Verifying Blood Products Before Transfusion

Scenario

You are preparing to start a unit of packed red blood cells (PRBCs).
During verification, you notice that the unit label shows O Positive, while the patient’s wristband and EMR list O Negative.

Question: What is your next step?

Best Practice Answer

1. Stop Immediately — Do Not Start the Transfusion:
   Even a single-character mismatch in blood type, patient ID, or unit number is a critical safety event.
   Never begin transfusion while any discrepancy exists.

2. Perform a Full Verification with a Second RN:
   According to hospital and AABB policy, two licensed RNs must verify:

   • Patient identifiers: name, MRN, date of birth
   • Blood product: unit number, blood type, expiration date, and compatibility tag
   • Physician order and consent presence
     The check must occur at the bedside, using wristband and blood unit together, not from labels or memory.

3. Identify and Communicate the Discrepancy:

   • Inform the blood bank and provider immediately.
   • Return the unit to the blood bank—never discard or attempt to relabel.
   • Document the event as a near miss following institutional policy.
   • Do not ask the lab to “confirm later” — transfusion should never proceed under uncertainty.

4. Reverify New Unit Upon Issue:
   Once a corrected unit arrives, repeat the two-RN verification in full.
   Confirm vital signs pre-transfusion and monitor for first 15 minutes closely after initiation.

Real-World Application

Errors in transfusion identification are among the most preventable sentinel events in hospitals.
Interviewers ask this scenario to assess vigilance, policy adherence, and assertiveness under time pressure.
A strong candidate demonstrates they understand that no urgency outweighs patient safety.

This applies in ICU, ED, med-surg, and oncology settings where blood products are administered frequently.

Tip: The correct phrase to use in interviews is:
“I would stop immediately, verify with another RN, notify the blood bank, and document the near miss — no transfusion proceeds until every detail matches.”
It shows confidence, accountability, and sound clinical judgment.