OUR LADY OF FATIMA UNIVERSITY

College of Nursing – Pampanga Campus

PROGRAM Bachelor of Science in Nursing STUDENT NAME

YEAR & SECTION

NCMA219 Care of Mother and Child at
COURSE Risk or Problems (Acute and Chronic) 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
(4) (3) (2) (1)
1. Verify the written order for Verified the Verified the Verified the Failed to verify
the transfusion doctor’s order doctor’s order doctor’s order the doctor’s
properly and with minimal improperly and order.
accurately. error. inaccurately.
2. Greet and identify the Greeted and Greeted and Greeted and Failed to greet
patient. identified patient performed the performed one and identify
by asking his/her two (2) ways of (1) way of patient.
name and identifying identifying
checking his/her ID patient. patient.
band politely.
3. Explain the procedure. Start Explained Explained Explained Failed to explain
IV line if necessary. procedure to the procedure but procedure but in procedure and
client clearly and lacks details. an unclear started IV line.
completely with Started IV line. manner but
client’s approval started an IV line.
and started an IV
line.
4. Have the client sign the Observed Consent signing Consent signing Consent signing
consent forms. principles of was done with was done with not done.
autonomy and let minimal errors. maximal errors.
the patient signed
the consent.
5. Obtain baseline vital signs. Performed the step Performed the Performed the Failed to
with ease. step with little step with some perform the
errors. errors. procedure.
6. Obtain the blood product Performed the step Performed the Performed the Failed to
from the blood bank within 30 with ease. step with little step with some perform the
minutes of initiation. errors. errors. procedure.

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 7. Verify the blood Performed the Performed the Performed the Failed to
product and the client with procedures with procedures with procedures with perform the
another nurse. ease. 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

8. Wash hands and put on gloves Observed Hand washing was Hand washing was Hand washing
principles of done with minimal done with and gloving was
medical hand errors but maximal errors not done.
washing and don perfectly don but perfectly don
gloving. gloving. gloving.
9. Open blood administration kit Performed the step Performed the Performed the Failed to perform
and close roller clamps with ease. step with little step with some the procedure.
errors. errors.
10. For Y-tubing set. Performed all the Performed all the Performed all the Failed to perform
10.1. Spike the normal saline steps with ease. steps with little steps with some the procedures.
bag and prime the tubing errors. errors.
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. For single tubing set. Performed all the Performed all the Performed all the Failed to perform
11.1. Spike blood unit using steps with ease. steps with little steps with some the procedures.
filter tubing. errors. errors.
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. Attach tubing to venous Performed the step Performed the Performed the Failed to perform
catheter aseptically and open with ease. step with little step with some the procedure.
clamps on blood tubing. Infuse errors. errors.
the blood product at the ordered
rate.

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13. Remain with client for the Performed the step Performed the Performed the Failed to perform
first 15-30 minutes, monitoring with ease. step with little step with some the procedure.
vital signs frequently according errors. errors.
to institutional policy.

14. After blood has infused, flush Performed the step Performed the Performed the Failed to perform
the tubing with normal saline. with ease. step with little step with some the procedure.
errors. errors.
15. Wash hands and Washed hands and Washed hands Washed hands but Washed hands
documentation documented and some of the most of the details but
the information details of of documentation
about the procedure were procedure were was not done.
procedure not not
properly and documented. documented.
completely.

SCALE:
4 – (EXCEPTIONAL) Works competently and independently at all times
3 – (GOOD) Requires minimum guidance and supervision
2 – (AVERAGE) Requires frequent guidance and supervision
1 – (POOR) Requires close guidance and supervision most of the time

OVERALL SCORE: ______________

Target Raw Score: 45 out of 60. If the raw score is less than 45, repeat the return demonstration.

_________________________________________________ _________________________________________________
FACULTY SIGNATURE OVER PRINTED NAME STUDENT NURSE SIGNATURE OVER PRINTED NAME

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