TAR - Transfusing Blood Products

Key points:

1. Reminder: Consent remains on paper and is scanned into the EMR. Prior to beginning transfusion, confirm that consent has been obtained.
2. TAR Vital Signs Frequencies are a requirement and will flag next due vitals based on the following:

• Baseline vital signs prior to beginning transfusion. Monitor the patient closely for the first 15 minutes.
• 15 minutes after starting the transfusion. 
• 30 minutes after starting the transfusion.
• Hourly until transfusion is complete. 
• At the end of the transfusion - no longer than 30 minutes post.

3. A Transfusion is not considered complete until the blood product transfusion has been ended and the vital signs are documented in the TAR.

Transfusing Blood Products:

The status of a blood product can be viewed in the TAR column of the Status Board, and also using the ‘Other Clinical, Blood Bank Summary’ tab in the EMR. Status may display as follows:

• Ready - Ready for pick up in lab (see ‘Blood Product Request’ below)
• Issued - Issued to the nurse for transfusion
• Hold - Unit has been paused 
• Transfusing - In progress
• Transfused - Completed

Blood Product - Request:

When a blood product has been ordered and is ready for pick up, ‘Ready’ will appear. The process to request the blood product from the Lab is site specific (see site policy/procedure for obtaining products).

Transfusing a Blood Product

1. Enter TAR and select the unit to be transfused (displays in green). Select ‘Verify’ in the header.

2. Complete the displayed checklists. Scanning and verification is variable between unique and non-unique products:

• Unique products (i.e. PRBC) will require scanning of patient ID band and product with a cosignature to complete verification. (see TAR Order of Scanning tip sheet)
• Non-unique products (i.e. albumin) will only require that patients ID band to be scanned with no cosignature

3. Select ‘Verify and Begin.’

4. A pop up will appear if vital signs have not yet been documented in TAR. To document, select ‘Doc Vitals/Capture Vitals’ (note: vitals must be documented within TAR or will not be associated with the transfusion).

5. Begin the transfusion by entering ‘Begin Date/Time’ and ‘Transfusion Rate’ (Volume will default). Save.

6. The unit will display as transfusing. ‘Next Vitals Due’ will display according to the ONE Regional policy.

7. To document intake, enter the ‘Transfusion Rate’ and remaining ‘Container Volume’ (taken from your IV pump). The intake fields will auto-calculate.

8. Continue to document the transfusion using the ‘Doc Vitals’ and ‘Doc Intake’ buttons as required. 
9. To end, select ‘End’ from the header and enter the End Date/Time. Enter ‘Any Product Waste’ and the remaining ‘Container Volume’ (often 0). Cumulative Intake will auto-calculate. 

10. One final set of vital signs must be entered into TAR no longer than 30 minutes after the transfusion has completed using the ‘Doc Vitals’ button. This completes the transfusion. 

Transfusion Reactions and Hold/Resume

1. In the case of a Transfusion Reaction, first place the unit on Hold using the ‘Hold’ header button in TAR (a reason is required).

2. Select ‘Doc Reactions’ in the header. This will open the Transfusion Reaction Assessment (note: users should also notify Lab of a potential reaction).
3. To resume, select the ‘Resume’ header button.

Administering Rhogam

Enter TAR and select the unit to be transfused (displays in green). Select ‘Verify’ in the header. 

1. Complete the displayed checklists and select ‘Verify and Begin’ (you will be prompted to document vitals if not already done in TAR).

2. Begin the transfusion by entering the ‘Begin Date/Time’ (Container Volume will default). Save. Note: You do not need to enter the transfusion rate.

3. RHOGAM will display as ‘Transfusing.’ 

4. To end, select ‘End’ from the header. Enter ‘End Date/Time’ and ‘Container Volume’ (must be a whole number - often 0). Cumulative Intake will auto-calculate.

5. One final set of vital signs must be entered into TAR no longer than 30 minutes after the transfusion has completed using the ‘Doc Vitals’ button. This completes the transfusion.