SKILLS LABORATORY CHECKLIST

Name Date
Course & Sec RLE Group

BLOOD TRANSFUSION
Correctly Incorrectly Not
Steps Remarks
Done Done Done

1. Verify the doctor’s written prescription for BT

2. Observe the twelve (12) Rights when preparing
and administering any blood components
3. Explain procedure/rationale to reassure the
patient and significant others
4. Secure consent.
5. Get patient histories regarding previous
transfusion
6. Explain the importance of the benefits on
voluntary blood donation(R.A7719-National blood
service act of 1994)
7. Request prescribed blood/blood components
from the blood bank.

8. Collect the prescribed blood from the blood bank

utilizing appropriate container.
9. Get the baseline vital signs- BP,RR and
Temperature before transfusion
10. Two (2) health care providers should countercheck
the necessary documents prior to blood
transfusion per hospital policy.
11. Give pre-med 30minutes before transfusion as
prescribed per hospital policy.
12. Prepare materials needed for BT
13. Do hand hygiene
14. Wear gloves
15. Main line is suggested to have Plain NSS during
blood transfusion for flushing and regulate to
keep vein open.
16. Disinfect the Y-injection port of IV tubing (plain
NSS)
17. Transfuse the prescribed blood.
18. Secure the tubing in applying appropriate taping
technique
19. Observe/ assess patient during and after the
transfusion procedure
20. After the transfusion, regulate the main line as
prescribed.
21. Discard blood bag and BT set and sharps
according to health care waste management
(DOH/DENR)
22. Do hand hygiene after procedure
23. If adverse reaction is noticed, fill-out adverse
reaction sheet as per institutional policy.
24. Document procedure and hand-off accordingly

Grade:
Rating Scale:

Excellent : 96-100 Good : 80-84

Very Satisfactory : 90-95 Fair : 75-79
Very Good : 85-89 Poor : 74 & below

Clinical Instructor

Signature over Printed Name