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Safe-Transfusion-Practice-Transfusion-Checklist-July-2020

This document provides a checklist for safe transfusion practice that outlines 9 key steps: 1) ensuring proper documentation and consent for transfusion, 2) completing pre-transfusion checks, 3) collecting the correct blood component, 4) administering the transfusion and monitoring for adverse reactions, 5) performing post-transfusion checks, 6) documenting the outcome, 7) using a decision tree to determine if transfusion is necessary, 8) following a 9-step transfusion process, and 9) emphasizing the importance of this checklist in improving transfusion safety. The checklist aims to ensure the right blood component is given to the right patient at the right time.

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Sol Diaz De Torres
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Download as PDF, TXT or read online on Scribd
91 views

Safe-Transfusion-Practice-Transfusion-Checklist-July-2020

This document provides a checklist for safe transfusion practice that outlines 9 key steps: 1) ensuring proper documentation and consent for transfusion, 2) completing pre-transfusion checks, 3) collecting the correct blood component, 4) administering the transfusion and monitoring for adverse reactions, 5) performing post-transfusion checks, 6) documenting the outcome, 7) using a decision tree to determine if transfusion is necessary, 8) following a 9-step transfusion process, and 9) emphasizing the importance of this checklist in improving transfusion safety. The checklist aims to ensure the right blood component is given to the right patient at the right time.

Uploaded by

Sol Diaz De Torres
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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Safe Transfusion Practice: Transfusion Checklist

Transfusion Request Signature to


Ensure that: confirm
The reason for transfusion is documented in the patient record
Details on the transfusion authorisation (prescription) sheet are completed and any specific
requirements documented
All fields on the transfusion request form are completed and the form is signed
The identity details on the transfusion sample are completed correctly and samples labelled at the
patient’s bedside. These must be handwritten unless electronic systems are available that generate and
print a label at the bedside from the patient ID band are available
The patient has (and where appropriate family/carers have) received information, has agreed to the
transfusion, and this is documented Or
In cases where the patient is unconscious and/or unable to consent and the blood component is given
in patient’s best interest, ensure this is documented in the patient’s notes, and information given
retrospectively
The laboratory is informed of the degree of urgency of the request
Pre-Transfusion Checks
Ensure that
There is adequate and satisfactory venous access: establish or verify patency of peripheral or central
venous access device
A formal pre-transfusion risk assessment for transfusion-associated circulatory overload (TACO) is
undertaken whenever possible (especially if older than 50 years or weighing less than
50kg), and appropriate preventative actions taken
The blood component is ready to be collected
Collection
Ensure that:
Documentation stating the patient identity details is correct and matches the details on the unit
You have the correct component as per the prescription or authorisation
The unit has the special requirements that are documented on the prescription or authorisation
The patient blood group matches or is compatible with the group of the unit
The unit is in date and is in good condition (i.e. no leaks/clots or discolouration)
The unit is signed for by a person trained and competency assessed in blood collection
The time the component was removed from temperature control (e.g. refrigerator) and received in the
clinical area are both recorded
Administration
Ensure that:
Pre-transfusion observations are taken and recorded within 60 before commencement
Temperature Blood pressure
Pulse Respiration rate
Documentation for the transfusion record is complete and accurate
The unit has the special requirements that are documented on the prescription or authorisation
You have the correct component as per the prescription or authorisation
The patient blood group matches or is compatible with the group of the unit
The correct blood transfusion administration set is used, (and a fresh set if transfusing platelets)
Pre-administration identification checks are performed at the bedside, including a check of the identity
band against the unit compatibility label. Confirm identity verification with the patient where possible,
using open ended questions
A blood warmer or infusion device (if used) is set correctly and monitored
Observations are carried out, as a minimum at 15 minutes
Temperature Blood pressure
Pulse Respiration rate
Any adverse events/complications are reported to the responsible clinician and the transfusion
laboratory, and are immediately acted upon and documented in the patient record and reported
The finish time of the transfusion is documented
The transfusion is completed within 4 hours of removal from temperature‐controlled storage
(Note that once thawed, FFP should be transfused as soon as possible. If delay is unavoidable, FFP
should be used within 4 hours if stored at 20–24 °C or within 24 hours if stored at 2–6 °C.
Cryoprecipitate, once thawed has to be kept at room temp and used within 4 hours)
Safe Transfusion Practice: Transfusion Checklist
Post Transfusion Signature to
Ensure that: confirm
Post-transfusion observations are taken and recorded
Temperature Blood pressure
Pulse Respiration rate
The traceability documentation record is completed and correctly returned or scanned electronically as,
as per local policy
The component pack and other equipment is disposed of correctly
The outcome of the transfusion is documented in the patient record
A post-transfusion information sheet given to the patient (if a day-case or received the transfusion in an
emergency)
The A-E Decision Tree to facilitate decision making in transfusion

•Assess patient
A •Any avoidable blood loss (frequent, unnecessary tests/interventions)

•Blood results (all) reviewed including trends - ensure results valid and reliable
•Best treatment option- is transfusion the best treatment option? If yes, what components needed, how many,
B what order and any specific requriements needed?

•Consent/Communication (adequate patient information- both verbal and written) to patients and where
appropriate families and carers
C •Correctable factors to be addressed like bleeding, haematinic deficiency

•Do not forget other measures (vitamin K, tranexamic acid, cell salvage, etc)
•Do not hesitate to question colleagues regarding decisions made and ask for rationale
D •Do not forget to document in patient's notes and in discharge summaries

•Ensure timely communications to laboratory- need to be clear, concise and accurate


•Ensure all relevant transfusion checklists including TACO risk assessment and actions rising thereafter have
been completed
E •Evidence based decisions made weighing risks, benefits and options available
•Ensure patient receives adequate post-transfusion information if transfusion given as a day case

Transfusion process (nine steps) This checklist has been updated in June 2020 and provides a
structured process to ensure that the right component is
transfused to the right patient at the right time for the right
reason and will help ensure patients have received the right
information about their transfusion in a timely manner where
possible. There is a lack of unequivocal evidence to support either
a one‐ or two‐person checking procedure. There is no evidence
from SHOT reports (Bolton‐Maggs, 2015) to suggest that two‐
person checking is safer than one. If local policy requires a two‐
person checking procedure, each person should complete all the
checks independently (double independent checking).The checklist
will help improve transfusion safety and is a requirement following
the CMO CAS alert sent out in November 2017:
CEM/CMO/2017/005 and can be found at this link:
https://www.cas.mhra.gov.uk/ViewandAcknowledgment/ViewAl
ert.aspx?AlertID=102663. We encourage users to utilise this
document to help draft checklists locally.

The NHSBT Patient Blood Management team and SHOT have co-
produced a ‘Pre-transfusion blood sampling’ animated video and
another outlining critical steps for completing ‘Pre-
administration bedside checks of blood components’. These can
be found here: https://www.shotuk.org/resources/current-
resources/videos/

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