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GUIDELINES FOR THE CARE OF A PATIENT RECEIVING A BLOOD

TRANSFUSION
Reference
Date 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 Development
Matrons (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 Bond
Further
Guidance/Information
Hospital Transfusion Committee
Distribution:

Ward Sisters/Charge Nurses, PDMs, Clinical
Leads, Matrons, Nursing Practice Guidelines
Group (includes University of Nottingham
representative), Clinical Quality, Risk and
Safety Manager, Trust Intranet.

This guideline has been registered with the Trust. However, clinical
guidelines are guidelines only. The interpretation and application of
clinical guidelines will remain the responsibility of the individual
clinician. If in doubt, contact a senior colleague or expert. Caution
is 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 4
1.2 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 11
2.2 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 20
Equality 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 are
guidelines only. The interpretation and application of clinical guidelines will remain
the responsibility of the individual clinician. If in doubt, contact a senior colleague
or 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 disorders
e.g. rheumatoid arthritis, thalassaemia, sickle cell disease and leukaemia

PRINCIPLES OF CARE

See General Principles for All Procedures


















GUIDELINES FOR THE CARE OF A PATIENT
RECEIVING A BLOOD TRANSFUSION


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1.0 PRIOR TO TRANSFUSION

PRINCIPLE RATIONALE

1.1

Patient information

Ensure the patient has received
the appropriate leaflet
Will I need a blood
transfusion
Information for patients
needing irradiated blood
Children receiving a Blood
Transfusion, a parents guide
in addition, is aware of all the
potential risks and benefits
involved in having a transfusion.
Stocks of leaflets are available
from the National Blood Service
(01865 440042)



Patients have a right to receive good
quality, written information to enable them
to give informed consent to any invasive
procedure.

Handbook of Transfusion Medicine (4
th

Edition) 2007 (stationary office) Section 2
page 18 & appendix 1 page 67

1.2

Prescribing
A clear rational for transfusion
should be recorded on the blood
transfusion record sheet and the
patients notes. It should also be
documented in the patients notes
that the patient has verbally
consented to the transfusion.
Ensure the blood is correctly
prescribed, by a registered medical
practitioner, on the Trust Blood
Transfusion Record Chart.
Whenever possible blood
transfusions should not be
administered overnight, except
where the patient's condition
makes this necessary.


Complies with National Safety Patient
Agency (NPSA), Safety of Blood Tissues &
Organs (SaBTO), Better Blood Transfusion
3 (DoH circular) for the appropriateness of
transfusion
Handbook of Transfusion Medicine (4
th

Edition) 2007 (stationary office) Section 2
page 18


Complies with local policy and National
recommendations from the Serious
Hazards of Transfusion (SHOT) scheme.

Frequent observations disturb the patient's
rest. Reduced staffing levels and difficulty
observing the patient in a light dimmed
environment make detection of a possible
reaction more difficult.

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1.3

Venous access

Ensure the patient has a patent
peripheral cannula or central venous
catheter in situ. There is no
maximum or minimum size of
peripheral cannula as this depends
on the size of the patient's vein and
the speed at which the blood is to be
infused.
Intravenous Administration of
Medications- NUH Intranet



Ensures there are no delays in
administration. Blood should be
administered immediately after being
removed from the issue fridge to decrease
the possibility of potential bacterial
contaminants Handbook of Transfusion
Medicine 2007.
If not used immediately & transfusion
cannot be completed within the 4 hours of
removal from issue fridge, it must be
returned and handed to a member of blood
bank staff.
DO NOT PLACE IN FRIDGE
Out of hours - Bleep Blood Transfusion
Laboratory staff.

1.4

Identity

The patient should already have
an identity band on. If not, attach
one to the patient that states the
patients last name, first name,
gender, date of birth, NHS
Number &/or hospital identification
number. .
POSITIVE PATIENT
IDENTIFICATION
Check these details are correct
with the patient verbally
(if possible) and the patients
hospital notes



All patients must have an identification
wristband - NPSA safer practice notice
11. (SPN)
NHS number is the preferred number
NPSA SPN 001


The identity of patients MUST be
confirmed prior to commencing a blood
transfusion. This reduces the risk
associated with wrong patient errors
Positive Identification of Patients
Procedure CL/CGP/037

1.5

Observation

Check and record the baseline
observations - temperature, pulse,
blood pressure, respiration rate,
SpO
2
, and consciousness level
(AVPU or GCS) and Early warning
Score should be taken, prior to
collecting and commencing the
blood transfusion. (No more than
1 hour previous)




Do not send staff to collect blood
before these have been done




Baseline observations are required to
identify any possible deviations from the
patients norm. If baseline observations
are not within normal limits, medical staff
may wish to review and delay
transfusion.
To comply with N.I.C.E. Guidance (2007)

Confidential enquiry into patient outcome
and death [NCEPOD 2005] had reported
that in critically ill medical patients, the
respiratory rate is an important indicator
of deterioration.
May waste unit if transfusion delayed


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1.6
























Collection and Transport of
Blood

Only members of staff who have
been trained in the collection of
blood from the blood fridge may
do so. This is also applicable to
bank and agency staff. It is the
responsibility of the nurse in
charge to ensure the individual
has been trained, before sending
them to collect blood.
ONLY in life threatening
haemorrhage will Blood Bank staff
help in the collection of products,
providing the member of staff has
their own ID and ID details of the
patient

To collect blood the preferred
documentation is a completed
Transfusion Record Sheet.
For blood being moved to theatre
satellite fridges the Theatre
Collection Sheet could also be
used

City Staff ONLY
Never use another member of
staff's bar-coded issue card to
remove a unit of blood.






Withdrawing of an incorrect component
from the blood fridge remains the most
common error in incidents where the
incorrect blood is transfused (SHOT 2006).
Adequate checking procedures are
therefore essential to the process.
NPSA SPN 14
Handbook of Transfusion Medicine (4
th

Edition) 2007 (stationary office) Section
2 page 18

See Training & Development on home
page of NUH Website or email
Transfusion Practitioners for details of
training courses available.









Using another individual's bar-coded
issue card is a disciplinary offence. It
also means that you could be held
accountable for a mistake made by
another member of staff.
1.6a

All staff
Document the required details on
the signing-out sheet at QMC
Campus or the electronic sign out
system at City Campus.

Laboratory staff have to audit the
movement of all blood units in line with
local and national guidelines to ensure
compliance with cold chain
documentation - Blood Safety & Quality
Regulations 2005 (BSQR)
Non-compliance will result in the
wastage of blood products.


1.6b

The compatibility form is collected
with the first unit of blood and should
be filed in patients notes.
Never use to collect or check Blood
Products

Information on the compatibility form and
a donor unit label will be identical.
However, this may not correspond with
the details in the patient's medical
records for which the blood is prescribed.
NPSA SPN-14

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1.6c

Remove the unit of blood from the
blood bank fridge, ensuring the door
is firmly closed.
Units of blood should be used in the
order in which they appear on the
compatibility form.
No more than one unit of blood per
patient should be collected at any
one time unless specifically
requested by medical staff.

Blood must be stored between 2- 6
C
in
order to remain suitable for transfusion.
The use of blood is rationalised so units
are used before their expiry and are not
wasted.
Never store blood in a ward fridge.
Only validated Blood fridges can be used.










1.6d

When using a satellite blood
fridge, ensure all units of blood
are booked in and out, so that the
bag number and date/time of
entering into and removal from
fridge are recorded.
This information is to be recorded
on the Cold Chain Management
Form supplied with the units.


Ensures an accurate record of the
movement of blood units to satellite
fridges, which complies with British
Standard 4376 that maintains a
consistent recorded temperature.
Satellite Fridge at City Campus are:
Main Theatre
CICU Theatre
Toghill Ward
Maternity Theatre (Used for Emergency O
Negative units ONLY)

Satellite Fridge at QMC Campus:
Main Theatres

National guidelines require this in case of
adverse incidents occurring - BSQR
2005.
Best Practice WITHDRAWING OF BLOOD FROM BLOOD BANK

Withdrawing of an incorrect component from the blood fridge remains the most
common 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 checking
the patients identification,
taken to the blood fridge
(usually Transfusion record
sheet), with the full name, date
of birth, gender and NHS or
hospital number on the unit
Check the unit is in date
Ensure that the donation
numbers (the G number) is
the same on both labels (front
and reverse) of the unit
Check that this number also
matches the number of the
donation which is being signed
out
Check special requirements
Usually the donor unit and the
patient unit are the same blood
group but on occasions, they
are not. If you are not happy
with this, check with the
transfusion laboratory staff


Ensures that the correct unit of blood is
removed for the correct patient. NPSA
SPN-14
Handbook of Transfusion Medicine (4
th

Edition) 2007 (stationary office) Section
2 page 20



Expired blood MUST NOT be
administered under any circumstances.
BSQR 2005





CMV & Irradiated products
On occasions, patients blood group may
not be available and Laboratory staff will
select appropriate group.
Rh (D) Negative can be safely given to
Rh (D) Positive patients.
Only in emergency situations will Rh (D)
Positive blood be issued to Rh (D)
Negative women of child bearing age
(<60 years)
1.6f Check for leakage by gently
squeezing the bag and observing
along the seams for exudates.

The blood may be contaminated if the
bag is not intact. If any leakage is
present return bag to a member of the
blood bank staff immediately in a
container that prevents spillage.
1.6g Check unit for discolouration. If dark coloured or black, this could
indicate presence of infection. If unit is
discoloured return bag to blood bank
staff immediately.
1.6h
If any detail, however minor, does
not match. DO NOT take back to
clinical area. Seek advice from
Laboratory Staff
Telephone & Bleep numbers are
available to contact Laboratory Staff at
the issue fridge










Best Practice RETURNING BLOOD UNITS TO BLOOD BANK

If a unit of blood has been out of the fridge for 30mins or more, it must be
returned to the blood bank and handed to a member of the laboratory staff. It
must NOT, under any circumstances, be placed back in the blood fridge.
If the unit has been out for more than 30 minutes, but transfusion is imminent, the
unit may be used, but transfusion must be completed within 4 hours of removal
from the fridge.

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1.7

1.7a

Bedside Checking procedure

Each unit of blood must be
checked independently by two
people prior to the administration
of the unit.
This check must be made beside
the patient, i.e. at bedside or
theatre trolley.
The following staff are able to
check blood: Registered
Nurse/Midwife, Registered
Medical Practitioner, and
Registered Operating Department
Practitioner.
A student nurse/midwife may act
as a second checker provided
they have the necessary
knowledge to perform the role e.g.
drug administration training




Complies with NUH Transfusion Policy
2011, NPSA SPN-14

To ensure the correct patient receives
the correct blood. If a patient is
transfused with an incompatible unit of
blood, there is a high risk of an acute
haemolytic reaction, which could prove to
be fatal.

Handbook of Transfusion Medicine (4
th

Edition) 2007 (stationary office) Section
2 page 20
Must understand reasons for checking
patient ID at the bedside

1.7b

The following details (last name,
first name, date of birth, gender
and patient identification number)
must be checked and found to be
identical by:
Positively identifying the
patients using verbal
questioning i.e. Tell me your
full name and date of birth and
checking the details are the
same on the ID band &
Transfusion Record Sheet.
If verbal confirmation is not
possible, the ID band must be
carefully checked.
If possible, check with parents
for paediatric patients who are
unable to respond
Checking the blood transfusion
compatibility form for order of
unit transfusion ONLY
Checking that the compatibility
label attached to the unit of
blood, has the same donation
number (the G number) as the
label on the front of the unit


To prevent an error in administration.










NO ID band NO transfusion






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


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1.7c
The unit of blood must be checked
for compliance with any special
requirements on the transfusion
record sheet and patients notes
E.g. Cytomegalovirus (CMV) status.

The unit of blood must be checked
to ensure it has not passed its expiry


Complete the Transfusion Record
Sheet details time collected (if
on the sheet) start and finish times
of the transfusion and signature of
the person who set up the
transfusion & witness. Donation
number of unit being transfused
The blood bank may not have been
informed of any special requirements. It is
imperative these requirements are checked
and this is the last opportunity to do so.


The Nation Blood Service (NBS) only
accept liability for the product up to the
expiry date at 23:59 as printed on the
unit
To facilitate patient transfusion records
BSQR 2005
1.7d
If any discrepancies are found
during the bedside identity
checking procedure then consult
with the blood transfusion
laboratory staff before
commencing the transfusion.
(Ward does not need to match)
Depending on the discrepancy,
the unit may be authorised for
transfusion or returned to the
laboratory.

Each unit of blood must be
checked using the above
procedure. All details checked at
all stages must match exactly.
Mis-spelling or incorrect details
are not acceptable.

Complete the transfusion record
sheet with both the signatures of
the person administering the
blood transfusion and the checker.
Ensure the donation numbers (the
G numbers) are accurately
recorded including check digit and
pack number. This should also
include the start and stop time of
administration of each unit of
blood.
Outcome of transfusion?
Was there a reaction?
At the end of the transfusion
episode the Transfusion Record
Sheet must be returned promptly
to Blood Transfusion so final fate
of unit can be recorded
The most important single cause of mis-
transfusion is failure of some aspect of
the bedside checking procedure
immediately prior to administering the
transfusion (Annual Report, Serious
Hazards of Transfusion, 2006).


























Required by BSQR 2005 to show final
fate of every unit transfused which is
kept by the Blood Bank for 30 years to
aid in look back for Transfusion
Transmitted Infections

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2. DURING TRANSFUSION

PRINCIPLE RATIONALE

2.1

2.1a

Administration

Blood must be administered using
a designated blood administration
set which has a filter with a
minimum size of 200 microns.



It is not necessary to prime the
giving set routinely. If it is
required, use 0.9% sodium
chloride intravenous infusion

The majority of the filter chamber
should be filled when priming the
administration set.

The amount of blood units able to
be transfused through one
administration set is subject to
manufacturer's guidance,
although usually, this is two units
per administration set.



The 200m filter on a standard blood
administration giving set traps large
aggregates.
A leucocyte filter is no longer required
when administering blood as blood is
now leucocyte depleted at source to
remove the risk of transferring viruses.





Covering the majority of the filter with
blood when priming the line facilitates
maximum use of the filter.

If too many units are transfused through
an administration set, the filter can
become clogged and not work
effectively.
Best Practice: The final patient ID check at the bedside is the last
opportunity to detect an error

A failure to undertake the formal ID check of the component with
patient at the patient at the bedside:
Puts the patient at risk
Breaches professional standards & guideline (Positive
Identification of Patients Procedure CL/CGP/037, NPSA SPN-14)

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2.1b

Wash hands and apply apron and
gloves

Connect the administration set
according to the procedure for the
'preparation of an intravenous
infusion and care of a patient
receiving an intravenous infusion'

In accordance with Trust policy and to
prevent cross infection

To promote safe evidence-based
practice.
Intravenous Administration of
Medications (2010)



2.1c

If multiple venous access is
present then ensure that blood is
not administered at the same time
as any other drug likely to also
cause an anaphylactic reaction.
If single venous access is present,
do not introduce other drugs into
the blood administration set
unless absolutely necessary and
directed by a clinician.

Under no circumstances must a
drug be added to the blood pack.

If administration of a drug is
unavoidable then ensure the line is
flushed with 0.9% sodium chloride
before and after the drug
administration.

Ensures that it is possible to accurately
identify which infusion/drug is
responsible for reaction, facilitating
appropriate action to be taken if
necessary.
Introducing other drugs to the
administration set increases the
possibility of contamination or blood
clotting/haemolysing in the line


2.1d

Ensure the blood is administered
at the prescribed rate, which
should not exceed 4 hours from
removal of cold storage.

Electronic infusion devices may
damage blood cells and should
not be used unless specified as
safe by the manufacturer.

Fluid overload may occur if the blood is
infused too quickly.
There is increased risk of bacterial
growth after 4 hours.
Handbook of Transfusion Medicine (4
th

Edition) 2007 (stationary office)




Best Practice TRANSFUSION TIMES

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

- 13 -


2.2

2.2a











































Observations

A full set of observations -
temperature, pulse, blood
pressure, respiration rate, SpO
2
,
consciousness level (AVPU or
GCS) and early warning score
should be taken prior to the
transfusion starting.

The nurse/midwife should remain
with the patient for the first 5
minutes after each unit of blood is
commenced.

A full set of vital signs should be
performed and recorded (as
indicated above) 15 minutes after
the start of each unit.

The patient should be asked to
inform the nurse/midwife if he/she
feels at all 'different' during the
transfusion.

Unconscious patients are less easy
to monitor for possible reaction. As a
result, frequent observation patterns
should be maintained, according to
the patient's condition.

This is the same for each new unit
of blood commenced.

A temperature increase of up to
1.5 above the baseline
recording is treated with anti-
pyretics and slowing the
transfusion rate.
Any rise above this and the
transfusion must be stopped and
a Doctor informed.

NB. If baseline is raised above
normal at the start of the transfusion
and then continues to rise, inform
medical staff.



To establish a baseline (NICE ref CG50
2007)






Severe reactions can occur during the
first 5 minutes of transfusion.



An increase in temperature and pulse
may be a sign of incompatibility.



Patients may complain of feeling unwell
prior to any changes in temperature and
pulse that may indicate a reaction.
(Handbook of Transfusion Medicine
2007)
The patient is unable to alert the staff if
they feel unwell.




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

Patients can react to non red cell
components within the unit of blood and
this can cause a small raise in
temperature.


Contact Blood Bank




Hyperpyrexia can cause serious
complications.



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2.2b The patient should not leave the
ward unless supervised by staff
competent to deal with transfusion
reactions/anaphylaxis while the
transfusion is in progress
Un-supervised patients may have a life
threatening reaction at any time during
the transfusion episode


2.2c During the transfusion observe the
patient 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 transfusion
should be stopped and a member of
the medical staff should be
contacted immediately.

Undertake a complete set of vital
signs as outlined above and
commence Early Warning Scores or
Paediatric equivalent every 5
minutes.
Further management depends on
the type and severity of the reaction
and may be suggested by the
medical staff.
Further routine observations during
the transfusion of each blood unit
are dictated by the patients
condition.
Any of these symptoms could be an
indication of a transfusion reaction or
anaphylaxis.
Urgent intervention is required as
transfusion reactions can be fatal.
Refer to Anaphylaxis policy.











To prevent further deterioration of patient
condition and to treat symptoms.
















2.2d. If the decision is to stop the
transfusion, disconnect the
administration set immediately
and withdraw blood (approx 2mls)
from the venous access device.
Flush with 0.9% sodium chloride
to maintain its patency. Full
observations should be taken and
recorded as stated above.

Withdrawing blood from the venous
access device ensures that no more of
the transfused blood enters the patient's
circulatory system.


- 15 -

Best Practice:

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

Adverse reaction can occur with all blood products

Additions observations should be made if an adverse reaction is
suspected


Monitoring the unconscious/compromised or paediatric patient:
Be alert as they may not be able to report symptoms of a
transfusion 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 suspected
following 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 and
maintain venous access using
an infusion of 0.9% sodium
chloride.
Return of the implicated unit
and the giving set to the blood
bank
Obtain blood samples from the
patient as per blood bank
instructions
Complete and return
Transfusion Reaction Ward
Form that is sent to you by
Blood Bank as soon as
possible




To prevent transfusion of any further
suspect blood.

To enable investigation of the incident



It is now legal requirement that all serious
adverse reactions be reported to the blood
bank for onward reporting to the
government (Blood Safety and Quality
Regulations 2005), SHOT & Serious
Adverse Blood Reactions & Events
(SABRE)
Analysis of the unit of blood and
administration set may identify
contaminants and their point of origin.
These results may guide medical
intervention in the patient's care.


2.3b

The blood unit and administration
set should be transported back to
blood bank using a waterproof
container such as a sealed clinical
waste 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 under
any circumstances

2.3c


Follow Hospital Transfusion Policy
2011 for reporting adverse
transfusion reactions.

Frequent observations of
temperature, pulse, blood
pressure, respiration rate, SpO
2
,
and consciousness level (AVPU
or GCS) and Early warning Score
urine output and colour should be
continued until the patient's
condition is stable.






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


- 18 -

3. POST TRANSFUSION

PRINCIPLE RATIONALE

3.1

Observations

Once the transfusion is completed, a
set of observations should be
completed and documented.

Complete the blood transfusion
prescription and record sheet,
including the outcome and return
the 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. These
records must be kept for 30 years
3.2 Disconnection

Once the transfusion is completed,
disconnect the blood administration
set and flush the access device, or
change for a fluid administration set
if required.

Do not attach an infusion bag of
0.9% sodium chloride directly to the
blood administration set to 'flush'
through the blood.








Infusing any fluid other than blood through
the administration set after a transfusion
encourages particles that have been
trapped by the 200 microns filter to enter
the patient's bloodstream.

For further information, see Guide to IV
Therapy 4th Edition.
3.3 Disposal of waste

The empty blood bag should be
discarded according to the hospital
policy for the disposal of clinical
waste.
Part empty bags still attached to an
administration set should be
disposed of together in a new sharps
bin containing absorbent gelling
agent, for example, Vernagel .


To avoid spillage.

There is no requirement to store empty
bags providing the product has been
transfused without adverse event




- 19 -







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 the
patients medical notes
The full completed top copy of the Transfusion Record sheet is
returned to Blood Transfusion


- 20 -

Equality and Diversity Statement

All patients, employees and members of the public should be treated fairly
and with respect, regardless of age, disability, gender, marital status,
membership or non-membership of a trade union, race, religion, domestic
circumstances, 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 relevant
legislation (non-exhaustive list) where applicable:

Equal Pay Act (1970 and amended 1983)
Sex Discrimination Act (1975 amended 1986)
Race Relations (Amendment) Act 2000
Disability Discrimination Act (1995)
Employment Relations Act (1999)
Rehabilitation of Offenders Act (1974)
Human Rights Act (1998)
Trade Union and Labour Relations (Consolidation) Act 1999
Code of Practice on Age Diversity in Employment (1999)
Part Time Workers - Prevention of Less Favourable Treatment Regulations
(2000)
Civil Partnership Act 2004
Fixed Term Employees - Prevention of Less Favourable Treatment
Regulations (2001)
Employment Equality (Sexual Orientation) Regulations 2003
Employment Equality (Religion or Belief) Regulations 2003
Employment Equality (Age) Regulations 2006
Equality 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 this
commitment all policies, procedures, services, projects or functions will
undergo an Equality Impact Assessment.

Reviews of Equality Impact Assessments will be conducted inline with the
review 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 2007/001
http://www.dh.gov.uk/en/Publicationandstatistics/Lettersandcirculars/Healthse
rvicecirculars/DH_080613

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

Handbook of Transfusion Medicine. DBL McClelland (United Kingdom Blood
Services 4
th
Edition) 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 of
Transfused 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 Hospital
http://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 Improves
Patient Safety http://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 Cliffe
Transfusion Practitioners
Clinical Pathology

NMPGG Link: Hayley Bond

For Review: November 2014