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
TM
Oras Gold , Level 1, all modules
Date completed:
KSF Links: IK3 Level 2, HWB7 Level 3, HWB7 Level 4
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.
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
Perform preliminary checks to include:
 child/parent understanding and
agreement to transfusion
 suitable venous access
 suitably completed Blood Transfusion
Prescription Chart
Arrange collection of blood / blood
component:
 child minimum dataset given to
person collecting blood / blood
component
o family name and first name
o date of birth
Blood Administration Competency Assessment Form
Page 1 of 4
Version 6
Issued February 2013
Review date February 2015
Confirm that:
Assessment 1
Date:
Assessment 2
Date:
YES / NO
YES / NO
Comments
o hospital number
name and telephone number of
person requesting collection
 destination for blood / blood
component
 level of urgency
On receipt of blood / blood component
 blood / blood component checked to
ensure for correct child
 collection form completed and
returned to porter / sent to Blood
Transfusion
Check the component for suitability to
include:
 visual quality checks
 checking the unit number on the
compatibility label and blood
component bag are the same
 expiry date
 check blood group on component bag
are compatible with those of the child
 special requirements are met
At the bedside:
 check the child’s wristband or
alternative
 check prescription chart
 check child’s details are the same on
blood component bag, prescription
chart and pink form
 blood component connected to pump
/ syringe appropriately
 correct rate set
 recheck child’s wristband prior to
commencing transfusion
Complete traceability documentation
Return traceability information to the
transfusion laboratory

Observations:
Pre transfusion (up to 1 hr before
commencement) of each component:
 temperature
 pulse
 respiration
 blood pressure
15 minutes after commencement of
transfusion:
Blood Administration Competency Assessment Form
Page 2 of 4
Version 6
Issued February 2013
Review date February 2015
Confirm that:
Assessment 1
Date:
Assessment 2
Date:
YES / NO
YES / NO
Comments
 temperature
 pulse
 respiration
 blood pressure
On completion of transfusion:
 temperature
 pulse
 respiration
 blood pressure
Start and stop time, unit number recorded on
Blood Transfusion Prescription Chart and
observation 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., including compatibility and
special requirements
Yes / No
5. 30 minute rule once collected from appropriate storage
Yes / No
6. Bedside checking procedure
Yes / No
7. Legal requirements for traceability
Yes / No
8. Accurate documentation
Yes / No
9. Procedure for dealing with adverse reactions
Yes / No
10. Incident reporting procedure
Yes / No
Comments:
Blood Administration Competency Assessment Form
Page 3 of 4
Version 6
Issued February 2013
Review date February 2015
All the above criteria must be achieved to gain competency
If competency not gained:

Manager must give clear feedback

Re-assessment date to be arranged after further training, which must include
completing the Administration of Blood and Blood Components Competency
Assessment Workbook

Candidate assessed as competent

Candidate NOT competent, referred to complete the Administration of Blood and
Blood Components Competency Assessment Workbook
Signature of Assessor ………………………………………………..Date…………………….
Re-Assessment Date:

Candidate assessed as competent
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 Administration of
Blood and Blood Components Competency Assessment Workbook before signing
to indicate that you are competent.
For Office Use:
Education & Training Department notified
Yes / No
Specialist Practitioner of Transfusion notified
Yes / No
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 6
Issued February 2013
Review date February 2015