ASSESSMENT CRITERIA FOR
BLOOD TRANSFUSION: ADMINISTRATION OF BLOOD AND BLOOD COMPONENTS
Name of Candidate
Name of Assessor
Band:
Band:
Job Title / Dept:
Job Title / Dept:
(Print details clearly in BLOCK capitals)
e-learning completed
YES / NO
Level 1: Safe Transfusion Practice for Paediatrics
Date completed:
Skills for Health National Workforce Competence CHS101/102/103
At least 1 observational assessment must be performed to assess candidate
competence. If there are any concerns or ‘no’ has been entered in any area of the
assessment process another observational assessment must be completed, and
repeated until fully competent. Please enter N/A if a section is not applicable to a
particular job role.
Observational assessment
Did the candidate meet the following criteria?
Confirm that:
Assessment 1
Date:
Assessment 2
Date:
YES / NO
YES / NO
Comments
The child to be transfused is wearing a
wristband or approved alternative. The
wristband contains:
 family name and first name
 date of birth
 hospital number (not PX number)
Perform preliminary checks to include:
 child/parent understanding and
consent to transfusion
 suitable venous access
 suitably completed Blood Transfusion
Prescription Chart (check with
anaesthetist if in theatres)
Arrange collection of blood / blood
component:
 Order via CARPS
 Print pick up slip using blood track
ward enquiry
 Ensure correct destination
 level of urgency
Blood Administration Competency Assessment Form
Page 1 of 4
Version 9
Issued February 2015
Review date February 2017
Confirm that:
Assessment 1
Date:
Assessment 2
Date:
YES / NO
YES / NO
Comments
If unable to print pick up slip complete
manual collection form on GosWeb:
Forms – Clinical - Pathology
On receipt of blood / blood component
 blood / blood component checked to
ensure for correct child
 blood arrived using blood tracking
device (sign and date pick up slip if
blood track unavailable).
Check the component for suitability to
include:
 visual quality checks
 use blood tracking device to perform
compatibility checks (begin
transfusion)
Always check :
 child’s details are the same on blood
component bag, prescription chart
and pink form (and consent form if in
theatres)
 the unit number on the compatibility
label and blood component bag are
the same
 blood group on component bag is
compatible with that of the child
 special requirements are met
If blood track unavailable:
 Perform High Risk Independent
double check
 check the child’s wristband or
alternative immediately prior to
starting transfusion
 Sign pink form and prescription.
 Complete red tag for traceability and
return to lab once transfusion is
running.
 Blood component connected to
appropriate giving set
 Correct ANTT technique used
 Infusion pump set up correctly to
include rate and volume to be infused
(rate/volume needs second check)
Observations: check and record on
observation chart (or anaesthetic chart until
patient moves to recovery if in theatre)
Pre transfusion (up to 1 hr before
commencement) of each component:
Blood Administration Competency Assessment Form
Page 2 of 4
Version 9
Issued February 2015
Review date February 2017
Confirm that:
Assessment 1
Date:
Assessment 2
Date:
YES / NO
YES / NO
Comments
 temperature
 pulse
 respiration
 blood pressure
15 minutes after commencement of
transfusion:
 temperature
 pulse
 respiration
 blood pressure
On completion of transfusion (up to 1hr after):
 temperature
 pulse
 respiration
 blood pressure
Perform end transfusion using blood tracking
device, enter volume transfused and note
whether any symptoms of transfusion
reaction.
If blood track unavailable record end time on
observation chart.
Unit number (peel off label from red tag)
recorded on Blood Transfusion Prescription
Chart (and anaesthetic chart – start and stop
time also annotated on anaesthetic chart)
Adverse reactions dealt with appropriately
Standard hand hygiene observed
Packs disposed of appropriately
Knowledge assessment
Date:
Did the candidate demonstrate an understanding of the importance of the following
points?
1. Importance of correct patient identification?
Yes / No
2. Suitable venous access availability prior to requesting collection
of blood / blood components?
Yes / No
3. Suitably completed Blood Transfusion Prescription chart, including
completion of special requirements and consent boxes
Yes / No
4. Pre transfusion check (blood track and manual), including compatibility and
special requirements
Blood Administration Competency Assessment Form
Page 3 of 4
Yes / No
Version 9
Issued February 2015
Review date February 2017
5. Action in event blood is not deemed suitable for the patient
Yes / No
6. Appropriate storage of components if not required
Yes / No
7. Bedside checking procedure
Yes / No
8. Legal requirements for traceability
Yes / No
9. Accurate documentation
Yes / No
9. Procedure for dealing with adverse reactions
Yes / No
10. Incident reporting procedure
Yes / No
Comments:
All the above criteria must be achieved to gain competency
If competency not gained:

Manager must give clear feedback

Retraining requirements must be determined

Re-assessment date to be arranged after further training, which must include
completing the Intravenous Workbook.

Candidate assessed as competent

Retraining and reassessment required.
Signature of Assessor ………………………………………………..Date…………………….
I agree that I have sufficient current knowledge and understanding of the Blood
Transfusion process and feel that I am competent to practice.
Signature of Candidate ……………………………………………….Date………………….…
If you feel that you do not have sufficient current knowledge and / or skill you
must discuss this with your line manager and complete the Intravenous Workbook
before signing to indicate that you are competent.
For Office Use:
Blood Administration Competency ‘Skill’ added to personal record on Trust Training Database
Yes / No
Checked by (Print name) ………………………………… Signature………………..……………..…………Date……………….
Blood Administration Competency Assessment Form
Page 4 of 4
Version 9
Issued February 2015
Review date February 2017