When is the best time for blood transfusion?

[Davia, BSN]

I worked the day shift. I come in to receive report on my patient load of 5:1. The night shift nurse informs me of a critical hemoglobin and that my patient needed a blood transfusion. She was aware doing the night shift of this critical low hemoglobin during the night shift. Just want to hear thoughts. What time is the best time for a transfusion?

[Sour Lemon]

I worked the day shift. I come in to receive report on my patient load of 5:1. The night shift nurse informs me of a critical hemoglobin and that my patient needed a blood transfusion. She was aware doing the night shift of this critical low hemoglobin during the night shift. Just want to hear thoughts. What time is the best time for a transfusion?

There are too many variables to answer that question with the information provided. Being "aware" of a critical low doesn't mean the night nurse had consent, the blood was ready, or that it was her highest priority task. I will say that shift change (or near it) is usually not the best time to start a transfusion ...but if the patient is confused, gasping for breath, and their Hgb is 5, the right time is "now"- whenever "now" happens to be.

[TriciaJ, RN]

Generally when a critical lab value is ascertained the doctor is notified immediately. An order is received, in this case it would likely be to run 2 units of packed red cells, but it may be something else. Then an order is placed with the blood bank, and then it depends on how long it takes to receive the 1st unit from the blood bank. As soon as it arrives on the unit, you immediately start the protocol for running it.

The only issue here is if there was a delay in calling the doctor with a critical value. What is your facility's policy?

[Davia, BSN]

The policy is to call the doctor first of course and notify of the critically low Hgb. Then go threw the facility's protocol to administer blood products. When you have 5:1 ratio. You do have to know how to multitask and prioritize. For instance a patient having a low Hgb and a patient asking for pain meds. There are exceptions to every rule. Some patients run low and they don't want to transfuse. Also sometimes the nurses do delay patient care.

[TriciaJ, RN]

If you have a reason to believe patient care was delayed unnecessarily, then you need to complete an incident report. Otherwise, you just start the transfusion process and carry on.

[Davia, BSN]

I was informed that consent was signed, transfusion orders were in the blood was order but the blood was not administered. I was informed that the night shift nurse just did not get a chance to give it. She ran out of time. I don't have a problem with blood administration on the day shift as blood administration is time consuming on any shift. It's just a part of one of the many task nurses perform. How would you respond to the physician? when he asks how did the transfusion go on that patient that he ordered the blood transfusion on approximately 9 or 10 hours ago.

[Sour Lemon]

I was informed that consent was signed, transfusion orders were in the blood was order but the blood was not administered. I was informed that the night shift nurse just did not get a chance to give it. She ran out of time. I don't have a problem with blood administration on the day shift as blood administration is time consuming on any shift. It's just a part of one of the many task nurses perform. How would you respond to the physician I do have a problem asking how did they do with the transfusion that they ordered on the night shift that was never started.

How long was everything ready on her shift and what reason(s) did she have for not staring it?

I tend to give people the benefit of the doubt unless they never manage to get anything done. The opposite shift does the same for me. It's a much nicer way to work than second guessing everything the opposite shift does and fuming about it.

[Davia, BSN]

Maybe the nurse can ask for assistance from the charge nurse. The patient may need a higher level of care and need to be watched more closely. Just a possibility.

[beekee]

Chances are the night nurse should have done it. However, if everything was set to go within 2 hours of shift change, I might be willing to give the nurse a break. I've had nights, for example, where I become the sitter because a patient sundowns and it's not possible to get a sitter overnight. Or, an admission comes late in the shift and is a hot mess. Also, I'm not going to start blood so that the prime reaction time ends up during shift change and it's tough to gauge because you never know how long the blood bank will take to get it ready.

Generally, it dumping stuff on the next shift happens once in awhile, the nurse is trying and had a reason for not getting something done and I do it. If the nurse is always dumping on me, the there's something else going on - lazy, poor time manager or both. But at the end of the day, I can't change that nurse and the patient still needs blood so I do it. I chose not to waste energy on getting annoyed with my coworkers.

[Davia, BSN]

Sorry but she admitted it had been ready and all the other patients were stable. She did not have a reason. She just said she ran out of time. I had follow the nurse on previous shifts only to come in and hear the same response on several occasions . Being the person I am I just took the report and the transfusion patient was top priority unless I had a critical low Glucose and or insulin to give or a code. Team work with night and day shift working together would make the dream work.

[Sour Lemon]

Sorry but she admitted it had been ready and all the other patients were stable. She did not have a reason. She just said she ran out of time. I had follow the nurse on previous shifts only to come in and hear the same response on several occasions . Being the person I am I just took the report and the transfusion patient was top priority unless I had a critical low Glucose and or insulin to give or a code. Team work with night and day shift working together would make the dream work.

Well, if you feel this was an inappropriate delay in care and the nurse is a "repeat offender", go ahead and write your incident report. Just be aware that the opposite shift will be writing incident reports of their own if you dare to miss anything or make even the smallest of mistakes.

[Davia, BSN]

Well said I understand stuff does happen. Nursing care is 24 hours around the clock. I would be staying late to do simple things because I didn't want it to be said that I was always leaving things for the night shift. You are right we can't waist our energy on foolishness. After all we are there for the patients and the ultimate goal is to keep them safe.