When is the best time for blood transfusion?

Nurses General Nursing

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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?

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.

Ok, so you're wanting to hear, "You were right and she was wrong." If "being the person you are" means not having the communication skills to talk to her about it, then, well, you're not getting anywhere are you? If she genuinely had no excuse to carry out an order for a critical low Hgb, then that is neglect, is it not? And did you report it? Is there anything you did other than come to a website to hear other nurses tell you how right you are?

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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.

I hate it when nurses feel that way. I wish they'd just go home and free up the computers. I'm going to be there for twelve hours, anyway. I will stay a few minutes late on occasion when there's an urgent situation, but most people receiving blood transfusions on my unit are stable and it's OK to "work in" starting the transfusion around other tasks.

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I hate it when nurses feel that way. I wish they'd just go home and free up the computers. I'm going to be there for twelve hours, anyway. I will stay a few minutes late on occasion when there's an urgent situation, but most people receiving blood transfusions on my unit are stable and it's OK to "work in" starting the transfusion around other tasks.

Or worse...they "help out" and then management asks why they're not going home on time and they blame you.

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Or worse...they "help out" and then management asks why they're not going home on time and they blame you.

Yikes! I've never been blamed for someone else not leaving on time.

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Ermehgerd so did she see the result, order the blood and then have the blood for 9 hours and didn't get to it? I guess she can't give blood anyway that's out that long but if it happened like that YES file an IR (after reordering the blood and get it going yourself). If you are a floor nurse someone better be coding if you don't transfuse someone who needs it. Recently I was trying to get a guy to pee (he had been but 15 min left in shift MD decided the 2 times in 11 hours was not enough) so I scanned him at shift change. I felt badly leaving the oncoming with a prompt to void or I&O, but I would never sit on a transfusion order.

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Specializes in Renal, Phone Triage, End Stage Renal, Acute Dialys.

No I didn't come to the internet site to hear who is right and who is wrong. Yes I communicated with the nurse. I never said anyone was right or wrong. I just wanted to hear opinions. As stated in a previous thread. Nursing care is around the clock. Team work makes the dream work. Thanks for you input. Have a great afternoon.

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Ermehgerd so did she see the result, order the blood and then have the blood for 9 hours and didn't get to it? I guess she can't give blood anyway that's out that long but if it happened like that YES file an IR (after reordering the blood and get it going yourself). If you are a floor nurse someone better be coding if you don't transfuse someone who needs it. Recently I was trying to get a guy to pee (he had been but 15 min left in shift MD decided the 2 times in 11 hours was not enough) so I scanned him at shift change. I felt badly leaving the oncoming with a prompt to void or I&O, but I would never sit on a transfusion order.

It's never that fast for me. It's get the call from lab, then find time to call the MD. Wait for the MD to call back, then get orders. Find time to enter the orders, then wait for lab to draw the type and screen. Overnight, we frequently have one lab tech and even stat orders aren't "quick". After the results are back we wait for the blood to get ready ...again, with a skeleton crew in lab. A great deal of the time, the patient is not able to sign for themselves. So while doing these other things, we put a call out to family and wait for them to call back. That can take LONG time. And when everything is finally completed, I need time to pick up the blood (a fairly extended process at some places), 15 minutes to "sit around" and a second nurse who's available (key word) to double check everything with me.

Very occasionally, I've received an order at the beginning of my shift and still not been able to transfuse by the end of the shift. In those cases, antibodies are usually an issue, but consent can also be the culprit. Two MDs can bypass family consent, but are reluctant to do so unless the patient is in distress.

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Specializes in Renal, Phone Triage, End Stage Renal, Acute Dialys.

No the blood was not out that long. It never made it to the unit on the night shift. I was saying that I would be working on giving the blood as the top priority in my multitasking over everything else unless one of my other patients was coding or had a critical low blood glucose or something.

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Specializes in NICU.

Ha ha ha,been there,we had to do all the transfusions as soon as we came on because the blood was never"ready" on the previous shift....until..one MD got wise to the situation and then it all changed when he checked with the lab records.

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:nurse: ASAP ...

...or STAT in emergency cases.:snurse:

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Specializes in Critical Care and ED.

I get that "stuff" doesn't get done. I get that the patient wasn't bathed yet, or the lines weren't changed, or that the patient wasn't shaved, or even if the tube feed hadn't been started yet because you were waiting for a pump. I don't get the patient not getting PRBC with an Hb of 5. No excuse for it unless the patient on either side of them have been coding all night, getting intubated or having constant seizures. What kind of stuff was she "busy" with? Was she busy with med passes, washing patients, walking them to the bathroom? If that was the kind of "busy" she meant then I would deduce that her critical thinking and time management skills were sorely amiss and that she'd need some intervention to determine what was critical and what was not. And also perhaps a class in what Hb does and the implications of what lack of oxygen-carrying molecules does to end organs and the acid base balance. Just saying.

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Specializes in Critical Care; Cardiac; Professional Development.

The first transfusion never happens as fast as it could. The type and cross often takes hours to get done. I have had the blood bank drop the ball before and the night shift nurse ticked at me that blood didn't get started. I can't control what other departments do or don't do.

That being said, 9 hours seems like an extreme delay and I am wondering if said nurse could use some help with organization skills and time management, since this sounds like an ongoing issue. I personally would either do an incident report or escalate it quietly to the assistant manager to see if there is a way to help this nurse become more effective at his or her job, particularly if said nurse is in the first two years of their nursing career. Incident reports aren't meant to be punitive. They are meant to initiate the beginning of a root cause analysis so that errors that affect patient care and safety can be addressed before something terrible happens.

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