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• To enhance your knowledge of the regulations and policies regarding the storage, collection and delivery of blood components for transfusion
• To understand the procedures for collecting and returning blood components
• To recognise how to minimise the risk of adverse events, including handling and storage errors
Rationale and key points
There are several steps in the transfusion process that aim to ensure the correct blood component is given to the correct patient at the correct time. Ensuring the correct blood component is collected for the correct patient is crucial to safe transfusion practice and patient safety. This article explains the blood component collection and delivery procedure in the UK and outlines the steps that are necessary to enable nurses to collect blood components safely. Nurses in other countries can access their local guidelines and protocols and review these against the guidelines outlined in this article.
• All nurses involved in the collection or administration of blood components must understand safe transfusion practice and the important steps in ensuring patient safety.
• Collection of blood components must only be undertaken by trained healthcare professionals who have been assessed as competent by a trained assessor.
• It is important to understand the types of handling and storage errors that can occur due to human error during the blood components collection procedure.
Reflective activity
How to articles can help to update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of:
• How you think this article has increased your knowledge and understanding of the blood component collection procedure.
• How you could use this resource to practice safely and inform others on the safe collection of blood components for transfusion, in conjunction with local training and competency assessments.
Nursing Standard. doi: 10.7748/ns.2021.e11644
Peer reviewThis article has been subject to external double-blind peer review and checked for plagiarism using automated software
Correspondence Conflict of interestNone declared
Cottrell S (2021) How to safely collect and deliver blood components for transfusion. Nursing Standard. doi: 10.7748/ns.2021.e11644
DisclaimerPlease note that information provided by Nursing Standard is not sufficient to make the reader competent to perform the task. All clinical skills should be formally assessed according to local policy and procedures. It is the nurse’s responsibility to ensure their practice remains up to date and reflects the latest evidence
The patient safety functions of the National Patient Safety Agency are now jointly undertaken by NHS England and NHS Improvement
Published online: 21 June 2021
• The main blood components for transfusion are red cells, platelets, fresh frozen plasma (FFP) and cryoprecipitate.
• The Blood Safety and Quality Regulations 2005 state that only trained, competent and authorised staff can participate in the collection and delivery of blood components from a designated controlled storage environment (for example, a blood issue fridge) to the clinical area. Larger hospitals may have several blood issue fridges placed at various locations on-site.
• Before collecting a blood component for transfusion, vital pre-collection patient safety checklists must be completed to ensure the patient is ready for transfusion once the blood component has been collected and delivered to the clinical area (Norfolk 2013, Robinson et al 2018). These pre-collection patient safety checklists are usually completed by the nurse responsible for the patient’s care, and include ensuring that (National Blood Transfusion Committee 2015):
• The patient is wearing an identity band or a risk-assessed alternative to ensure positive patient identification. Check local patient identification policy for alternatives.
• The indication for transfusion and the patient’s consent to the procedure (where appropriate) are clearly documented in the patient’s healthcare record.
• The transfusion has been authorised.
• The patient has the appropriate intravenous access equipment in place such as a cannula, and that this is patent.
• The patient’s baseline observations have been taken and recorded within the 60-minute period before the transfusion commences, and that these have been assessed as acceptable (Cowan and Davies 2018, Jones 2018, Robinson et al 2018).
• Local documentation, such as a blood collection form, should be completed before the collection of blood components. This documentation contains patient identifiers to ensure that the correct blood component is collected from the controlled storage environment for the correct patient. This documentation should include:
• The patient’s first name.
• The patient’s last name.
• The patient’s date of birth.
• The unique patient identification number. The NHS (2019) recommends the use of the patient’s NHS number in England and Wales. The equivalent in Scotland is the Community Health Index number (Information Services Division Scotland 2020), while in Northern Ireland patients are identified using the Health and Care number (Department of Health, Social Services and Public Safety 2009).
• Any additional identifiers that are specific to the local area such as the patient’s middle name, address or gender. Check your local policy for further information about this.
• For unknown or unidentified patients, their unique patient identification number and gender are required as a minimum until they can be identified (Hunt et al 2015, Robinson et al 2018).
• It is a legal requirement for transfusion laboratories (where all samples are processed and components issued) to provide evidence of the collection of the blood component from the controlled storage environment, and its delivery and receipt in the clinical area. This enables full traceability of the ‘cold chain’, providing evidence that the blood component has been stored at the correct temperature during its journey from the controlled storage environment to administration in the clinical area. This audit trail also details the final destination of the blood component, for example its use in a transfusion. The audit trail also applies to any unused blood components returned to the controlled storage environment from the clinical area. Cold chain data must be retained for 15 years (The Blood Safety and Quality Regulations 2005, Hunt et al 2015, Robinson et al 2018).
• Blood components can only be collected by appropriately trained and competent healthcare professionals, who must have completed the local competency training programme on the collection and delivery of blood components. Examples of healthcare staff who may be involved in the collection procedure include nurses, midwives, healthcare support workers and porters.
1. Ensure the pre-collection safety checklist has been completed before the collection of the blood component for transfusion from the controlled storage environment (National Blood Transfusion Committee 2015).
2. The blood collection form or equivalent local documentation must be completed by the healthcare professional requesting the blood component to be collected for transfusion. Figure 1 shows an example of a blood collection form.
3. The patient identification details completed on the blood collection form must be checked and verified with the patient’s identity band.
4. The blood component type must be recorded on the blood collection form.
5. The time of request for collection of the blood component must be recorded on the blood collection form.
6. The signature of the healthcare professional requesting the blood component to be collected for transfusion must be recorded on the blood collection form.
7. Positive patient identification checks must be undertaken by the healthcare professional collecting the blood component for transfusion (The Blood Safety and Quality Regulations 2005, Norfolk 2013, Robinson et al 2018). The patient identification details cited on the blood collection form must be checked with the laboratory-generated label attached to the blood component. All identifiers must match; if there are any discrepancies, the blood component must not be removed from the controlled storage environment, and the transfusion laboratory must be contacted.
8. Only one unit of the blood component should be collected at a time, unless in an emergency situation (Robinson et al 2018).
9. Blood components are stored at various temperatures. Red cells should be stored in an authorised blood issue fridge at a temperature between 2ºC and 6ºC (Cowan and Davies 2018). Platelets are stored at room temperature (between 20ºC and 24ºC) in a temperature-controlled incubator in a transfusion laboratory (Norfolk 2013). FFP and cryoprecipitate are stored at ≤-25ºC for up to 36 months (Green et al 2018), and are thawed before transfusion. Platelets, FFP and cryoprecipitate should be collected directly from the transfusion laboratory. It is important to check local policy because practice may vary.
10. The blood component type and expiry date are additionally checked by the healthcare professional collecting the unit to ensure the blood component documented on the blood collection form is the one that is being collected, and that the unit is in date.
11. The removal of the blood component must be clearly documented on the issue register – or other locally implemented method – before it is removed from the controlled storage environment. Completion of the issue register is the first step in the cold chain audit and providing evidence of traceability. Details to be documented on the issue register include the patient’s identification details, ward, donation number and blood component type, the date and time of removal from the controlled storage environment, and the signature of the healthcare professional collecting the blood component.
12. The component is placed into a validated transport box or bag for delivery to the clinical area.
13. The time of removal of the blood component from the controlled storage area, and the signature of the healthcare professional collecting the blood component, must be documented on the blood collection form on collection. The time of removal enables the healthcare professional undertaking the blood component transfusion to ensure that it will be completed within four hours of removal from the controlled storage environment (Robinson et al 2018).
14. In the clinical area, the healthcare professional receiving the blood component must check that the correct blood component unit has been received for the correct patient.
15. The date and time of delivery to the clinical area are required on the blood collection form, as is the signature of the healthcare professional delivering the component to the clinical area, to complete the audit trail (The Blood Safety and Quality Regulations 2005, Robinson et al 2018).
16. It is important to check local policy to ascertain who retains the blood collection form because this will provide evidence of the cold chain audit for compliance with The Blood Safety and Quality Regulations 2005.
17. When collecting emergency units of O-negative red cells (the most common blood type used for transfusions when the patient’s blood type is unknown), the same principles apply; that is, these cells can only be collected by appropriately trained and competent healthcare professionals, who must have completed the local competency training programme on the collection and delivery of blood components.
18. Any emergency stock of O-negative red cells must be clearly identified in the controlled storage environment and be stored away from any blood that has been allocated to a specific patient. This is to prevent errors in an emergency situation, where the incorrect unit of blood might be collected.
19. The availability of emergency O-negative red cells must not be compromised, and the transfusion laboratory must be informed if emergency units are collected for transfusion (Hunt et al 2015, Robinson et al 2018). This means that stocks of O-negative red cells can be replenished to ensure they are always available in an emergency.
20. When returning blood components to the controlled storage environment, the same principles apply as for their removal; that is, blood components can only be returned by appropriately trained and competent healthcare professionals. The return of blood components must be included as part of the local competency training programme for healthcare professionals.
21. If blood components are to be returned unused from a clinical area, the date and time must be recorded on the issue or return register, and the signature of the healthcare professional returning the blood component must also be recorded. Always check the local policy for returning blood components to the controlled storage environment.
22. Unused red cells should be returned directly to the controlled storage environment within 30 minutes of their collection time. If this time period exceeds 30 minutes, the red cells should be returned directly to the transfusion laboratory (Robinson et al 2018).
23. When considering the return of platelet and plasma components, contact the transfusion laboratory for further advice because these components will not be returned directly to the same controlled storage environment as red cells.
24. Always return unused components in accordance with local policy and inform the transfusion laboratory without delay (Norfolk 2013, Robinson et al 2018).
The Serious Hazards of Transfusion (SHOT) haemovigilance reporting scheme collects and analyses blood transfusion information on adverse events and reactions from UK healthcare organisations involved in the transfusion of blood and blood components (SHOT 2020). SHOT has collated this evidence since 1996 and its data informs national guidelines and patient safety initiatives. Handling and storage errors involving blood components reported to SHOT include errors in both clinical and laboratory practice. Handling and storage errors have been defined by SHOT (2020) as ‘all reported episodes in which a patient was transfused with a blood component intended for the patient, but in which, during the transfusion process, the handling and storage may have rendered the component less safe for transfusion’.
In addition to handling and storage errors, SHOT collects data on ‘near miss’ events. A near miss event is defined by SHOT (2020) as ‘any error which if undetected, could result in the determination of a wrong blood group or transfusion of an incorrect component, but was recognised before the transfusion took place.’
In 2019, a total of 306 cases related to handling and storage errors were reported, with 199 of these relating to clinical errors and 107 relating to laboratory-based errors. All cases reported could have been prevented and were due to human error. A further 164 near-miss handling and storage events were reported where there was the potential for harm to a patient (SHOT 2020). Figure 2 shows a breakdown of all cases (n=3,397) associated with UK blood component transfusion and reported to SHOT in 2019. Figure 3 shows a breakdown of handling and storage error cases (n=306) associated with UK blood component transfusion reported to SHOT in 2019.
The important message from SHOT (2018, 2019, 2020) reports remains consistent: that communication and not making assumptions about details or verification are vital to patient safety.
SHOT (2020) continues to emphasise the importance of having appropriately trained and competent staff participating in the collection and delivery of blood components, and that this is vital to patient safety. Jones (2018) and Cowan and Davies (2018) emphasised the importance of appropriately trained and competent staff, and this is consistent with recommendations from the British Society for Haematology (Robinson et al 2018) and the National Blood Transfusion Committee (2015).
The legal requirement to introduce a competency-based training programme for all healthcare staff involved in the collection and delivery of blood components was implemented following the introduction of The Blood Safety and Quality Regulations 2005. This has resulted in the development of a theory and clinical skills-based competency programme that enables healthcare organisations in the UK to comply with The Blood Safety and Quality Regulations 2005. The national LearnBloodTransfusion e-learning programme is available via education platforms such as LearnProNHS (nhs.learnprouk.com) and e-Learning for Healthcare (www.e-lfh.org.uk/programmes/blood-transfusion). The LearnBloodTransfusion modules ‘safe transfusion practice’ and ‘blood collection pathway’ meet the theoretical learning needs of nurses involved in collecting blood components.
The Scottish National Blood Transfusion Service transfusion team has also developed a national competency-based programme, which is delivered across all NHS Boards in Scotland (National Services Scotland 2020). Additionally, the National Patient Safety Agency* (2008) developed a core competency framework for staff involved in collecting blood components for transfusion, which many NHS trusts have adopted.
Blood establishments and hospital blood banks are legally required to submit an annual compliance report to the Medicines and Healthcare products Regulatory Agency (2020), which monitors compliance with The Blood Safety and Quality Regulations 2005. Hospital blood transfusion laboratories are also required to provide evidence that they are complying with The Blood Safety and Quality Regulations 2005, which ensures that only staff who are trained and competent in blood component collection can participate in this procedure. This additional patient safety measure is a further positive contribution towards preventing ‘never events’. A never event is a serious incident that is entirely preventable if policies and procedures are followed in the delivery of safe care.
The blood collection procedure is a stage of the transfusion process where errors could potentially occur and result in a patient being exposed to potential or actual harm (NHS Improvement 2021). Therefore, the safety measures detailed in this article are crucial.
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