Pre-transfusion sampling competency assessment guidance

We are required, as a Health Board, to ensure that all staff involved in the
transfusion process are assessed for competency.

Each year, SHOT (Serious Hazards of Transfusion)1 reports show that errors
continue to occur at all stages of the transfusion process, and that these errors
are preventable.

The standards for the pre-transfusion assessment are the minimum required for
safe practice, and are aimed at reducing error in this part of the transfusion
process. The assessments have been developed by the Education Sub Group of
the Blood Implementation Group (part of the Welsh Assembly Government Blood
Advisory Structure). They are a requirement of the Blood Safety and Quality
Regulations (2005)2 and the National Patient Safety Agency (NPSA) Safer
Practice Notice (14)3.

The assessment is scenario based, followed by supplementary questions. You

will be assessed by a nominated assessor or the Transfusion Practitioner.
Candidates will then be deemed as competent, or not competent (further training
will then be provided, and a date given for re-assessment).
The assessment when passed is valid for 3 years and transferable between
Health Boards.
Records will be kept by the Transfusion Practitioner, and you will receive a
certificate.

Regardless of professional background, the essential common element remains

correct patient identification at every stage.

1. Complete the request form

Safest practice is that the patient details are completed on the request form
before you take the sample, and that you then use the form to correctly
identify the patient. Patient details may be handwritten or addressographs may
be used.

• Full name
• Date of birth
• Address
• Hospital No
• Gender
• Printed name, signature of the person making the request with contact
details (bleep no) and date

Other required details on the form are:

• Ward/location
• Consultant
• Clinical details (Please enter in box headed ‘reason for transfusion’)
• Test required
• Reason for transfusion if units requested
• Any special requirements
• Number of units required if cross match requested and when required

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2. Prevent the event
Basic principle – bleed only one patient at a time.
Bleeding more than one patient at a time can result in wrong blood in tube, due to
samples being mixed up.

3. Patient identification
Inpatients
Must be done at the bedside.
Obtain verbal identification by asking the conscious patient to state their:
a. Full name
b. DOB
c. Address
Do not use closed questions (e.g. are you Mrs Jones – patients may answer yes
or no incorrectly because they are anxious/in pain/hard of hearing etc). Open-
ended questions must be used as the patient has to state their own identity
details which can then be checked against the documentation.
Where the patient is unconscious or otherwise unable to provide verbal
identification, i.e. neonates, children, confused etc. a relative/carer or responsible
person can be asked to verify ID.
Match verbal details given with the patient’s wristband that will include the
minimum information of:
a. Full Name
b. DOB
c. Hospital No
d. 1st line address
Check that verbal/wristband details match exactly the details on the request
form.
If the patient does not have an ID band on, inform ward staff, do not bleed until an
ID band is applied.
Bleeding without a wristband could result in wrong blood in tube.
Outpatients - It is unlikely that a patient identity band will be worn. If an out-
patient is unable to provide verbal ID, check the details with a relative/carer or
responsible person, and document that you have done so.

Positive Patient Identification section on request form MUST be completed

by sampler, with printed name, signature, bleep no, time and date sample
taken. Failure to complete this section will result in sample rejection.

4. Labelling the tube

Minimum LEGIBLE labelling is:
a. Full name
b. Date of Birth
c. 1st line of address
d. Hospital No
e. Ward, time, date and signature
MUST be handwritten at the patient’s side. Details MUST match exactly those
on the request form.
NO ADDRESSOGRAPHS.
DO NOT pre-label tubes.
If you pre-label a tube or do not complete it at the bedside, there is again the risk
of wrong blood in tube.

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Please use ballpoint, not ink, pens to write on the tube. Ink can smudge when put
into sample pouch, making it illegible.

Wrong blood in tube can result in a patient receiving an incompatible blood

transfusion which could be fatal.
ZERO TOLERANCE
Non compliance with sampling policy will result in rejection of the sample. This
will inevitably cause delay and further venepuncture will be required. This will
ultimately impact on patient care.
1st line of address is an extra requirement for patient identification in
Wales. This is due to a higher percentage of the population with same/similar
names
All non compliances are documented in the transfusion department and the
sampler may then be subject to further training/assessment

All transfusion errors are avoidable. Best Practice can be achieved by

 Following guidelines
 Being aware of relevant policies and protocols
 Reporting errors
 Sharing experiences

References:
1. Serious Hazards of Transfusion (SHOT)– www.shotuk.org
2. The Blood Safety and Quality Regulations 2005 SI 2005/50
3. National Patient safety Agency (NPSA) Safer Practice Notice: Right
Patient, Right Blood. - http://www.npsa.nhs.uk/health/display?
contentld=5298

Further Reading and Sources of Information

 ABC of Transfusion, Contreras, M BMJ Publishing Group, 1996,
3rd Edition
 Handbook of Transfusion Medicine, McLelland, DBL HMSO, 2007,
4th Edition (available to download from intranet, see below)
 Practical Transfusion Medicine, Michael F Murphy and Derwood H
Pamphilon Blackwell Science, 2005, 2nd Edition
 Trust Transfusion Policy
 Welsh Health Circular 2007, 042 Blood Transfusion Procedures

Useful Websites
www.bcshguidelines.com – British Committee for Standards in Haematology
www.blood.co.uk – National Blood Service
www.welsh-blood.org.uk – Welsh Blood Service
www.transfusionguidelines.org.uk – UK Blood Transfusion and Tissue
Transplantation Guidelines
www.learnbloodtransfusion.org.uk – free e-learning package
www.shotuk.org - Serious Hazards of Transfusion (SHOT)

Advice and information can always be sought from the Transfusion Department,
or the Transfusion Practitioner