Introduction to Blood Transfusion Competencies
Blood transfusion is a complex multi-step process involving personnel from diverse
background with different levels of knowledge and understanding. In order to properly
and safely accomplish their role in transfusion each individual needs to be trained to the
appropriate level. This will very according to the particular task they need to perform as
part of the process. Regardless of professional background the essential common
element remains correct patient identification (ID) at every stage.
A requirement of compliance with the Blood Safety and Quality Regulations 20051,
which became UK law on 8th February 2005 is that all staff receive formal, documented
training in blood transfusion practice for distribution and traceability of blood and blood
components and in Adverse Event Reporting.
The information in these competencies has been formally risk assessed against the
competencies developed by the National Patient Safety Agency (NPSA) within their
Safer practice Notice (14) Right Patient, Right Blood2 which states:
“Formal assessment of the relevant competencies is required for nurses,
midwives, medical staff, phlebotomists, healthcare, assistants, porters, operating
department practitioners and other staff involved in blood transfusion process.”
The risk assessment confirms that these materials are fit for the purpose as stated
above.
Further information can be obtained from:
Specialist Practitioner of Transfusion
023 80 798910 Bleep 2463
Diana.agacy-cowell@suht.swest.nhs.uk.
The appropriate knowledge and
competencies can be found in:•
•
•
understanding
required
to
underpin
these
SUHT Blood Transfusion Policy
Trust Infection Control Policy
NMC Code of Professional Conduct
Additional References:
1. The Blood safety and Quality Regulations 2005 SI 2005/50
2. National Patient Safety Agency (NPSA) Safer Practice Notice, Right Patient,
Right Blood. http://www.npsa.nhs.uk/health/display?contentld=5298
3. NHS Knowledge and Skills Framework (KSF) October 2004
4. British Committee for Standards in Haematology (BCSH). The administration of
blood and blood components and the management of transfused patients.
Transfusion Medicine, 1999, 9, 227-238
5. www.transfusionguidelines.com
Disclaimer
The competency assessment is designed for use and deemed fit for purpose in its
current format. The authors are not responsible for any subsequent local modifications.
When using the competency assessment package it is the responsibility of the assessor
to ensure that the documents are current and in date.
The authors are not responsible for use of the training package or competency
assessments by unauthorised persons.
The record of competency relates to performance at the time of assessment and does
not guarantee future performance.
Blood Transfusion competency is linked to the Individual Learning Log. Once a
member of staff has been deemed competent a record of the evidence of competence
must be entered into the Individual Learning Log and reviewed at their annual
appraisal or development review (for medical staff the appropriate process for their
grade).
Page 2 of 26
Blood Transfusion key facts
When taking a sample, verbally check patient’s ID handwrite the bottle at the bedside
copying the patient’s details from the patient’s wristband. Blood Transfusion Laboratory
staff will reject all samples that are incorrectly labelled, illegible or have pre-printed
addressograph labels!
Before collecting or sending for a blood component carry out the pre-collection
checklist:
• Blood component is prescribed.
• If patient requires pre-medication to avoid a reaction.
• Is the venous access patent?
• Do the baseline observations.
4 points of patient identification is required to collect blood components; Forename,
surname, date of birth (DoB) and Hospital/NHS number. If the unit is being collected by
ward staff use check the patient’s Transfusion Record (peach coloured) to the patient’s
wristband and use Transfusion Record to collect the unit.
If the request for collection is to the Portering Dept. again all 4 points of patient
identification
Blood should only be stored in the blood fridge, never in a domestic or drug
fridge.
Remember that you must fill in the laboratory register when removing red cells from a
blood bank fridge. Put the date and time of removal and your initials along side the unit
number you are collecting. Red cells can be returned to the blood bank fridge within
30mins, the return must be recorded on the laboratory register. Red cells should only be
removed from the blood bank fridge if it is going to be used immediately. Blood is
precious and it is expensive, a donor has taken the time to give blood, we should
ensure that it is not wasted.
All blood components should be transported in the ‘Blood in Transit’ bags provided or in
blood boxes.
When administering a transfusion, the checking procedure should be carried out by two
qualified persons but separately (Individual checking).
Patients should be transfused in an area they can readily be observed, ensure
you give them a call bell.
The blood must be checked at the bedside. Firstly check the patient’s ID verbally,
check special requirements e.g. Irradiated, CMV negative. Check 14 digit donor number
on NHSBT label to 14 digit donor number on unit identity label, these should be the
same. Check the patient’s wristband, to the patient information printed on the unit
identity tag. If these are correct the transfusion can proceed.
The observations for a transfusion are as follows:
•
•
•
Baseline: Temp, pulse, blood pressure and respiratory rate
Repeat at 15mins from start of transfusion
End of the unit.
Page 3 of 26
Red cells should be transfused over 2hours, unless the patient is a high risk of
circulatory overload.
If the patient has a minor reaction, e.g. rash or pyrexia less than 1.5 degrees above the
baseline. Stop! The transfusion check it’s the correct blood, if it is treat symptoms. If the
symptoms subside or do not get any worse recommence transfusion but at a slower
rate, increase observations. Document in patients notes.
If the patient’s temperature continues to rise after giving paracetamol, treat as a severe
reaction. Stop! transfusion, Airway, Breathing, Circulation, send the unit of blood and
giving set to the lab, collect urine sample, blood cultures (if patient gets a temperature)
a cross-match sample, FBC sample, chemistry sample, coagulation sample and clotted
sample. See page 5 for further information.
ALWAYS REMEMBER, TRANSFUSION ERRORS ARE THE
BIGGEST RISK TO PATIENTS.
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Assessment Verification
Personal Staff Details
Name:
Ward/Dept
Job title:
Band/Grade:
Personal Staff Record
Competence
task
Date sent
for
verification
Key Skill Guidance
Date
Certified
as
competent
If a tick is place under your grade you may need to take
the corresponding competency task on the left.
Renewal
date
Porter
CS/
HCSW
StN
DR
RN/
RM/
Th P
ANAE
Organising the
receipt of
blood/blood
products
Collecting
blood/blood
products
Preparing to
administer
blood/blood
products to
patients and
administering a
transfusion of
blood/
Blood products.
Obtaining a
venous blood
sample.
Quick Guide
Staff Grade
Min competency
requirement key
Porter
Porter
Student Nurse
Registered Nurse/ Registered
Midwives/ /Theatre
practitioner
StN
Clinical Support Worker or
Health Care Support
Worker
Doctor
RN/Th P
Anaesthetist
Staff Grade
Min
competency
requirement
key
CS /HCSW
DR
ANAE
Mandatory Training Attendance Record
Date Attended
Update Due Date
Page 5 of 26
Authorizing Signature
Core blood competencies assessment framework
Assessment criteria for organising the receipt of blood/blood
products for transfusion
This framework is for assessing staff’s ability to organise the receipt of blood/blood products for
transfusion. Staff should be assessed after they have attended a local training course on this core task.
Further information and training materials can be found at: www.npsa.nhs.uk
This framework was developed by the National Patient Safety Agency (NPSA) to assess the core blood
transfusion competence, BDS17 Organise the receipt of blood/blood products for transfusion.
This workforce competence is linked to the Knowledge and Skills Framework dimensions
developed by Skills for Health. The dimensions are Communication, Health and Safety, and Health
and Well-being.
How to use this competence assessment framework
The framework should be completed whilst observing a member of staff organising the receipt of
blood/blood products for transfusion. It is available from the local blood transfusion lead in every trust and
is part of the NPSA’s Right patient, right blood initiative.
Please note that when the competence assessment framework is used to evaluate the competence of
porters, they do not have responsibility for verbal patient identification, and this aspect of the assessment
is not applicable to them.
It is important that the assessor informs the patient that the member of staff’s skills are being assessed as
part of a three-yearly process.
Page 6 of 26
Organising the receipt of blood/blood products for transfusion assessment
framework pro forma
Name of member of staff:
Name of assessor:
Job title/Band:
Job title:
Date of assessment:
Observational assessment
Core competency
1
Please put a tick or
cross to show
whether or not the
member of staff
completed the task
Notes for assessors
Confirm that the blood/blood product for
transfusion is ready for collection
Give a tick or cross for
each point separately
2a Patient identification check
Did the member of staff ask the patient to state
their:
a. Full name?
b. Date of birth?
Did the member of staff check:
c.
the detail provided with the information on the
Transfusion Record (TR)
d. match the information provided by the patient
to information on the wristband or other
attached identifier.
Page 7 of 26
2b Patient identification check
With an unconscious patient or those unable to
verbally comply, did the member of staff check:
a. the details on the wristband or other attached
identifier were correct?
b. the minimum dataset information of:
• full name?
• date of birth?
• hospital number or other
identification number?
3 Blood transfusion collection document:
Transfusion Record for ward staff/Porter task
sheet
Did the member of staff check the TR to the
patient’s wristband? Describe which points need
to be exactly the same:
a) the patient’s full name?
b) date of birth?
c) hospital or other identification number?
d) Instruct person collecting to initial, date and
time lab register?
.
4
Did the member of staff identify an
appropriate person to collect the blood/blood
products for transfusion and ensure:
a) there was clear communication about which
blood/blood products to collect?
b) there was clear communication about which
patient the blood/blood products is for? (Porter
collection)
c) there was verbal confirmation on where the
blood/blood product should be collected from?
d) there was verbal instruction on the procedure to
be carried out at the collection point?
5
Receipt of blood/blood products
Did the member of staff respond promptly to the
delivery of blood/blood products by:
a) checking that the details on the delivered
blood/blood products match the
Transfusion Record
b) ensuring that receipt of the blood was
documented with their signature, time and
date of receipt? (Porter delivery)
All of the above must be achieved to pass the assessment
Page 8 of 26
Knowledge assessment
Does the member of staff know and understand the importance of:
Using open-ended questions for patient identification?
Why information on the;
• Porter task sheet
• TR
must be complete?
The potential risks in the blood component collection process?
Why information should be cross-checked against the blood
compatibility form attached to the blood component at the point of
collection?
Page 9 of 26
Assessment Record for the receipt of Blood components/products
Assessor comments
Candidates comments
Assessor signature
Date
Print Name
Candidate signature
Date
Print Name
Having undertaken the above competency assessment the candidate achieved a:
PASS
REFERRAL
Please circle the appropriate action
If referred date for re-assessment
Page 10 of 26
Core blood competencies assessment framework
Assessment criteria for collecting blood/blood products for
transfusion
This framework is for assessing staff’s ability to collect blood/blood products for
transfusion. Staff should be assessed after they have attended a local training course
on this core task.
Further information and training materials can be found at: www.npsa.nhs.uk
This framework was developed by the National Patient Safety Agency (NPSA) to
assess the core blood transfusion competency, BDS18 Collect blood/blood products for
transfusion.
This workforce competence is linked to the Knowledge and Skills Framework
dimensions developed by Skills for Health (2004).
Core 5 Quality
Level 1; Indicators: a, b, c, d, e
EF3 Transport and logistics
Level 1; Indicators: a, b, c, d, e
How to use this competence assessment framework
The framework should be completed whilst observing a member of staff who is
collecting blood/blood products for transfusion. It is available from the local blood
transfusion lead in every trust and is part of the NPSA’s Right patient, right blood
initiative.
It is important that the assessor informs the patient that the member of staff’s skills are
being assessed as part of a three-yearly process.
Page 11 of 26
Collecting blood/blood products for transfusion assessment
framework pro forma
Name of member of staff:
Name of assessor:
Job title/Band:
Job title:
Date of assessment:
Observational assessment
Core competency
Please put a tick or a
cross to show
whether or not the
member of staff
completed the task
1 Did the member of staff demonstrate
effective use of health and safety measures
by:
a) washing their hands or using alcohol gel
b) using personal protective equipment?
c) adhering to other infection control
procedures?
2 Documentation taken to the issue fridge
or BT laboratory – Transfusion record/porter
task sheet – contains required identifiers
•
•
•
•
Forename
Surname
DOB
Hospital no/NHS no.
3 Match details on the written/typed
documentation with the patient information
on the issue bank register and compatibility
label attached to unit.
4 Full documentation is completed to include
• Date of removal
• Time of removal
• Signature & initial
5 Take units immediately to the clinical area
and according to local transport
requirements.
Page 12 of 26
Notes for assessors
Give a tick or cross for
each point separately.
6
Hand unit to appropriate member of staff
a) Obtain a record of receipt to include the
date, time and signature of member of
staff
b) (where an electronic tracking system is in
place) demonstrating that they know how
to maintain a secure ID throughout and
showing this by scanning in and out
correctly?
7 RETURNING BLOOD COMPONENTS
•
•
•
Date of return
Time of return
Signature & Initial
All of the above must be achieved to pass the assessment
Page 13 of 26
Knowledge assessment
Did the candidate demonstrate an understand of the importance of the following
points:
Right blood – Right patient
Action to take if blood is not in the fridge.
Following correct transport procedures
Leaving blood unattended
Following correct procedure for return of blood and components
Transfer to satellite fridge ( if not observed)
Page 14 of 26
Assessment Record collecting of Blood components/products
Assessor comments
Candidates comments
Assessor signature
Date
Print Name
Candidate signature
Date
Print Name
Having undertaken the above competency assessment the candidate achieved a:
PASS
REFERRAL
Please circle the appropriate action
If referred date for re-assessment
Page 15 of 26
Core blood competencies assessment framework
Assessment criteria for preparing to administer blood/blood
products to patients and administering a transfusion of
blood/blood products
This framework is for assessing staff’s ability to prepare and administer blood/blood products
to a patient. Staff should be assessed after they have attended a local training course on this
core task.
Further information and training materials can be found at: www.npsa.nhs.uk
This framework was developed by the National Patient Safety Agency (NPSA) to assess the
core blood transfusion competencies, BDS19 Prepare to administer blood/blood products to
patients and BDS20 Administer a transfusion of blood/blood products.
This workforce competence is linked to the Knowledge and Skills Framework
dimensions developed by Skills for Health. The dimensions are Communication, Health
and Safety, and Health and Well-being.
Core 5 Quality
Level 1; Indicators: a, b, c, d, e
HWB7 Interventions and treatments
Level 1; Indicators: a, b, c, d, e
How to use this competence assessment framework
The framework should be completed whilst observing a member of staff who is involved in
preparing and administering blood and/or blood products. It is available from the local blood
transfusion lead in every trust and is part of the NPSA’s Right patient, right blood initiative.
It is important that the assessor informs the patient that the member of staff’s skills are being
assessed as part of a three-yearly process.
Page 16 of 26
Preparing and administering a transfusion of blood/blood products
assessment framework pro forma
Name of member of staff:
Name of assessor:
Job title/Band:
Job title:
Date of assessment:
Observational assessment
Core competency
Please put a tick or
cross to show
whether or not the
member of staff
completed the task
Did the member of staff carry out the four
types of pre-transfusion checks
correctly:
1
a)
b)
c)
d)
personal?
equipment?
patient?
blood component?
a) personal: clean hands, wear personal
protective equipment and adhere to
infection control guidelines at all times
b) equipment: check that all equipment is
clean and available (i.e. Transfusion
Record, giving set, disposable bags and
a trolley)
c) patient: prior to blood being collected
from the fridge; carry out a baseline
assessment of the patient; check venous
access has been obtained; read through
the prescription; and check that the
patient understands they are going to
receive a transfusion,
d) blood component: check the quality of
the blood product, expiry dates, and any
special transfusion requirements
Page 17 of 26
Notes for assessors
Give a tick or cross for
each point separately.
2 Patient identification for the conscious
patient
Did the member of staff ask the patient to
state their:
a) full name?
b) date of birth?
Did the member of staff check:
c) the details on the wristband or other
attached identifier were correct?
3 Patient identification for unconscious
patients or patients unable to verbally
respond:
Did the member of staff check:
a) the details on the wristband or other
attached identifier:
full name?
date of birth?
hospital number?
b) To the information on the blood or blood
product?
4 Did the member of staff record the
patient’s
vital signs?
a)
b)
c)
d)
5
blood pressure?
temperature?
pulse rate?
resp rate?
Administering the blood transfusion
Did the member of staff ensure that the
blood transfusion was:
a) completed within four hours of it leaving
the fridge, OR
b) within 30 minutes for platelets & Fresh
Frozen Plasma?
Did the member of staff
c) record the patient’s vital signs prior to
starting the transfusion?
d) monitor the patient’s vital signs 15
minutes after starting the transfusion?
e) dispose of equipment safely?
f) monitor the patient’s vital signs on
completion of the blood transfusion?
Page 18 of 26
6
Documentation
Did the member of staff record the following
information in the patient’s notes:
a) date?
b) start time?
c) stop time of the transfusion?
Did the member of staff:
d) complete the traceability documentation
in accordance with national law?
All of the above must be achieved to pass the assessment
Knowledge assessment
Does the member of staff know and understand the importance of:
Using open-ended questions for patient identification?
The timescales for administering blood and/or blood product safely after it had
been collected from the fridge?
Correct procedure if unconscious patient or unable to give verbal identification?
The risks associated with checking the blood compatibility form against the
blood product instead of the information on the wristband?
Monitoring the patient’s vital signs throughout the transfusion process?
Page 19 of 26
Assessment Record for Administration of Blood and Blood Components
Assessor comments
Candidate comments
Assessor signature
Date
Print Name
Candidate signature
Date
Print Name
Having undertaken the above competency assessment the candidate achieved a:
PASS
REFERRAL
Please circle the appropriate action
If referred date for re-assessment
Page 20 of 26
Core blood competencies assessment framework
Assessment criteria for obtaining a
venous blood sample
This framework is for assessing staff’s ability to obtain a venous blood sample. Staff
should be assessed after they have attended a local training course on this core task.
Further information and training materials can be found at: www.npsa.nhs.uk
This framework was developed by the National Patient Safety Agency (NPSA) to assess
the core blood transfusion competence, Obtain a venous blood sample.
This workforce competence is linked to the Knowledge and Skills Framework
dimensions developed by Skills for Health. The dimensions are Communication,
Health and Safety, and Health and Well-being.
Core 5 Quality
Level 1; Indicators: a, b, c, d, e
HWB6 Assessment and treatment planning
Level 1; Indicators: a, b, c, d, e
HWB8 Biomedical investigation and intervention
Level 1: Indicators: b, e
How to use this competence assessment framework
The framework should be completed whilst observing a member of staff obtaining a
venous blood sample. It is available from the local blood transfusion lead in every trust
and is part of the NPSA’s Right patient, right blood initiative.
It is important that the assessor informs the patient that the member of staff’s skills are
being assessed as part of a three-yearly process.
Page 21 of 26
Obtaining a venous blood sample assessment framework pro forma
Name of member of staff:
Name of assessor:
Job title/band:
Job title:
Date of assessment:
Observational assessment
Core competency
Please put a tick or a
cross to show
whether or not the
member of staff
completed the task
1 Did the member of staff check for each of
the following on the request form:
Notes for assessors
Give a tick or cross for
each point separately
a) full name?
b) date of birth?
c) hospital number?
Did the member of staff:
d) sign and write their contact details to
show who had taken the sample?
e) print their name to show who had taken
the blood sample?
.
2
Did the member of staff bleed only one
patient at a time?
3a Patient identification for conscious
patient
Did the member of staff ask the patient to
state their:
a) full name?
b) date of birth?
Did the member of staff check:
c) details on the wristband or other
attached identifier?
d) The information on the wristband against
that on the request card?
Page 22 of 26
Give a tick or cross for
each point.
3b Patient identification for unconscious
patient
or patient unable to verbally respond
Did the member of staff check details on the
wristband or other attached identifier?
a) full name?
b) date of birth?
c) hospital number?
Did the member of staff check the
information on the wristband with the
transfusion request card and to at least
another patient document e.g. Prescription
Drug Transfusion Record?
Can the member of staff describe the trust’s
policy for identifying unconscious patients?
4
Personal checks
Did the member of staff wash their hands?
Did the member of staff use personal
protective equipment?
5
Taking the venous blood sample
Did the member of staff:
a) prepare the skin properly?
b) use the tourniquet (disposable)
appropriately?
c) minimise discomfort for the patient?
d) take blood appropriately if a transfusion
is being carried out alongside other
sampling procedures?
e) monitor the patient’s responses?
f) remove needles using an appropriate
technique?
g) apply a dressing at the end of the
procedure?
If the last two questions are not applicable to
the patient from whom the sample has been
taken, can the member of staff say what they
would do in these circumstances?
Page 23 of 26
6
Labelling the venous blood sample
Did the member of staff label the venous
blood sample as soon as it was taken before
leaving the patient’s side?
Does the label include the following
information:
a) full name?
b) date of birth?
c) hospital number?
d) gender?
e) date?
f) the member of staff’s signature and
contact details?
7
Packaging and documentation
Did the member of staff take the blood
sample to the correct collection point?
If the sample was urgent were the
appropriate steps followed as per Blood
Transfusion policy
Did the member of staff record the following
information in the patient’s notes:
a) why the sample had been taken?
b) when the sample was taken?
c) who took the sample?
All of the above must be achieved to pass the assessment
Page 24 of 26
Knowledge assessment
Does the member of staff know and understand the importance of:
using open-ended questions for identifying patients?
not using pre-labelling bottles?
correct procedure if patient is unconscious or unable to give verbal
identification?
the risks created if more than one patient is bled at a time?
correct action to take if the information identifying a patient is missing?
Page 25 of 26
Assessment Record for obtaining a venous blood sample
Assessor comments
Candidates comments
Assessor signature
Date
Print Name
Candidate signature
Date
Print Name
Having undertaken the above competency assessment the candidate achieved a:
PASS
REFERRAL
Please circle the appropriate action
If referred date for re-assessment
Page 26 of 26