Can Nurse Practitioners Order Blood Products
The following question was submitted to the experts on the CBBS panel.
Is it permissible for a Registered Nurse Practitioner (RNP) to order blood products for transfusion in the state of California? Please cite the specific regulation in your response if possible.
The following answers have been submitted
in response to the posed question. These opinions are paraphrased and are
being presented without attribution. They do not represent an official
opinion or position of the CBBS.
- One panelist stated that according to the AABB Standards (18th edition, J7.000) "Transfusions must be prescribed and administered under medical direction". In California, as elsewhere, blood products are considered a prescription drug. This panelist was not unaware of any special exemption to the requirement that a physician order must order a blood product transfusion.
- A second panelist, however, pointed out that nurses are able to order blood for transfusion under specifically worded regulations regarding "Standardized Procedures." Policy statements of the Board of Registered Nursing state, "Standardized Procedures are authorized in the Business and Profession Code, Nursing Practice Act (NPA) Section 2725 and further clarified in California Code of Regulation (CCR 1480). Standardized procedures are the legal mechanism for registered nurses, nurse practitioners to perform functions that would otherwise be considered the practice of medicine. Standardized procedures must be developed cooperatively by nursing, medicine, and administration in the organized health care system where they will be utilized. A registered nurse or nurse practitioner may perform standardized procedure functions only under the conditions specified in a health care system's standardized procedure; and must provide the system with satisfactory evidence that the nurse meets its experience, training, and/or education requirements to perform the functions."The panelist did admit that it is not an easy matter to develop a "Standardized Procedure." At the panelist's institution they have approval for one nurse in hematology/oncology and 5 or 6 nurses in the neonatal intensive care unit. Finally, this panelist commented that a person who may be able to provide additional details regarding the appropriate mechanism for developing relevant "Standardized Procedures".
The panelist is Alice Takahashi, MS, RN, Nursing Education Consultant, California Board of Registered Nursing. Ms. Takahashi provides educational seminars on this topic. The telephone number of the California Board of Registered Nursing is (916) 322-3350.
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