Okay, let me begin by stating that I do not like to complain about my assignment at work. I just don't. I feel like we're here to help people, and my preference of patient should never determine my attitude while taking care of people who need me.
That being said, I had an interesting night at work the other day. (Sorry for the long rant.)
I've observed that a number of my co-workers aren't keen to the idea of having a patient who needs blood transfused. I get it, it can be time consuming. In the ICU, where you might have 2-3 patients, it's almost more manageable than on the Med/Surg floor where you've anywhere from 4-8 patients.
Myself? I actually don't mind transfusing, at all. But there are certain... things that absolutely irk me, and here's one of them...
I get into work, told by the day nurse that I'm getting an immediate admission from the ED, and that the patient will need 2 units PRBC's, no problem, really. This patient had a hemoglobin of 5.2, mildly symptomatic in the ED, mind you.
The patient hits the floor about 20 minutes into shift. No blood band on the patient, no problem, I proceed to complete my admission otherwise, and decide to pass meds to all other patients until Lab is finished cross/matching their blood.
An hour and a half goes by... I call down to Lab, just to check on the status.
"I don't see any order for a cross/match." Lab says.
You have got to be kidding me... This patient had been in the ED since Noon that day. Her labs were completed, and reported to the ED by 1430 that afternoon... The patient hit my floor at 1950. 5 hours...
5 hours without anyone, Doctor, Nurse, anyone making mention to the Lab that we needed a cross/match. It's one thing if the ED was swamped, and couldn't get the blood started, I can understand that, but to not even pick up the phone, and get the cross/match?? Seriously?
I immediately call the ED, and the nurse who brought the patient up tells me, "I didn't really get report on the pt., I was asked by the day nurse to transfer the patient up.
I asked, "Were you aware that this patient has a Hgb of 5.2?"
They state, "Day nurse told me it was low, but I didn't know how low."
Me, "May I speak with the nurse who had the patient?"
ED, "They're gone for the day. The doctor too."
Sigh.
I call the attending, and get the order myself. Call down to the Lab, and ask if they can get this one done, stat, due to how long the patient has already been waiting. Fortunately, they did. However, the patient's blood had antibodies.... Ergh.
The blood wasn't available until 0330, and they were febrile, so I had to wait another hour (post acetaminophen) before starting transfusing at 0500. What a mess.
And I can see how this would have ended, especially if the patient continued to be symptomatic. The cross-hairs would have been on my forehead... Nuh uh, ain't happenin'. I absolutely hate doing it, but I reported this incident. To the supervisor, the clinical leader (on my floor, and the ED), as I refuse to be bait for someone else' negligence.
Had I been the one on the phone to get the report (remember, the day nurse had already gotten report, and just handed it off to me when I came in), I would have resolved this before the patient hit the floor. But it was a cascade of mishaps, just waiting for me when I walked into the door.
The cherry on top? I ended up with another admission at 0530, almost at end of shift, and that patient came up with an infiltrated IV, haha (I laughed at the time too).
Really though, you guys don't think I was in the wrong for being upset, do you? Or that I reported the incident? I mean, that patient could have been seriously injured due to this oversight. I've got to protect myself as much as the patient, yes?
