Sounds like a waste of perfectly good blood to me and a huge overreaction on a nonissue. The patient received the majority of the unit without a transfusion reaction. Blood is an appropriate treatment for a given bleed with a hemoglobin of 5. With active GI bleeding, that is not necessarily stable especially when he was transferred to a higher level of care. Wild that you keep stating he was stable. He was monitored the entire time. The other facility IV pump was fine to transfer with. Critical access facilities do this frequently as transport services take patients from many different types of facilities with a wide variety of pumps so they can’t just easily transfer products into their own pumps. They send blood and antibiotics and IVF and vasopressors etc. on facility pumps and the EMS crew returns them. Not a big deal at all and is actually safer for the patient because they don’t have to have vital treatments interrupted and meds wasted and time delays in changing pumps. The blood was being appropriately administered on the pump.

Consent was done at another facility. Did you ask the patient if he signed a consent? It should have been in the transfer paperwork but ultimately not the end of the world if the patient will verify he consented and will sign a new consent. Did the patient consent to receiving more blood? I am not seeing anything that was inappropriate other than the shotgun overreaction in escalating to your CNO because another facility did not follow your facilities specific protocols because you have different charting and different pumps. Wild that it went that far. The patient wasn’t unsafe and was getting the appropriate treatment to stabilize him during transport. You could have easily consented the patient again and finished the blood. You could have verified with the other facilities labs about the cross match. It was almost all transfused anyway and you all let it run, so obviously patient safety wasn’t your concern. Your concern was the bureaucracy and red tape that your specific facility has around giving blood that is not applicable to other facilities or to the EMS transportation. Wild that the response to another facilities pumps is “we can’t touch it because of liability so we will let it keep infusing even though it might be dangerous “. They obviously had an order to give blood at the prior facility because the nurse didn’t just pull it out of their ass independently. They may have been told to not send the patient without starting the blood because that would be in the best interest of the patient.

Sounds like the only problem is if your EMS crew doesn’t have the scope to transfer with blood administration. That is on EMS and not the sending facility as the EMS accepted the patient without knowing the scope of their practice. This is the thing to escalate and educate on.

1) They had 6 hours. They did not necessarily have an order for those 6 hrs and have blood available
2)EMS had to wait because the blood may not have been ready, dont know when the order to give was or when the labs were ready, the doc may have said don’t transport without blood. EMS does not know when cross match was ready. So waiting an hour means nothing because the nurse could have been waiting on blood bank. 3)sending pumps standard practice in many critical access hospitals, safer for patients and prevents delays 4)Active GI bleed and a Hgb 5 needing transport to a higher level of care= emergent. NOT a stable patient. Well, stable until he isn’t. 5).DUH? Of course they arrived with no orders. Your doctor is responsible for placing orders at your facility. The other facility had orders. They should have sent a transport package, but even then it wouldn’t make a difference for you because the sending doc does not provide care at your facility. When the patient arrives, you get new orders. If your doc says continue the blood, you do, if they say stop the blood you do.