AUDIT TOOL

Demographic data

1. Is the patient male  / female ?

2. What is the patient’s age at the time of transfusion? 
3. How many units were transfused at this episode?
4. Is it internal medicine consultant who manage the patient at the time of transfusion?
Yes  / No 
5. What was the final diagnosis(es) for admission?

Please provide the following information (use results nearest to before the date/time of
transfusion, but no earlier than 3 months before the date of transfusion)
1. MCV:
2. MCH:
3. Ferritin:
4. TIBC:
5. Fe:
6. TSH:
7. Coombs:
What was the patient’s Hb on admission? …
What was the date of this Hb result? …
What was the time of this Hb result? …

Transfusion episode
Date of transfusion: …
If possible, please supply the transfusion start time: …
What was the pre-transfusion Hb? … (this should be the Hb immediately or closest prior to the
patient being transfused)
What was the date of this Hb result? …
What was the time of this Hb result? …

What was the patient’s Hb after the transfusion episode? (this should be the first Hb done after
transfusion) …
What was the date of this Hb result? …
What was the time of this Hb result? …