OUR LADY OF FATIMA UNIVERSITY

College of Nursing – Valenzuela City

PROGRAM Bachelor of Science in Nursing STUDENT NAME

YEAR & SECTION

NCMA113 FUNDAMENTALS OF NURSING
COURSE INSTRUCTOR
(SKILLS LABORATORY)
DATE
PROCEDURE : ADMINISTERING BLOOD TRANSFUSION
EXPECTED OUTCOME : The student should be able to administer blood transfusion correctly
ASSESSMENT TASK : Return Demonstration

Exceptional Good Average Poor

Assessment Dimension SCORE
(3) (2) (1) (0)
1. Verified the Verified the Verified the Failed to verify
Verify the written order for the doctor’s order doctor’s order doctor’s order the doctor’s
transfusion properly and with minimal improperly and order.
accurately. error. inaccurately.
Greeted and Greeted and Greeted and Failed to greet
identified patient performed the performed one and identify
2. by asking his/her two (2) ways of (1) way of patient.
Greet and identify the patient. name and checking identifying identifying
his/her ID band patient. patient.
politely.
Explained Explained Explained Failed to
procedure to the procedure but procedure but in explain
client clearly and lacks details. an unclear procedure and
3.
completely with Started IV line. manner but started IV line.
Explain the procedure. Start IV
client’s approval started an IV
line if necessary.
and started an IV line.
line.
Observed Consent signing Consent signing Consent signing
4. principles of was done with was done with not done.
Have the client sign the autonomy and let minimal errors. maximal errors.
consent forms. the patient signed
the consent.
Performed the step Performed the Performed the Failed to
5. with ease. step with little step with some perform the
Obtain baseline vital signs. errors. errors. procedure.
Performed the step Performed the Performed the Failed to
6. with ease. step with little step with some perform the
Obtain the blood product from errors. errors. procedure.
the blood bank within 30
minutes of initiation.
7. Performed the pro- Performed the Performed the Failed to
Verify the blood product and cedures with ease. procedures with procedures with perform the
the client with another nurse. little errors. some errors. procedure.
7.1. Client’s name, blood
group, RH type.
7.2. Cross match compatibility.
7.3. Client’s name, blood
group, RH type.
7.4. Unit and hospital number
7.5. Expiration date and time
on blood bag.
7.6. Type of blood product
compared with written order.
7.7. Presence of clots in blood
Observed Hand washing Hand washing Hand washing
 principles of was done with was done with and gloving was
8. medical hand minimal errors maximal errors not done.
Wash hands and put on gloves washing and don but perfectly but perfectly
gloving. don gloving. don gloving.
Performed the step Performed the Performed the Failed to
9. with ease. step with little step with some perform the
Open blood administration kit errors. errors. procedure.
and close roller clamps
10. Performed all the Performed all Performed all Failed to
For Y-tubing set. steps with ease. the steps with the steps with perform the
10.1. Spike the normal saline little errors. some errors. procedures.
bag and prime the tubing
between the saline bag and
the filter.
10.2. Squeeze the sides of drip
chamber and allow filter to
partially fill.
10.3. Open lower roller clamp
and prime tubing to the hub.
10.4. Close lower clamp.
10.5. Invert blood bag once or
twice. Spike blood bag, open
clamps and fill tubing
completely, covering the filter
with blood.
10.6. Close lower clamp
11. Performed all the Performed all Performed all Failed to
For single tubing set. steps with ease. the steps with the steps with perform the
11.1. Spike blood unit using little errors. some errors. procedures.
filter tubing.
11.2. Squeeze drip chamber
and the filter filled with blood.
11.3. Piggyback a saline into
the blood administration
tubing.
11.4. Secure all connections
with tape.
12. Performed the step Performed the Performed the Failed to
Attach tubing to venous with ease. step with little step with some perform the
catheter aseptically and open errors. errors. procedure.
clamps on blood tubing. Infuse
the blood product at the
ordered rate.
13. Performed the step Performed the Performed the Failed to
Remain with client for the first with ease. step with little step with some perform the
15-30 minutes, monitoring errors. errors. procedure.
vital signs frequently according
to institutional policy.
14. Performed the step Performed the Performed the Failed to
After blood has infused, flush with ease. step with little step with some perform the
the tubing with normal saline. errors. errors. procedure.
Washed hands and Washed hands Washed hands Washed hands
documented the and some of the but most of the but
15.
information about details of details of documentation
Wash hands and
the procedure procedure were procedure were was not done.
documentation
properly and not not
completely. documented. documented.

OVERALL SCORE: ______________

Target Raw Score: 34 out of 45. If raw score is less than 34, repeat the return demonstration.

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FACULTY SIGNATURE OVER PRINTED NAME