Once the decision to transfuse has been made, everyone involved in the clinical transfusion process has the responsibility to ensure the right blood gets to the right patient at the right time. National guidelines on the clinical use of blood should always be followed in all hospitals where transfusions take place.
If no national guidelines exist, each hospital should develop local guidelines and, ideally, establish a hospital transfusion committee to monitor clinical blood use and investigate any acute and delayed transfusion reactions.
Each hospital should ensure that the following are in place.
1. A blood request form.
2. A blood ordering schedule for common surgical procedures.
3. Guidelines on clinical and laboratory indications for the use of blood, blood products and simple alternatives to transfusion, including intravenous replacement fluids, and pharmaceuticals and medical devices to minimize the need for transfusion.
4. Standard operating procedures for each stage in the clinical transfusion process, including:
• Ordering blood and blood products for elective/planned surgery
• Ordering blood and blood products in an emergency
• Completing the blood request form
• Taking and labelling the pre-transfusion blood sample
• Collecting blood and blood products from the blood bank
• Storing and transporting blood and blood products, including storage in the clinical area
• Administering blood and blood products, including the final patient identity check
• Recording transfusions in patient records
• Monitoring the patient before, during and after transfusion
• Managing, investigating and recording transfusion reactions.
5. The training of all staff involved in the transfusion process to follow standard operating procedures. The safety of the patient requiring transfusion depends on cooperation and effective communication between clinical and blood bank staff.
1. Correctly complete a blood request form.
2. Collect the blood sample from the right patient in the right sample tube and correctly label the sample tube.
3. Order blood in advance, whenever possible.
4. Provide the blood bank with clear information on:
• The products and number of units required
• The reason for transfusion
• The urgency of the patient’s requirement for transfusion
• When and where the blood is required
• Who will deliver or collect the blood.
5. Ensure the correct storage of blood and blood products in the clinical area before transfusion.
6. Formally check the identity of the patient, the product and the documentation at the patient’s bedside before transfusion.
7. Discard, or return to the blood bank for safe disposal, a blood pack that has been at room temperature for more than 4 hours (or whatever time is locally specified) or a pack that has been opened or shows any signs of deterioration.
8. Correctly record transfusions in the patient‘s notes:
• Reason for transfusion
• Product and volume transfused
• Time of transfusion
• Monitoring of the patient before, during and after transfusion
• Any adverse events.
• Each patient should be identified using an identity wristband or some other firmly-attached marker with a unique hospital reference number
• This number should always be used on the blood sample tube and blood request form to identify the patient.
Informing the patient Whenever possible, explain the proposed transfusion to the patient or relatives and record in the patient’s notes that you have done so.