Lloyd Bennett is a 76-year-old male who was admitted through the Emergency Department 2 days ago with a femoral head fracture sustained in a fall outdoors and underwent left hip arthroplasty. All drains have been removed. Provider changed the dressing this morning, and the dressing is currently clean, dry, and intact. Patient has complained of fatigue with physical therapy and does not tolerate changes in position without dizziness. Complete blood count this morning identified hemoglobin of 7 g/dL. The provider has ordered two units of packed red blood cells to be given. The lab has called and the first unit is ready.

1.   How did the scenario make you feel?

2.   Prior to blood administration, what assessments of the blood product and the patient are required to promote safe delivery and lessen potential complications?

3.   What signs and symptoms first indicated the patient was having a transfusion reaction?

4.   Review the immediate priorities when a transfusion reaction occurs and the rationale for each.

5.   What key elements would you include in the handoff report for this patient? Consider the SBAR (situation, background, assessment, recommendation) format.

6.   What follow-up blood work may be required?

7.   What follow-up disclosure is required with Lloyd Bennett and his family?

8.   What would you do differently if you were to repeat this scenario? How would your patient care change?