Information

  • Conducted on

  • Unit Location

  • Patient MR. Number

  • Staff Name

  • Prepared by

Compliance Area

  • Signed, witnessed, dated and timed blood consent form in chart. <br>* Correct Answer:<br> Exception to requirement for consent if transfusion was for emergency use.

  • Order in chart for blood product and number of products.<br>* No exceptions.

  • Blood product type administered matches order.<br>* Order in Sunrise matches documentation of the type of blood product administered in EMR.

  • Prior to transfusion, pt. information and correct blood product verified by and cosigned by 2 licensed professionals on the Blood Product Requisition From, one of whom MUST be the person administering the blood.<br><br>* Verification can be done by the RN, MD, dentist, NP, PA, technologist, nurse midwife, nurse anesthetist, RT who also does ECMO, perfusionist, critical care tech (CCT), or medical students who have completed 2nd year.

  • Blood Product Requisition Form remains attached to unit until transfusion is complete.<br>* Direct observation or interview only.

Transfusion start time documented:

  • On Blood Product Requisition Form

  • In Sunrise clinical documentation system

Vital signs documented in Sunrise EMR: * Mark N/A for rapidly transfused blood (e.g., Level 1 infusor).

  • Before Transfusion started

  • After 15 minutes

  • At completion of infusion

Transfusion ending documented:

  • On Blood Product Requisition Form

  • In Sunrise clinical documentation system

Total volume documented:

  • In Sunrise clinical documentation system (e.g., I&Os)

  • Blood Product Requisition Form (only required for outpatient and Oncology areas)

  • There is a Blood Product Requisition Form in the paper chart for every documented unit of blood product given while on the inpatient unit.<br>* If patient has more than 5 units of blood product given, audit for the first 5 products given.

  • If any adverse reaction occurred, it is documented and reported.

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. Any ratings or scores displayed in our Public Library have not been verified by SafetyCulture for accuracy. Users of our platform may provide a rating or score that is incorrect or misleading. You should independently determine whether the template is suitable for your circumstances. You can use our Public Library to search based on criteria such as industry and subject matter. Search results are based on their relevance to your search and other criteria. We may feature checklists based on subject matters we think may be of interest to our customers.