Transfusion medicine handbook

3. Guide to Good Transfusion Practice

3.2 Prescribing Blood Components and Fractionated Products

Prescribing blood components and fractionated products is normally the responsibility of a registered medical practitioner or mātanga tapuhi nurse practitioner. Registered midwives are authorised prescribers, as defined by the Medicines Amendment Regulations 2011, and, in accordance with their scope of practice, as defined by the Midwifery Council. For example, registered midwives are able to prescribe medicines during pregnancy, labour and the post-partum period up to six weeks, to facilitate births and to provide care for the newborn. This does not include prescribing of medicines for the treatment of underlying conditions.

Decisions to transfuse should, taking individual patient needs into account, be based on international and regional guidelines such as Patient Blood Management Guidelines | National Blood Authority (nba.gov.au)

It is the responsibility of the authorised prescriber to ensure that transfusion therapy is given only when clinically indicated and that the patient is appropriately monitored before, during and after the transfusion procedure.

The following questions should be taken into consideration when deciding to transfuse:

• What improvement in the patient’s condition am I aiming to achieve?
• Can I minimise blood loss to reduce the patient’s need for transfusion?
• Are there any other treatments I should give before making the decision to transfuse?
• What are the specific indications for transfusing this patient?
• Do the benefits of transfusion outweigh the risks to this particular patient?
• Has the patient been given a clear explanation of the potential risks and benefits of blood transfusion therapy in their particular case?

Once the decision to transfuse has been made it is also important to consider the following:

• Have I documented my decision to transfuse and the reasons for transfusion in the patient’s clinical records and completed any documentation used in the ordering or administration of blood components or fractionated products?
• Will a trained person monitor this patient and respond immediately if any acute transfusion reactions occur?
• Has crossmatching and other relevant testing been carried out?
• Does the patient have patent venous access?

Prescribing Unapproved Pharmaceuticals

Authorised prescribers should, where possible, prescribe pharmaceuticals that are approved under the Medicines Act 1981. If authorised prescribers intend to use an unapproved pharmaceutical or a pharmaceutical for an indication for which it is not approved, they should:

a) be aware of and comply with their obligations under Section 29 of the Medicines Act 1981 and otherwise under that Act and the Medicines Regulations 1984;

b) be aware of and comply with their obligations under the Health and Disability Commissioner’s Code of Consumer Rights, including the requirement to obtain informed consent from the patient; and

c) exercise their own skill, judgement, expertise and discretion, and make their own prescribing decisions with respect to the use of an unapproved pharmaceutical or a pharmaceutical for an indication for which it is not approved.

d) Where medicines, supplied under Section 29 of the Medicines Act, are used for emergency situations, the required patient details may be retrospectively provided to the supplier.