who can check blood at the bedside to "two healthcare individuals, one of whom must be an RN". They have interpreted this to mean an RN, LPN/LVN, MD or a CNA. They say they have research to support this decision though I have not seen it yet. When I questioned this policy I was told that "they are just numbers" and "it's just another pair of eyes" I tried to explain as cogently as I could my severe reservations about having unlicensed people verifying blood, to no avail. I approached this from a safety issue and also said that the difference between professional nursing and being a CNA is that we have rationale for our actions. The numbers on the blood bag and band are more than numbers; they represent the potential lethality of the product and therefore the rationale for two people to check. It only takes 15 cc of the wrong blood to kill a patient. I also expressed concern that we as registered nurses are charged with the duty to directly supervise CNA's and questioned how we could then ask them to check what we are reading is accurate. They believe this will free up the nurse. I told them I do not need my nursing assistants to do my job; I need them to do theirs, to pass the water and assist patients to the bathroom etc. If they did that, we would have time to check blood. And if truth be told, I have never heard a nurse complain about having to check blood but we all complain about getting called to a room because the pt. needs water. Anyway, sorry for the long post, but I am really interested in what others have to say about this new practice.

Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.
AT my facility it is two nurses, Rn and Rn or Rn and LVN. At another hospital I worked in, in was two Rn's.

Kassy : )

So weird that it has to be two RNs in so many places. Here only an RN can administer blood, so one of those checking needs to be the RN hanging the blood. But surely an LPN can check an armband and verify we're giving the right blood to the right patient? What if the primary nurse is an LPN? We let the LPN monitor the patient after the initial period, but don't let her/him check an armband and identify the patient? What about consents for surgery, are only RNs qualified to do that? Can LPNs not administer medication and check the 5 (or 8) rights? Seems a bit strange to me that in so many areas they can't verify blood.

Specializes in Utilization Management.

Only an RN can hang the blood, but it's verified with an RN and anyone else at my facility. I have them read me the armband out loud, spelling names if necessary, then I have the second person read me the sheet attached to the blood bag while I check the bag itself.

Then we both sign.

I personally like this system. I've worked places where another RN was the only one who could verify and hang blood, and to be honest, I'd rather have a PCT who's paying attention than an RN who's just trying to get outta there.

Specializes in Clinical Research, Outpt Women's Health.

Back in the day's when I was a unit secretary I did the check frequently with the nurses. It worked out well.

Specializes in med/surg, telemetry, IV therapy, mgmt.

I think all your concerns are justified. You always have the option of going above the standard established by hospital policy. What I mean is that just because the facility is telling you that it's OK that an LPN or CNA can check blood with you before hanging a transfusion doesn't mean that you have to accept this. If it were me, I'd take the extra effort to find another RN (the supervisor counts as an RN) to verify blood before hanging it. You just need to coordinate this between the time the other RN will be available to you and the blood bank since, as you know, blood must be hung and started infusing almost as soon as it is taken from the blood bank. It's my license on the line ultimately.

Our hospital policy is one RN along with another licensed personnel (RN, LPN, MD).

Many LPNs are responsible for monitoring vs, etc after bld is hung by a RN, I think that LPNs are definitely able to verify the inital hanging with an RN!!

The hospitals that have a policy for only RN/RN, are any LPNs then able to stay the first 15 min with the patient or is this soley part of the RN role as well? Just curious about the different policies!

Anyway, no, CNAs are not allowed to verify/hang blood with an RN.

Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.
Our hospital policy is one RN along with another licensed personnel (RN, LPN, MD).

Many LPNs are responsible for monitoring vs, etc after bld is hung by a RN, I think that LPNs are definitely able to verify the inital hanging with an RN!!

The hospitals that have a policy for only RN/RN, are any LPNs then able to stay the first 15 min with the patient or is this soley part of the RN role as well? Just curious about the different policies!

Anyway, no, CNAs are not allowed to verify/hang blood with an RN.

I agree. If the policy says an LPN can check blood, why worry about your license to hunt down another RN?

In our facilty, only RNs can hang blood, this includes remaining with the patient for the initial period of five minutes. We must remain with the patient initally, then an LPN can monitor the patient after that. But the RN has to be there initially.

When you are about to hang the blood, this is when it's most important to confirm the information and done at the bedside. The RN is the one that will be held accountable if something is amiss. When it is checked out from the lab they are checking to make sure the blood matches in their log book. At the bedside, you are checking to make sure it matches the PATIENT. 2 NURSES are required at our facility. The supervisor will do this if another nurse isn't available.

Specializes in Cardiac.
When you go to the blood bank is it two RN's down there checking the potentially lethal blood. I'd worry more about their qualifications down there than whether it's a CNA checking an armband with me.

Everywhere I've worked, it was the tech that went down to the blood bank, and checked the blood with the lab tech and then brought the blood back up to the unit. As a PCT, I was always responsible for getting the blood when the lab called-the nurses never went. They felt as if it was another check. 2 different people at the lab looking over the numbers, and 2 nurses checking at bedside.

That being said, it wouldn't matter to me what the policy was, I'd still hunt down another RN to check with me...

Specializes in Day Surgery/Infusion/ED.

RN+RN/RN+LPN. Never, ever a CNA. I don't know how some of you check blood, but our process involves a wee tad more than just checking an armband. :uhoh21:

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