West Midlands Regional Training Package for Safe Blood Transfusion Practice

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West Midlands Regional Training Package for Safe
Blood Transfusion Practice
Version 3 (2008)
MODULE 7 Blood / Blood Component Ordering,
Recording and Prescribing
DISCLAIMER NOTE The information contained in this
training package has been produced as a training
aid only. Neither authors nor publisher can
accept any responsibility for any errors or
omissions. The British Committee for Standards in
Haematology (BCSH) issue guidelines relating to
blood transfusion this training document is not
intended as a substitute. Local hospital policies
and procedures must be followed at all times.
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Module 7 Blood / Blood Component Ordering,
Recording and Prescribing

• Contents
• Blood / blood component ordering
• Recording a blood transfusion in the patients
  clinical notes
• Prescribing blood / blood components

Aim Increase staff awareness and knowledge and
thus reduce blood transfusion errors

• Objectives
• To identify the correct procedures for blood
  component ordering
• To discuss the importance of recording
  information / good record keeping in relation to
  blood transfusion in the patients clinical notes
• To recognise the correct way to prescribe blood /
  blood components

All these aspects are the prescribers
responsibility. However, all staff involved in
blood transfusion administration should be aware
of the information contained in this module.
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Blood / Blood Component Ordering General
information
Module 7 Blood / Blood Component Ordering,
Recording and Prescribing
When a clinical decision has been made that a
patient requires a blood transfusion (refer to
module 4), the following steps should be taken
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Module 7 Blood / Blood Component Ordering,
Recording and Prescribing

• The transfusion request form must be correctly
  labelled with
• Full patient identification details i.e. last
  name, first name, date of birth, gender, and
  the patients unique identification number (for
  unknown patients, a temporary emergency number
  and gender should be used refer to local Trust
  policy).
• The location of the patient (and location where
  transfusion will take place if different).
• Number and type of blood / blood components,
  including any special requirements (e.g.
  irradiated or CMV negative), and the date and
  time they are required.
• Past obstetric and transfusion history this
  information is of importance to blood bank
  cross-matching procedures.
• Patients diagnosis / full clinical details.
• Reason for transfusion (if pre-operative, the
  surgical procedure must be stated).
• (BCSH Guidelines for the administration of blood
  and blood components and the management of
  transfused patients1999) http//www.bcshguidelines
  .com/publishedHO.asp?tfBlood20Transfusionstatus

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Telephone Requests
Module 7 Blood / Blood Component Ordering,
Recording and Prescribing
Special care must be taken if blood components
are requested by telephone
Ensure that you clearly state the patients last
name, first name, unique patient identification
number, the number and type of blood / blood
components required (including any special
requirements), the reason for the request, and
the time and date the blood / blood components
are required (BCSH Guidelines 1999).
All requests made should be documented in the
patients clinical notes
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Maximum Surgical Blood Ordering Schedule
Module 7 Blood / Blood Component Ordering,
Recording and Prescribing
For elective surgical patients, many hospitals
have an MSBOS (Maximum Surgical Blood Ordering
Schedule). These schedules have been agreed at
hospital level, and lists the number of units of
blood routinely requested for each procedure.
MSBOS is used as a guide/tool to indicate how
many units to order for different surgical
procedures.

• The blood bank may query the requesting clinician
  if a request differs from the MSBOS therefore,
  any reasons for non-compliance following patient
  assessment should be stated on the request form.

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Requests for pre-transfusion compatibility
testing and blood components
Module 7 Blood / Blood Component Ordering,
Recording and Prescribing
The following are the main services provided by
most hospital transfusion laboratories. You
should familiarise yourself with the details for
your own hospital. Hold the sample will be
booked into the laboratory and held (often for a
week - check hospital policy). Most requests for
a group and save will be treated in this manner
unless they are surgical or if the clinical
details give specific reasons for processing.
Group, antibody screen and save - the sample
will be processed in anticipation of blood being
required in the future. All patients with known
antibodies should have their samples processed.
Most samples are saved for a week unless they are
from pre-operative assessment clinics (check
hospital policy). Request for red cell units -
specify whether routine or emergency and include
whether any special requirements (e.g. irradiated
or CMV negative). Request for other blood
components - specify whether routine or emergency
and include whether any special requirements
(e.g. irradiated or CMV negative). Investigation
of transfusion reactions Send EDTA and clotted
samples plus 20ml urine with details of
reaction. These requests should have been
discussed with the laboratory. Other
investigations including referral of material
to the National Blood Service
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Out of Hours Ordering
Module 7 Blood / Blood Component Ordering,
Recording and Prescribing
Routine transfusions should not be requested
out of hours. Out of hours requesting should
only be used for emergencies, as there is a
greater risk of error occurring during this
time. In 2006, SHOT reported 60 of all
laboratory transfusion errors occurred out of
hours.
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Emergency Ordering
Module 7 Blood / Blood Component Ordering,
Recording and Prescribing
Inform the hospital transfusion laboratory
immediately of an emergency situation where blood
/ blood products are required transfusion
laboratory staff can provide information
regarding the availability of blood
components. Ensure that transfusion laboratory
staff are aware of the urgency of the situation.
General availability of blood in an
emergency Immediately - emergency group O Rh
(D) negative red cells and AB plasma can be given
while the patients blood group is being
determined. 15 minutes after receipt of blood
sample in the transfusion laboratory ABO group
specific blood can be provided. NB As soon as
the patients blood group has been determined a
switch should be made from O Rh (D) negative
blood to ABO group specific blood. 45 minutes
after receipt of blood sample in the transfusion
laboratory fully cross-matched blood can be
provided in most cases.
Always ensure that all blood components
administered are prescribed and documented in the
patients clinical notes.
NB the use of group O RhD negative blood is not
risk free other antibodies may be present. It
is the prescribers responsibility to assess
appropriateness of use. Wherever possible, wait
until cross-matched blood is available
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Recording of Blood Transfusions
Module 7 Blood / Blood Component Ordering,
Recording and Prescribing
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Prescribing of Blood / Blood Components
Module 7 Blood / Blood Component Ordering,
Recording and Prescribing
All blood / blood components to be administered
must be prescribed (either on a prescription
sheet for intravenous fluids or on special
transfusion prescription sheets check your
hospital policy). Only staff authorised to
prescribe are allowed to do so.

• The prescription should clearly state
• The type of blood components to be transfused
• Any special requirements (e.g. irradiated / CMV
  negative) refer to module 3 - Clinical
  Indications for Use
• The quantity of units to be given each unit
  should be prescribed separately.
• The duration of the transfusion Infusion times
  should take into consideration the volume of the
  component and the patients clinical condition
  (N.B. the average volume of a unit of blood is
  270mls. Therefore, if the patient is clinically
  stable, a routine unit may be transfused over 23
  hours assess each patient / situation
  individually).
• Any special instructions e.g. any medication
  required before or during the transfusion (N.B.
  do not prescribe diuretics routinely for all
  patients, only if clinically indicated).
• (BCSH Guidelines 1999)

N.B. A unit of blood must be transfused within
four hours of removal from temperature controlled
storgage (Handbook of Transfusion Medicine
2007). Drugs must not be added to blood under
any circumstance.
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Module 7 Blood / Blood Component Ordering,
Recording and Prescribing
Highlight Case 1 from SHOT 2003 Post transfusion
increment should be monitored A female patient
of small stature was admitted with haematuria and
Hb estimation of 63g/L. Four units of red cells
were transfused, following which the Hb was
166g/L. A doctor failed to notice the post
transfusion Hb and prescribed a further four unit
transfusion. Following this the Hb was 205g/L and
the patient was noted to be hypertensive.
Venesection was carried out daily for 3 days. The
patient survived.
Highlight Case 2 from SHOT 2003 Why give
non-urgent elective transfusion at night? Two
patients on an oncology unit required elective
transfusions. Freda Fry was O Rh D positive
Linda Snell was B RhD negative. The two units of
blood were collected after midnight from the
blood bank and checked on the ward away from the
bedside. The units were inadvertently transposed
and transfused to the wrong patients. Freda Fry
suffered a severe acute haemolytic reaction after
the first 50ml of transfusion and required
admission to ICU. Linda Snells transfusion was
stopped she suffered no ill effects. Transfusion
should not take place at night unless clinically
indicated.
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Module 7 Blood / Blood Component Ordering,
Recording and Prescribing
Highlight Case 3 from SHOT 2005 Be careful how
you delegate A haematology SpR requested
platelets from the transfusion laboratory for his
patient, and instructed his house officer to
write them up. The house officer asked the
nurse how to prescribe platelets and was advised
to write 2 bags of FFP over 30 minutes. A
different nurse, on seeing the prescription,
telephoned the laboratory to request the FFP,
which was provided and transfused. The SpR
discovered the error on finding the labelled
platelets still on the agitator that next morning.
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Key Points
Module 7 Blood / Blood Component Ordering,
Recording and Prescribing

• Only staff authorised to request and prescribe
  blood are allowed to do so all transfusions
  must be prescribed.
• All transfusion request forms and samples must be
  correctly labelled and contain sufficient
  information for a safe cross-match procedure to
  be performed.
• Special care must be taken with any telephone
  requests.
• Routine transfusions should not be requested out
  of hours.
• Inform transfusion laboratory staff immediately
  if there is an emergency situation where blood /
  blood products are required ensure that
  transfusion laboratory staff are aware of the
  urgency of the situation.
• Infusion times should take into consideration the
  volume of the component and the clinical
  condition of the patient (Note a unit of blood
  must be transfused within four hours of removal
  from temperature controlled storage).
• A minimum data set should be recorded in the
  patients clinical notes.

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Module 7 - Quiz
Module 7 Blood / Blood Component Ordering,
Recording and Prescribing

• Question 1 of 6
• All qualified hospital staff are authorised to
  request or prescribe blood.
• True / False

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Module 7 - Quiz
Module 7 Blood / Blood Component Ordering,
Recording and Prescribing

• Question 2 of 6
• In order for a compatible ABO selected component
  to be issued from the transfusion laboratory a
  pre-transfusion sample must be tested.
• True / False

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Module 7 - Quiz
Module 7 Blood / Blood Component Ordering,
Recording and Prescribing

• Question 3 of 6
• Routine transfusions should not be requested or
  transfused out of hours.
• True / False

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Module 7 - Quiz
Module 7 Blood / Blood Component Ordering,
Recording and Prescribing

• Question 4 of 6
• Wherever possible, group O RhD negative should
  always be used in the emergency setting.
• True / False

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Module 7 - Quiz
Module 7 Blood / Blood Component Ordering,
Recording and Prescribing

• Question 5 of 6
• The clinical indication for transfusing blood /
  blood components and the outcome of the
  transfusion should always be recorded in the
  patients clinical notes.
• True / False

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Module 7 - Quiz
Module 7 Blood / Blood Component Ordering,
Recording and Prescribing

• Question 6 of 6
• All blood / blood components to be administered
  must be correctly prescribed on an appropriate
  prescription sheet.
• True / False

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Module 7 Quiz Answers
Module 7 Blood / Blood Component Ordering,
Recording and Prescribing

• Question 1 False
• Question 2 True
• Question 3 True
• Question 4 False
• Question 5 True
• Question 6 True