As Blood Utilization Committees work to implement standardized transfusion order forms that encourage clinically appropriate transfusions, I am seeing that it is often nurses who are filling out the forms (whether on paper or electronically) after the physician writes the order on a blank form. Nurses and BUC’s need to recognize the potential legal implications of this practice.
Hospitals often use pre-printed transfusion order forms drafted by the Blood Utilization Committee. As a mechanism to encourage compliance and to support auditing, the Blood Bank will not release blood products without the completed order form (except for emergencies). The order form is usually completed by a nurse taking a verbal order or transcribing a written order onto the form. Sometimes the physician does not provide an indication for a transfusion. The reality is that most of the time the nurse uses her best judgment (e.g. recent labs) to complete the form, however only care providers licensed to order blood products may diagnose the clinical indication for a transfusion.
A pre-printed or electronically formatted transfusion order form that has been approved by the medical staff is a valuable patient care tool: it encourages providers to comply with transfusion guidelines and communicates necessary clinical information from the ordering provider to the Blood Bank staff and to the transfusing nurse.
If a physician writes a transfusion order without an indication or does not document the indication on the hospital’s transfusion order form, the nurse must clarify the order with the prescriber. Regardless whether the nurse ‘knows’ the transfusion indication for her patient, failing to clarify the order would likely be practicing beyond the scope of a nursing license.
Nurses receiving verbal orders are taught to write the order in the patient’s chart then read it back for confirmation. The nurse receiving a verbal order for transfusion should document the order directly onto the transfusion order form; if the physician fails to state the indication, the nurse should ask the physician before reading back the complete order.
Physician noncompliance with approved medical staff procedures is a peer review matter. Effective leadership, for example through the hospital’s Blood Utilization Committee, can address any issues or concerns with communication and safe prescriber behavior.
- AABB 5.19.2 (Transfusions shall be prescribed and administered under medical direction.)
- AABB 5.11.1 (Transfusion service shall accept only complete, accurate, and legible requests.)
- CAP TRM. 40850
- Roback. Evidence based plasma guidelines. Transfusion 2010; 50:1227-1239.
- Napolitano. Clinical Practice Guideline: RBC transfusion in adult trauma and critical care. Crit Care Med 2009; 37(12):3124–3157.
Slichter, Evidence based platelet transfusion guidelines. Hematology 2007; 172-178.