Blood and blood product use in perioperative patient care

Nurses' practice of blood transfusion in the United Arab Emirates: an observational study

AIMS

The aim of this study was to document nurses' practice of red blood cells transfusion.

BACKGROUND

In the United Arab Emirates hospitals, nurses are responsible for the administration of blood transfusions. The safety and effectiveness of the transfusion process is dependent, among others, on the knowledge and skills of nurses who perform the procedure. Poor practice may result in avoidable complications that may threaten patients' safety. Published work indicated that nurses' practice varied across contexts and highlighted that patients received suboptimal care and incorrect transfusion that culminated in death or morbidity. In the United Arab Emirates, publications related to nurses' practice of blood transfusion are lacking.

DESIGN

Descriptive.

METHODS

Data were collected by means of non-participant structured observation. Data collection was undertaken in two general public hospitals in the Emirate of Abu Dhabi, United Arab Emirates. A random sample of 50 nurses from both hospitals was selected. Each nurse was observed once, from 10 minutes prior to blood collection until 15 minutes after initiating a transfusion.

RESULTS

Forty-nine nurses (98%) were observed. The maximum obtained score was 13 points of a possible score of 21, and 75% of nurses scored below the 50% level. Practice deficiencies included improper patient identification, suboptimal vital signs documentation and invalid methods of blood warming.

CONCLUSIONS

Patients in both hospitals were at risk of receiving incorrect blood, suffering unobserved transfusion reaction and acquiring bacterial infection.

RELEVANCE TO CLINICAL PRACTICE

This study revealed inadequate practices that nurses and hospitals should strive to change to provide a safer and more effective care that would, hopefully, minimise the risks and maximise the benefits of blood transfusion. These findings also have implications for clinical supervision and nurse education.

When Your Patient Is From the Obstetric Department: Postpartum Hemorrhage and Massive Transfusion

When caring for patients receiving massive transfusion, the nurse will be required to perform ongoing assessments and apply critical thinking to provide optimum care and avoid further complications. The perianesthesia nurse must be aware of the hemodynamic and coagulation changes of pregnancy when caring for an obstetric patient in the PACU to optimize patient outcomes. Understanding the causes of obstetric hemorrhage, which may result in the need for massive transfusion, will enable the nurse to anticipate and prevent potentially deadly complications.

Assessment of red blood cell and coagulation laboratory data

Critically ill patients present with a myriad of hematologic problems of various etiologies. The astute advanced practice nurse carefully reviews laboratory data incorporating principles of diagnostic reasoning and critical thinking while developing the plan of care. An in-depth understanding of hematology including red blood cells, red blood cell indices, and coagulation laboratory data is essential in the quest to understand the patient's pathophysiology. With every decade, nurses and physicians learn more about diseases that have plagued mankind for centuries--learning in greater detail about the deleterious effects and subsequent outcomes that often begin as subtle changes in traditional laboratory data. Greater focus on interpreting hematologic data and seeking support for diagnoses in clinical correlates will serve nurses well. This article intends to move advanced practice nurses beyond their current understanding of hematologic values--enabling them to understand that how and why we measure is as important as what we measure. No longer is it enough to simply measure physiologic data to develop a care plan driven by the patient's diagnoses. The contemporary nurse understands the importance of assigning meaning to data. Meaningful data are manageable data.

Hemolytic transfusion reaction: safeguards for practice

Most hemolytic transfusion reactions result from administration of ABO-incompatible blood. Even a small amount of incompatible blood may initiate a reaction and cause devastating consequences leading to death. Careful monitoring of the anesthetized patient is important in recognizing symptoms of a transfusion reaction so that the reaction may be promptly detected and treatment quickly initiated. Many factors contribute to blood transfusion errors resulting from the misidentification of either the patient or the blood product. Nursing has opportunities to establish policies and procedures, design nursing practices, and educate staff to help avoid blood transfusion errors.