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Blood Station Assessment Tool 2020
Blood Station Assessment Tool 2020
Department of Health
HEALTH FACILITIES AND SERVICES REGULATORY BUREAU
1. Check to make sure that you have the complete tool with a total of ------- pages with annex A------ that serve as reference for Equipment, Reagents & Supplies per Category.
2. If the corresponding items are present, available or adequate, place on of the appropriate spaces under the FINDINGS column or space provided alongside each corresponding item.
If not, put an X instead.
3. The REMARKS column shall document relevant observations for Quality Improvement.
4. Make sure to fill-in the blanks with the needed information. Do not leave any items blank; write (N/A) not applicable or ---if needed.
5. (Shaded cell) means that specific items are not applicable to the BSF category. With (*) asterisk-policies incorporated in One Stop Shop facility are acceptable.
GENERAL INFORMATION:
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Blood Blood Blood Hospital Hospital Blood Remarks
Station Collection Station / Blood Blood Center
STANDARDS AND REQUIREMENTS (BS) Unit Blood Bank Bank with (BC)
(BCU) Collection (HBB) Additional
Unit Functions
(BS/BCU) (HBB++)
Application Documents
1. MANAGEMENT REQUIREMENTS
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Blood Blood Blood Hospital Hospital Blood Remarks
Station Collection Station / Blood Blood Center
STANDARDS AND REQUIREMENTS (BS) Unit Blood Bank Bank with (BC)
(BCU) Collection (HBB) Additional
Unit Functions
(BS/BCU) (HBB++)
1.2.4.1.2. Resume
1.2.4.1.3. Notarized Contract of Employment or Service
Contract Agreement
1.2.4.1.4. Job Description
1.2.4.1.5. Training Certificate on Laboratory Management
and Transfusion Medicine
1.3.6 The Blood Service Facility shall designate and train one
(1) Registered Medical Technologist as a Quality
Assurance Officer. Such training shall be recognized
by the DOH.
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Blood Blood Blood Hospital Hospital Blood Remarks
Station Collection Station / Blood Blood Center
STANDARDS AND REQUIREMENTS (BS) Unit Blood Bank Bank with (BC)
(BCU) Collection (HBB) Additional
Unit Functions
(BS/BCU) (HBB++)
1.3.9 Each Staff member shall read and sign his Duties and
responsibilities
1.4.1 The Blood Service Facility has adequate space for the
conduct of its activities.
1.4.1.1 Ocular inspection demonstrates adequate space for
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Blood Blood Blood Hospital Hospital Blood Remarks
Station Collection Station / Blood Blood Center
STANDARDS AND REQUIREMENTS (BS) Unit Blood Bank Bank with (BC)
(BCU) Collection (HBB) Additional
Unit Functions
(BS/BCU) (HBB++)
DOH-BSF-LTO_ATO-AT
Revision: 01
01/07/2020
Page 7 of 24
Blood Blood Blood Hospital Hospital Blood Remarks
Station Collection Station / Blood Blood Center
STANDARDS AND REQUIREMENTS (BS) Unit Blood Bank Bank with (BC)
(BCU) Collection (HBB) Additional
Unit Functions
(BS/BCU) (HBB++)
DOH-BSF-LTO_ATO-AT
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01/07/2020
Page 8 of 24
Blood Blood Blood Hospital Hospital Blood Remarks
Station Collection Station / Blood Blood Center
STANDARDS AND REQUIREMENTS (BS) Unit Blood Bank Bank with (BC)
(BCU) Collection (HBB) Additional
Unit Functions
(BS/BCU) (HBB++)
1.5. EQUIPMENT
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Blood Blood Blood Hospital Hospital Blood Remarks
Station Collection Station / Blood Blood Center
STANDARDS AND REQUIREMENTS (BS) Unit Blood Bank Bank with (BC)
(BCU) Collection (HBB) Additional
Unit Functions
(BS/BCU) (HBB++)
DOH-BSF-LTO_ATO-AT
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01/07/2020
Page 10 of 24
Blood Blood Blood Hospital Hospital Blood Remarks
Station Collection Station / Blood Blood Center
STANDARDS AND REQUIREMENTS (BS) Unit Blood Bank Bank with (BC)
(BCU) Collection (HBB) Additional
Unit Functions
(BS/BCU) (HBB++)
DOH-BSF-LTO_ATO-AT
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01/07/2020
Page 11 of 24
Blood Blood Blood Hospital Hospital Blood Remarks
Station Collection Station / Blood Blood Center
STANDARDS AND REQUIREMENTS (BS) Unit Blood Bank Bank with (BC)
(BCU) Collection (HBB) Additional
Unit Functions
(BS/BCU) (HBB++)
DOH-BSF-LTO_ATO-AT
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01/07/2020
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Blood Blood Blood Hospital Hospital Blood Remarks
Station Collection Station / Blood Blood Center
STANDARDS AND REQUIREMENTS (BS) Unit Blood Bank Bank with (BC)
(BCU) Collection (HBB) Additional
Unit Functions
(BS/BCU) (HBB++)
1.7.6.1 Policy and procedure for testing for the five (5) TTIs,
i.e, HIV 1/2, HBsAg, HCV, Malaria and Syphilis
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Blood Blood Blood Hospital Hospital Blood Remarks
Station Collection Station / Blood Blood Center
STANDARDS AND REQUIREMENTS (BS) Unit Blood Bank Bank with (BC)
(BCU) Collection (HBB) Additional
Unit Functions
(BS/BCU) (HBB++)
1.7.8 There shall be a policy and procedure for the storage and
distribution of whole blood/ components.
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Blood Blood Blood Hospital Hospital Blood Remarks
Station Collection Station / Blood Blood Center
STANDARDS AND REQUIREMENTS (BS) Unit Blood Bank Bank with (BC)
(BCU) Collection (HBB) Additional
Unit Functions
(BS/BCU) (HBB++)
DOH-BSF-LTO_ATO-AT
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01/07/2020
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Blood Blood Blood Hospital Hospital Blood Remarks
Station Collection Station / Blood Blood Center
STANDARDS AND REQUIREMENTS (BS) Unit Blood Bank Bank with (BC)
(BCU) Collection (HBB) Additional
Unit Functions
(BS/BCU) (HBB++)
DOH-BSF-LTO_ATO-AT
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01/07/2020
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Blood Blood Blood Hospital Hospital Blood Remarks
Station Collection Station / Blood Blood Center
STANDARDS AND REQUIREMENTS (BS) Unit Blood Bank Bank with (BC)
(BCU) Collection (HBB) Additional
Unit Functions
(BS/BCU) (HBB++)
DOH-BSF-LTO_ATO-AT
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01/07/2020
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Blood Blood Blood Hospital Hospital Blood Remarks
Station Collection Station / Blood Blood Center
STANDARDS AND REQUIREMENTS (BS) Unit Blood Bank Bank with (BC)
(BCU) Collection (HBB) Additional
Unit Functions
(BS/BCU) (HBB++)
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ANNEX A. NUMBER OF PERSONNEL
Donor Transfusion
Testing for Component Compatibility Inventory Total Number of
BSF Category Recruitment/ Pre-collection / Collection Releasing Reaction Networking
TTIs Processing Testing Management personnel /24 hrs
Counselling Investigation
Hospital based
Designated RMT 1 designated RMT/shift 3 designated RMTs
Blood Station
Non-hospital
based Blood
1 RMT plus
Station (Not Same personnel in Releasing 2 RMTs
1 reliever
operating for
more 8 hours)
1 RMT
Non-hospital 1 RN or RMT or
2 phlebotomist which may be 1 MD
base Blood under board MT
composed of RMTs, RNs or 1 RMT plus 3 RMTs
Station / Blood trained by DOH Same personnel in Releasing
trained laboratory technician, or 1 reliever 2 Phlebotomists
Collection Unit recognized
under board MT 1 RN/RMT
(BS/BCU) training provider
1 MD per activity
1 RMT
1 RN or RMT or
2 phlebotomist which may be Same 1 MD
under board MT
Blood Collection composed of RMTs, RNs or personnel in 1 RMT
trained by DOH
Unit trained laboratory technician, or Donor 2 Phlebotomists
recognized
under board MT Recruitment 1 RN/RMT
training provider
1 MD per activity
1 MD (on-call)
1 RMT/shift plus 1 reliever
Blood Bank 1 RN/RMT 4 RMTs
1 MD (on-call)
1 RN/RMT
1 RMT
2 phlebotomist which may be *1 RMT/shift plus 1 reliever 1 MD
Blood Bank with
composed of RMTs, RNs or 1 RMT/shift 9 RMTs
additional 1 RN
trained laboratory technician, or Plus 1 reliever 2 Phlebotomists
functions
under board MT 1 RN
1 MD per activity
1 RMT
2 phlebotomist which may be Same RN 1 MD
1 RMT/shift Same RMT
composed of RMTs, RNs or assigned in 9 RMTs
Blood Center 1 RN plus 1 assigned in
trained laboratory technician, or *1 RMT/shift plus 1 reliever donor 2 Phlebotomists
reliever Releasing
under board MT recruitment 1 RN
1 MD per activity
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ANNEX B. EQUIPMENT
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11.1.3 Incubator or heating block or its equivalent
11.2 Chemiluminiscence (Optional) Optional
11.3 NAT testing
12. Fire Extinguisher
13. Freezer
13.1 Plasma freezer (-30°C) with AVR
13.2 Ultralow freezer (-70°C) with AVR
13.3 Blast freezer (Optional)
14. Generator with capacity of at least 40 KVA
15. Hematology Analyzer for QC of blood products
16. Hemoglobin determination, any one of the following:
16.1 Copper Sulfate for mobile blood donation
16.2 Hemoglobinometer, or Photometer or Spectrophotometer
17. Microscope, binocular, equipped with Oil Immersion Objective (OIO)
18. Needle destroyer
19. Pipettor
20. Plasma Extractor
21. Plasma Thawer or its equivalent, with regulated temperature
22. Platelet Rotator/ Agitator with incubator
23. Red Cell Antibody Screening System and phenotyping Optional Optional Optional
24. Refrigerator
24.1 Blood Bank Refrigerator controlled at 2-6 0C with temperature
recorder and alarm system, and AVR
24.2 Reagent refrigerator with laboratory thermometer and AVR
25. Rotator for RPR or VDRL Optional Optional
26. Sphygmomanometer (Non-mercurial)
27. Stethoscope
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28. Stopwatch or timer
29. Tackle box / Phlebotomy box
30. Thermometer
30.1 Clinical Thermometer (non-mercurial)
30.2 Laboratory Thermometer
30.3 Room Thermometer
31. Water bath/ dry bath set at 37°C for cross-matching and discrepant blood
typing
32. Clinical Weighing Scale
32.1 Calibrated up to 200 kilograms – for blood donors
32.2 Calibrated up to 500 grams – for blood units
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Republic of the Philippines
Department of Health
HEALTH FACILITIES AND SERVICES REGULATORY BUREAU
RECOMMENDATIONS:
A. For Licensing Process:
[ ] Issuance depends upon compliance to the recommendations given and submission of the
following within_____________________________ days from the date of inspection:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Inspected by:
Printed Name Signature Position/Designation
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Received by:
Signature ______________________________________
Printed Name___________________________________
Position/Designation _____________________________
Date_______________________________________________
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02/26/2018
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Republic of the Philippines
Department of Health
HEALTH FACILITIES AND SERVICES REGULATORY BUREAU
RECOMMENDATIONS:
B. For Monitoring Process:
[ ] Others (Specify)
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Monitored by:
Printed Name Signature Position/Designation
Dr. Myra M. Luminarias, RN MO IV
Engineer III
______________________________________________________________________________
Engr. Eliezer A. Mallorca
Ms. Sheila Marie P. Ybañez, RMT Licensing Officer III
______________________________________________________________________________
Ms. Vivian L. Ceballos, MAN-RN Licensing Officer III
______________________________________________________________________________
Mr. Renee James A. Tabacon, RMT Medical Technologist II
______________________________________________________________________________
Mr. John Hushein F. Suan RN Nurse II
Engineer II
______________________________________________________________________________
Engr. Keith Jayson B. Gales
Ms. Jedith G. Flores, RPh Pharmacist II
Received by:
Signature ______________________________________
Printed Name___________________________________
Position/Designation _____________________________
Date_______________________________________________
DOH-BSF-LTO_ATO-AT
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02/26/2018
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