COLLEGE OF NURSING

SKILLS LABORATORY
PERFORMANCE EVALUATION TOOL
NCM 109 – CARE OF MOTHER AND CHILD AT RISK OR WITH PROBLEMS
(ACUTE AND CHRONIC)

PROCEDURE:
ADMINISTERING BLOOD PRODUCTS

NAME OF STUDENT :______________________________________ Score:

Block :______ Date:______________

DIRECTIONS:
● The evaluation tool will be discussed by the clinical instructor/s.
● During the discussion, the instructor/s may demonstrate the procedures or may use video viewing for students’
orientation.
● The students should be given sufficient time to prepare for the return demonstration.
● The students will do the return demonstration based on the checklist given.
● The following rating scale shall be used in grading student’s performance:
DONE- able to perform
Perform the procedure safely and accurately in a very consistent and independent manner without
supportive assistance from the instructors.
Perform a difficult action quickly and skillfully
Spends minimal time on task
Focuses on the client while giving care
NOT DONE - unable to perform
Unable to perform the procedure even under close supervision of guidance
Require continuous, supportive, and directive cues
Takes a longer time to complete the procedure.
Performs in an unskilled manner
● At the end of each laboratory session, the instructor/s will give remarks based on the student’s performance per
the procedures indicated.

PROCEDURE DONE NOT DONE

1. Starting Blood Transfusion

Checks the physician’s orders

2. Informs the client and explains the procedure. Verify the client's
religion and refer accordingly.

3. Checks availability of blood in the blood bank.

4. Monitors and notes baseline vital signs. Refers for any

abnormality especially the temperature.

5. Washes hands

6. Prepares the following: blood administration set, normal saline

solution, g 19 butterfly needle/abbocatheter (if client has no
ongoing IV line), IV stand, adhesive tape.

7. Assists during IV insertion (makes sure that main IV fluid is plain

NSS).

8. Checks patency of the ongoing IV line.

9. Checks the cross-matching slip with the blood bag: client’s

name and bed number, blood type (A, B, AB, O), Rh factor,
hepatitis and AIDS tests, blood products (PRBC, FWB, FFP),

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number of “u” or cc, expiration date, and serial number, and
inspects the blood bag for clots and bubbles

10. Asks another nurse to countercheck.

11. Starts the transfusion by:

A. Inserts administration set to the entry port of the blood bag.

12. B. Fills the drip chamber half with blood

13. C. Primes the tubing with blood

14. D. Stop the main IV line temporarily. (If main IV is not PNSS,
flushes tubing with PNSS)

15. E. Connects the blood via the Y port of the main IV line and
infuses as side drip

16. Secures BT line using an adhesive tape.

17. Regulates blood accordingly.

18. Note the time the infusion is started.

19. Stays with the patient during the first 15 minutes.

20. Monitors vital signs every 15 or 30 minutes during the first hour
till stable (compared with baseline vital signs).

21. Resumption of IV Infusion after Blood Transfusion

Clamps BT set.

22. Detaches the BT set from the Y port.

23. Flushes tubing with PNSS.

24. Restarts/ regulates the main IV line at its previous rate

25. Discards blood bag, BT set, and needle observing universal

precautions as per hospital protocol.

26. Termination of Blood Transfusion and IV Infusion

Clamps BT set.

27. Detaches the BT set from the Y port of the main IV line.

28. Removes abbocatheter and applied pressure dressing over the

insertion site.

29. Discards the blood bag, BT set, and the abbocatheter observes
universal precautions or sends it to the laboratory for analysis (in
cases of BT reactions) as per hospital protocol.

30. Documents the following: start and end of infusion, blood

product, serial number, blood type, number of "u" or cc
transfused, vital signs before, during, and after transfusion,
untoward reactions/responses of patient during and after

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 COLLEGE OF NURSING
transfusion, laboratory work-ups done as requested post-BT and
medications given as ordered: pre- , mid-, or post-BT.

TOTAL

***nothing follows***
REMARKS:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

EXPECTED LEVEL OF PERFORMANCE:

23 to 30 items done: PASS

22 items below done: Repeat the procedure to PASS

Student’s Signature:_______________
Date:__________

Instructor’ Signature:________________
Date:__________

GEN-FM-019 Rev 2 Effective Date 24 July 2023