Blood Transfusion Guidelines

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GUIDELINES FOR THE CARE OF A PATIENT RECEIVING A BLOODTRANSFUSION

ReferenceDate approved

Approving Body Matrons Forum

Supporting Policy/Working in New Ways(WINW) Package

Implementation date November 2011

Supersedes Version1

Consultation

undertaken

Nursing Practice Guidelines Group, Ward

Sisters/Charge Nurses, Practice DevelopmentMatrons (PDMs), Clinical Leads, Matrons.

Target audience

Document derivation /evidence base:

See main references

Review Date November 2014

Lead Executive Director of Nursing

Author/Lead Manager Steven Cliffe & Hayley BondFurtherGuidance/Information

Hospital Transfusion Committee

Distribution: Ward Sisters/Charge Nurses, PDMs, ClinicalLeads, Matrons, Nursing Practice GuidelinesGroup (includes University of Nottinghamrepresentative), Clinical Quality, Risk andSafety Manager, Trust Intranet.

This guideline has been registered with the Trust. However, clinicalguidelines are guidelines only. The interpretation and application ofclinical guidelines will remain the responsibility of the individualclinician. If in doubt, contact a senior colleague or expert. Cautionis advised when using the guidelines after the review date.


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Contents

SECTION TITLE PAGE

Introduction 3

1.0 Prior to transfusion 4

1.1 Patient Information 41.2 Prescribing 4

1.3 Venous Access 5

1.4 Identity 5

1.5 Observations 5

1.6 Collection & Transport of Blood 6

1.7 Bedside Checking Procedure 9

2.0 During transfusion 11

2.1 Administration 112.2 Observations 13

2.3 Adverse Reaction 16

3.0 Post transfusion 18

3.1 Observations 18

3.2 Disconnection 18

3.2 Disposal of waste 18

Equality & Diversity Statement 20Equality Impact Assessment Statement 20

References 21


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Nottingham University Hospitals NHS Trust

CLINICAL GUIDELINES

"This guideline has been registered with the Trust. However, clinical guidelines areguidelines only. The interpretation and application of clinical guidelines will remainthe responsibility of the individual clinician. If in doubt, contact a senior colleagueor expert. Caution is advised when using guidelines after the review date."

These guidelines must be read in conjunction with the local Blood Transfusion

policy (NUH 2011, CL/CGP/008).

INTRODUCTION:

A red blood cell transfusion may be indicated for the following reasons:

Acute blood loss due to trauma or surgery

To increase the oxygen carrying capacity of the blood in some types of anaemia

To provide treatment and support for some types of chronic or malignant disorderse.g. rheumatoid arthritis, thalassaemia, sickle cell disease and leukaemia

PRINCIPLES OF CARE

See General Principles for All Procedures

GUIDELINES FOR THE CARE OF A PATIENTRECEIVING A BLOOD TRANSFUSION


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1.0 PRIOR TO TRANSFUSION

PRINCIPLE RATIONALE

1.1 Patient information

Ensure the patient has receivedthe appropriate leaflet

Will I need a bloodtransfusion

Information for patientsneeding irradiated blood

Children receiving a BloodTransfusion, a parents guide

in addition, is aware of all thepotential risks and benefits

involved in having a transfusion.Stocks of leaflets are availablefrom the National Blood Service

(01865 440042)

Patients have a right to receive goodquality, written information to enable themto give informed consent to any invasiveprocedure.

Handbook of Transfusion Medicine (4thEdition) 2007 (stationary office) Section 2page 18 & appendix 1 page 67

1.2 PrescribingA clear rational for transfusionshould be recorded on the bloodtransfusion record sheet and thepatients notes. It should also bedocumented in the patients notes

that the patient has verballyconsented to the transfusion.Ensure the blood is correctlyprescribed, by a registered medicalpractitioner, on the Trust BloodTransfusion Record Chart.Whenever possible bloodtransfusions should not beadministered overnight, exceptwhere the patient's conditionmakes this necessary.

Complies with National Safety PatientAgency (NPSA), Safety of Blood Tissues &Organs (SaBTO), Better Blood Transfusion3 (DoH circular) for the appropriateness oftransfusion

Handbook of Transfusion Medicine (4thEdition) 2007 (stationary office) Section 2page 18

Complies with local policy and Nationalrecommendations from the SeriousHazards of Transfusion (SHOT) scheme.

Frequent observations disturb the patient'srest. Reduced staffing levels and difficultyobserving the patient in a light dimmedenvironment make detection of a possiblereaction more difficult.


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1.3 Venous access

Ensure the patient has a patentperipheral cannula or central venouscatheter in situ. There is nomaximum or minimum size of

peripheral cannula as this dependson the size of the patient's vein andthe speed at which the blood is to beinfused.Intravenous Administration ofMedications- NUH Intranet

Ensures there are no delays inadministration. Blood should beadministered immediately after beingremoved from the issue fridge to decrease

the possibility of potential bacterialcontaminants Handbook of TransfusionMedicine 2007.If not used immediately & transfusioncannot be completed within the 4 hours ofremoval from issue fridge, it must bereturned and handed to a member of bloodbank staff.DO NOT PLACE IN FRIDGEOut of hours - Bleep Blood TransfusionLaboratory staff.

1.4 Identity

The patient should already havean identity band on. If not, attachone to the patient that states thepatients last name, first name,gender, date of birth, NHSNumber &/or hospital identificationnumber. .

POSITIVE PATIENTIDENTIFICATION

Check these details are correctwith the patient verbally(if possible) and the patientshospital notes

All patients must have an identificationwristband - NPSA safer practice notice11. (SPN)NHS number is the preferred numberNPSA SPN 001

The identity of patients MUST beconfirmed prior to commencing a bloodtransfusion. This reduces the riskassociated with wrong patient errorsPositive Identification of PatientsProcedure CL/CGP/037

1.5 Observation

Check and record the baseline

observations - temperature, pulse,blood pressure, respiration rate,SpO2, and consciousness level(AVPU or GCS) and Early warningScore should be taken, prior tocollecting and commencing theblood transfusion. (No more than1 hour previous)

Do not send staff to collect bloodbefore these have been done

Baseline observations are required to

identify any possible deviations from thepatients norm. If baseline observationsare not within normal limits, medical staffmay wish to review and delaytransfusion.To comply with N.I.C.E. Guidance (2007)

Confidential enquiry into patient outcomeand death [NCEPOD 2005] had reportedthat in critically ill medical patients, therespiratory rate is an important indicator

of deterioration.May waste unit if transfusion delayed


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1.6 Collection and Transport ofBlood

Only members of staff who havebeen trained in the collection of

blood from the blood fridge maydo so. This is also applicable tobank and agency staff. It is theresponsibility of the nurse incharge to ensure the individualhas been trained, before sendingthem to collect blood.ONLY in life threateninghaemorrhage will Blood Bank staffhelp in the collection of products,providing the member of staff has

their own ID and ID details of thepatient

To collect blood the preferreddocumentation is a completedTransfusion Record Sheet.For blood being moved to theatresatellite fridges the TheatreCollection Sheet could also beused

City Staff ONLYNever use another member ofstaff's bar-coded issue card toremove a unit of blood.

Withdrawing of an incorrect componentfrom the blood fridge remains the most

common error in incidents where theincorrect blood is transfused (SHOT 2006).Adequate checking procedures aretherefore essential to the process.NPSA SPN 14Handbook of Transfusion Medicine (4thEdition) 2007 (stationary office) Section2 page 18

See Training & Development on homepage of NUH Website or email

Transfusion Practitioners for details oftraining courses available.

Using another individual's bar-codedissue card is a disciplinary offence. Italso means that you could be heldaccountable for a mistake made byanother member of staff.

1.6a All staffDocument the required details onthe signing-out sheet at QMCCampus or the electronic sign out

system at City Campus.

Laboratory staff have to audit themovement of all blood units in line withlocal and national guidelines to ensurecompliance with cold chain

documentation - Blood Safety & QualityRegulations 2005 (BSQR)Non-compliance will result in thewastage of blood products.

1.6b The compatibility form is collectedwith the first unit of blood and shouldbe filed in patients notes.Never use to collect or check BloodProducts

Information on the compatibility form anda donor unit label will be identical.However, this may not correspond withthe details in the patient's medicalrecords for which the blood is prescribed.

NPSA SPN-14


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1.6c Remove the unit of blood from theblood bank fridge, ensuring the dooris firmly closed.Units of blood should be used in theorder in which they appear on thecompatibility form.

No more than one unit of blood perpatient should be collected at anyone time unless specificallyrequested by medical staff.

Blood must be stored between 2- 6Cinorder to remain suitable for transfusion.The use of blood is rationalised so unitsare used before their expiry and are notwasted.Never store blood in a ward fridge.

Only validated Blood fridges can be used.

1.6d When using a satellite bloodfridge, ensure all units of bloodare booked in and out, so that thebag number and date/time ofentering into and removal fromfridge are recorded.

This information is to be recordedon the Cold Chain ManagementForm supplied with the units.

Ensures an accurate record of themovement of blood units to satellitefridges, which complies with BritishStandard 4376 that maintains aconsistent recorded temperature.Satellite Fridge at City Campus are:

Main TheatreCICU TheatreToghill WardMaternity Theatre (Used for Emergency ONegative units ONLY)

Satellite Fridge at QMC Campus:Main Theatres

National guidelines require this in case ofadverse incidents occurring - BSQR

2005.

Best Practice WITHDRAWING OF BLOOD FROM BLOOD BANK

Withdrawing of an incorrect component from the blood fridge remains the mostcommon error in incidents where the incorrect blood is transfused (SHOT 2006).

Adequate checking procedures are therefore essential to the process.


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1.6e At the point of collection; Ensure that the unit of blood is

correctly identified by checkingthe patients identification,taken to the blood fridge(usually Transfusion record

sheet), with the full name, dateof birth, gender and NHS orhospital number on the unit

Check the unit is in date Ensure that the donation

numbers (the G number) isthe same on both labels (frontand reverse) of the unit

Check that this number alsomatches the number of thedonation which is being signed

out Check special requirements Usually the donor unit and the

patient unit are the same bloodgroup but on occasions, theyare not. If you are not happywith this, check with thetransfusion laboratory staff

Ensures that the correct unit of blood isremoved for the correct patient. NPSASPN-14Handbook of Transfusion Medicine (4thEdition) 2007 (stationary office) Section

2 page 20

Expired blood MUST NOT beadministered under any circumstances.BSQR 2005

CMV & Irradiated productsOn occasions, patients blood group maynot be available and Laboratory staff willselect appropriate group.Rh (D) Negative can be safely given toRh (D) Positive patients.Only in emergency situations will Rh (D)Positive blood be issued to Rh (D)Negative women of child bearing age(


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1.7

1.7a

Bedside Checking procedure

Each unit of blood must bechecked independently by twopeople prior to the administrationof the unit.

This check must be made besidethe patient, i.e. at bedside ortheatre trolley.The following staff are able tocheck blood: RegisteredNurse/Midwife, RegisteredMedical Practitioner, andRegistered Operating DepartmentPractitioner.A student nurse/midwife may actas a second checker provided

they have the necessaryknowledge to perform the role e.g.drug administration training

Complies with NUH Transfusion Policy2011, NPSA SPN-14

To ensure the correct patient receives

the correct blood. If a patient istransfused with an incompatible unit ofblood, there is a high risk of an acutehaemolytic reaction, which could prove tobe fatal.

Handbook of Transfusion Medicine (4thEdition) 2007 (stationary office) Section2 page 20Must understand reasons for checkingpatient ID at the bedside

1.7b The following details (last name,first name, date of birth, genderand patient identification number)must be checked and found to beidentical by: Positively identifying the

patients using verbalquestioning i.e. Tell me yourfull name and date of birth andchecking the details are thesame on the ID band &Transfusion Record Sheet.If verbal confirmation is notpossible, the ID band must becarefully checked.If possible, check with parents

for paediatric patients who areunable to respond Checking the blood transfusion

compatibility form for order ofunit transfusion ONLY

Checking that the compatibilitylabel attached to the unit ofblood, has the same donationnumber (the G number) as thelabel on the front of the unit

To prevent an error in administration.

NO ID band NO transfusion

Compatibility form should not be used asfinal part of identity check NPSA SPN-14


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1.7c The unit of blood must be checkedfor compliance with any specialrequirements on the transfusionrecord sheet and patients notesE.g. Cytomegalovirus (CMV) status.

The unit of blood must be checked

to ensure it has not passed its expiry

Complete the Transfusion RecordSheet details time collected (ifon the sheet) start and finish timesof the transfusion and signature ofthe person who set up thetransfusion & witness. Donationnumber of unit being transfused

The blood bank may not have beeninformed of any special requirements. It isimperative these requirements are checkedand this is the last opportunity to do so.

The Nation Blood Service (NBS) only

accept liability for the product up to theexpiry date at 23:59 as printed on theunitTo facilitate patient transfusion recordsBSQR 2005

1.7d If any discrepancies are found

during the bedside identitychecking procedure then consultwith the blood transfusionlaboratory staff beforecommencing the transfusion.(Ward does not need to match)Depending on the discrepancy,the unit may be authorised fortransfusion or returned to thelaboratory.

Each unit of blood must bechecked using the aboveprocedure. All details checked atall stages must match exactly.Mis-spelling or incorrect detailsare not acceptable.

Complete the transfusion recordsheet with both the signatures ofthe person administering the

blood transfusion and the checker.Ensure the donation numbers (theG numbers) are accuratelyrecorded including check digit andpack number. This should alsoinclude the start and stop time ofadministration of each unit ofblood.Outcome of transfusion?Was there a reaction?At the end of the transfusion

episode the Transfusion RecordSheet must be returned promptlyto Blood Transfusion so final fateof unit can be recorded

The most important single cause of mis-

transfusion is failure of some aspect ofthe bedside checking procedureimmediately prior to administering thetransfusion (Annual Report, SeriousHazards of Transfusion, 2006).

Required by BSQR 2005 to show final

fate of every unit transfused which iskept by the Blood Bank for 30 years toaid in look back for TransfusionTransmitted Infections


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2. DURING TRANSFUSION

PRINCIPLE RATIONALE

2.1

2.1a

Administration

Blood must be administered usinga designated blood administration

set which has a filter with aminimum size of 200 microns.

It is not necessary to prime thegiving set routinely. If it isrequired, use 0.9% sodiumchloride intravenous infusion

The majority of the filter chambershould be filled when priming theadministration set.

The amount of blood units able tobe transfused through oneadministration set is subject tomanufacturer's guidance,although usually, this is two unitsper administration set.

The 200m filter on a standard bloodadministration giving set traps large

aggregates.A leucocyte filter is no longer requiredwhen administering blood as blood isnow leucocyte depleted at source toremove the risk of transferring viruses.

Covering the majority of the filter withblood when priming the line facilitatesmaximum use of the filter.

If too many units are transfused throughan administration set, the filter canbecome clogged and not workeffectively.

Best Practice: The final patient ID check at the bedside is the lastopportunity to detect an error

A failure to undertake the formal ID check of the component withpatient at the patient at the bedside:

Puts the patient at risk

Breaches professional standards & guideline (PositiveIdentification of Patients Procedure CL/CGP/037, NPSA SPN-14)


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2.1b Wash hands and apply apron andgloves

Connect the administration setaccording to the procedure for the'preparation of an intravenous

infusion and care of a patientreceiving an intravenous infusion'

In accordance with Trust policy and toprevent cross infection

To promote safe evidence-basedpractice.Intravenous Administration of

Medications (2010)

2.1c If multiple venous access ispresent then ensure that blood isnot administered at the same timeas any other drug likely to alsocause an anaphylactic reaction.If single venous access is present,do not introduce other drugs into

the blood administration setunless absolutely necessary anddirected by a clinician.

Under no circumstances must adrug be added to the blood pack.

If administration of a drug isunavoidable then ensure the line isflushed with 0.9% sodium chloridebefore and after the drugadministration.

Ensures that it is possible to accuratelyidentify which infusion/drug isresponsible for reaction, facilitatingappropriate action to be taken ifnecessary.Introducing other drugs to theadministration set increases the

possibility of contamination or bloodclotting/haemolysing in the line

2.1d Ensure the blood is administeredat the prescribed rate, whichshould not exceed 4 hours fromremoval of cold storage.

Electronic infusion devices maydamage blood cells and shouldnot be used unless specified as

safe by the manufacturer.

Fluid overload may occur if the blood isinfused too quickly.There is increased risk of bacterialgrowth after 4 hours.Handbook of Transfusion Medicine (4thEdition) 2007 (stationary office)

Best Practice TRANSFUSION TIMES

Blood should not be transfused for more than 4 hours from removal from cold storage asthere is increased risk of bacterial growth after this time. Discontinue unit if infusion hastaken more than 4 hours even if unit of blood is not completely finished.Standard intravenous cannulas are suitable for blood com onents infusion.


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2.2

2.2a

Observations

A full set of observations -temperature, pulse, bloodpressure, respiration rate, SpO2,consciousness level (AVPU or

GCS) and early warning scoreshould be taken prior to thetransfusion starting.

The nurse/midwife should remainwith the patient for the first 5minutes after each unit of blood iscommenced.

A full set of vital signs should beperformed and recorded (as

indicated above) 15 minutes afterthe start of each unit.

The patient should be asked toinform the nurse/midwife if he/shefeels at all 'different' during thetransfusion.

Unconscious patients are less easyto monitor for possible reaction. As aresult, frequent observation patternsshould be maintained, according tothe patient's condition.

This is the same for each new unitof blood commenced.

A temperature increase of up to

1.5above the baseline

recording is treated with anti-pyretics and slowing the

transfusion rate.Any rise above this and thetransfusion must be stopped anda Doctor informed.

NB. If baseline is raised abovenormal at the start of the transfusionand then continues to rise, informmedical staff.

To establish a baseline(NICE ref CG502007)

Severe reactions can occur during thefirst 5 minutes of transfusion.

An increase in temperature and pulsemay be a sign of incompatibility.

Patients may complain of feeling unwellprior to any changes in temperature andpulse that may indicate a reaction.(Handbook of Transfusion Medicine2007)The patient is unable to alert the staff ifthey feel unwell.

Each unit is from a different donor andposes the same potential risks.

Patients can react to non red cellcomponents within the unit of blood andthis can cause a small raise intemperature.

Contact Blood Bank

Hyperpyrexia can cause seriouscomplications.


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2.2b The patient should not leave theward unless supervised by staffcompetent to deal with transfusionreactions/anaphylaxis while thetransfusion is in progress

Un-supervised patients may have a lifethreatening reaction at any time duringthe transfusion episode

2.2c During the transfusion observe thepatient for signs of the following; Flushing Itching Fever Vomiting Diarrhoea Urticaria Pain at or near transfusion site Rigor

Backache Throat swelling Haemoglobinuria Collapse Circulatory failure. Bleeding at infusion site

If any of these occur, the transfusionshould bestoppedand a member ofthe medical staff should becontacted immediately.

Undertake a complete set of vitalsigns as outlined above andcommence Early Warning Scores orPaediatric equivalent every 5minutes.Further management depends onthe type and severity of the reactionand may be suggested by themedical staff.

Further routine observations duringthe transfusion of each blood unitare dictated by the patientscondition.

Any of these symptoms could be anindication of a transfusion reaction oranaphylaxis.Urgent intervention is required astransfusion reactions can be fatal.Refer to Anaphylaxis policy.

To prevent further deterioration of patientcondition and to treat symptoms.

2.2d. If the decision is to stop thetransfusion, disconnect theadministration set immediatelyand withdraw blood (approx 2mls)from the venous access device.Flush with 0.9% sodium chlorideto maintain its patency. Full

observations should be taken andrecorded as stated above.

Withdrawing blood from the venousaccess device ensures that no more ofthe transfused blood enters the patient'scirculatory system.


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Best Practice:

Observations during & after the transfusion is essential for the earlydetection of any adverse events or reactions

Adverse reaction can occur with all blood products

Additions observations should be made if an adverse reaction issuspected

Monitoring the unconscious/compromised or paediatric patient:

Be alert as they may not be able to report symptoms of atransfusion reaction

NEONATES may become hypothermic rather than febrile in

response to a transfusion reaction


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PRINCIPLE RATIONALE

2.3

2.3a

Adverse reaction

If a severe reaction is suspectedfollowing review by medical staff

then; Report to the hospital's blood

bank Seek Haematology Medical

Advice if required Complete an incident report

form (DATIX) Change the blood

administration set andmaintain venous access usingan infusion of 0.9% sodium

chloride. Return of the implicated unit

and the giving set to the bloodbank

Obtain blood samples from thepatient as per blood bankinstructions

Complete and returnTransfusion Reaction WardForm that is sent to you byBlood Bank as soon as

possible

To prevent transfusion of any furthersuspect blood.

To enable investigation of the incident

It is now legal requirement that all seriousadverse reactions be reported to the bloodbank for onward reporting to thegovernment (Blood Safety and QualityRegulations 2005), SHOT & SeriousAdverse Blood Reactions & Events

(SABRE)Analysis of the unit of blood andadministration set may identifycontaminants and their point of origin.These results may guide medicalintervention in the patient's care.

2.3b The blood unit and administrationset should be transported back toblood bank using a waterproofcontainer such as a sealed clinicalwaste bag appropriately labelled.DO NOT USE AIRTUBE SYSTEM

Use of shallow or permeable containers,such as plastic trays or kidney receivers,may allow spillage of blood.

Sharps bins should NOT be used underany circumstances

2.3c Follow Hospital Transfusion Policy2011 for reporting adversetransfusion reactions.

Frequent observations oftemperature, pulse, bloodpressure, respiration rate, SpO2,and consciousness level (AVPUor GCS) and Early warning Scoreurine output and colour should be

continued until the patient'scondition is stable.

To comply with N.I.C.E Guidance (2007)


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3. POST TRANSFUSION

PRINCIPLE RATIONALE

3.1 Observations

Once the transfusion is completed, aset of observations should becompleted and documented.

Complete the blood transfusionprescription and record sheet,including the outcome and returnthe top copy to blood bank.

To provide a baseline for future monitoring.

To comply with N.I.C.E Guidance (2007)

Law (BSQR 2005) requires 100%traceability of all blood products. Theserecords must be kept for 30 years

3.2 Disconnection

Once the transfusion is completed,

disconnect the blood administrationset and flush the access device, orchange for a fluid administration setif required.

Do not attach an infusion bag of0.9% sodium chloride directly to theblood administration set to 'flush'through the blood.

Infusing any fluid other than blood throughthe administration set after a transfusionencourages particles that have beentrapped by the 200 microns filter to enterthe patient's bloodstream.

For further information, see Guide to IVTherapy 4th Edition.

3.3 Disposal of waste

The empty blood bag should bediscarded according to the hospitalpolicy for the disposal of clinicalwaste.

Part empty bags still attached to anadministration set should be

disposed of together in a new sharpsbin containing absorbent gellingagent, for example, Vernagel .

To avoid spillage.

There is no requirement to store emptybags providing the product has beentransfused without adverse event


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Best Practice: The person responsible for the transfusion must check:

The reason for transfusion is documented in the case notes

The patient has received information about the transfusion

There is a signature to confirm the pre-transfusion checks have

been completed The start & finish time & date is recorded for each unit transfused

There is a permanent record of the transfusion episode in thepatients medical notes

The full completed top copy of the Transfusion Record sheet isreturned to Blood Transfusion


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Equality and Diversity Statement

All patients, employees and members of the public should be treated fairlyand with respect, regardless of age, disability, gender, marital status,membership or non-membership of a trade union, race, religion, domesticcircumstances, sexual orientation, ethnic or national origin, social &

employment status, HIV status, or gender re-assignment.

All trust polices and trust wide procedures must comply with the relevantlegislation (non-exhaustive list) where applicable:

Equal Pay Act (1970 and amended 1983)Sex Discrimination Act (1975 amended 1986)Race Relations (Amendment) Act 2000Disability Discrimination Act (1995)

Employment Relations Act (1999)Rehabilitation of Offenders Act (1974)Human Rights Act (1998)Trade Union and Labour Relations (Consolidation) Act 1999Code of Practice on Age Diversity in Employment (1999)Part Time Workers - Prevention of Less Favourable Treatment Regulations(2000)Civil Partnership Act 2004Fixed Term Employees - Prevention of Less Favourable TreatmentRegulations (2001)Employment Equality (Sexual Orientation) Regulations 2003Employment Equality (Religion or Belief) Regulations 2003Employment Equality (Age) Regulations 2006Equality Act (Sexual Orientation) Regulations 2007

Equality Impact Assessment Statement

NUH is committed to ensuring that none of its policies, procedures, services,

projects or functions discriminates unlawfully. In order to ensure thiscommitment all policies, procedures, services, projects or functions willundergo an Equality Impact Assessment.

Reviews of Equality Impact Assessments will be conducted inline with thereview of the policy, procedure, service, project or function


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REFERENCES

Anaphylaxis-Guidelines for the Treatment of (2010)http://nuhnet/nursing_and_midwifery/preceptorship/Pages/ClinicalSkills.aspx

Better Blood Transfusion 2 and 3 HSC 2002/009 and HSC 2007/001http://www.dh.gov.uk/en/Publicationandstatistics/Lettersandcirculars/Healthservicecirculars/DH_080613

Blood Safety & Quality Regulations (2005) SI 2005/50http://www.legislation.gov.uk/uksi/2005/50/contents/made

Handbook of Transfusion Medicine. DBL McClelland (United Kingdom BloodServices 4thEdition) 2007 (stationary office)

Intravenous Administration of Medications (2010)http://nuhnet/nursing_and_midwifery/preceptorship/Pages/ClinicalSkills.aspx

Infection Prevention and Control Policy (2011) (CL/GP/031)http://nuhnet/diagnostics_clinical_support/infection_prevention_control/Pages/Policies.aspx

Kelsey P, Murphy M.F., Atterbury C.L.J., Chapman J.F., Lumley K.S.,McClelland D.B.L., Stockley R., Thomas D. & Wilkinson J., (1999) The

Administration of Blood and Blood Components and the Management ofTransfused Patients Transfusion Medicine Vol 9 pp 227-238

National Confidential Enquiry into Patient Outcome & Death NCEPOD (2005)An acute problem? http://www.ncepod.org.uk/2005aap.htm

NICE Guidance CG50, 2007, Acutely Ill Patients in Hospitalhttp://www.nice.org.uk/nicemedia/pdf/CG50FullGuidance.pdf

Nottingham University Hospitals NHS Trust, Transfusion Policy CL/CGP/008

NPSA Safer Practice Notice 14 Competency Assessment (2006)http://www.npsa.nhs.uk

NPSA Safer Practice Notice 24 (2007) Standardising Wristbands ImprovesPatient Safetyhttp://www.npsa.nhs.uk/patientsafety/alerts-and-directives/notices/wristbands/

Serious Hazards of Transfusion SHOT Report (yearly reports 2005-2011)www.shotuk.org
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Authors: Hayley Bond & Steven CliffeTransfusion PractitionersClinical Pathology

NMPGG Link: Hayley Bond

For Review: November 2014

Blood Transfusion Guidelines

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