PROGRA Bachelor of Science in Nursing STUDENT NAME

M
NCMA-113 YEAR & SECTION
(Fundamentals of Nursing
COURSE Procedure) INSTRUCTOR

DATE

PROCEDURE : ADMINISTERING BLOOD TRANSFUSION

EXPECTED OUTCOME : The student should be able to perform removing of nasogastric tube correctly.
ASSESSMENT TASK : Return Demonstration

Exceptional Good Average Poor SCORE

Assessment
(3) (2) (1) (0)
Dimension
1. Verify the order Verified the Verified the Verified the Failed to verify
for 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 Greeted and Performed the Performed one Failed to greet
identify the patient. identified two (2) ways of (1) way of and identify
patient by identifying identifying patient.
asking his/her patient. patient.
name and
checking his/her
ID band politely.
3. Explain the Explained Explained Explained Failed to explain
procedure. Start IV procedure to procedure but procedure but procedure and
line if necessary. the client clearly lacks details. in an unclear started IV line.
and completely Started IV line. manner but
with client’s started an IV
approval and line.
started an IV
line.
4. Have the client Observed Consent signing Performed the Failed to
sign the consent principles of was done with step with some perform the
forms. autonomy and n=minimal errors. procedure.
let the patient errors.
signed the
consent.
5. Obtain baseline Performed the Performed the Performed the Failed to
vital signs. step with east. step with little step with some perform the
errors. errors. procedure.
6. Obtain the blood Performed the Performed the Performed the Failed to
product from the step with east. step with little step with some perform the
blood back within errors. errors. procedure.
30mins of initiation.
7. Verify the blood Performed the Performed the Performed the Failed to
product and the step with east. step with little step with some perform the
client with another errors. errors. procedure.
nurse.
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 Observed Hand washing Hand washing Hand washing
put on gloves principles of was done with was done with and gloving was
medical hand minimal errors maximal errors not done.
washing and but perfectly but perfectly
don gloving. don gloving. don gloving.
9. Open blood Performed the Performed the Performed the Failed to
administration kit step with east. step with little step with some perform the
and close roller errors. errors. procedure.
clamps.
10. For Y-tubing set. Performed the Performed the Performed the Failed to
10.1 Spike the step with east. step with little step with some perform the
normal saline bag errors. errors. procedure.
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. For single Performed the Performed the Performed the Failed to
tubing set. step with east. step with little step with some perform the
11.1 Spike blood errors. errors. procedure.
unit using 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. Attach tubing to Performed the Performed the Performed the Failed to
venous catheter step with east. step with little step with some perform the
aseptically and errors. errors. procedure.
open clamps on
tubing. Infuse the
blood product at
 the ordered rate.
13. Remain with Performed the Performed the Performed the Failed to
client for the first step with east. step with little step with some perform the
15-30mins, errors. errors. procedure.
monitoring vital
signs frequently
according to
institutional policy.
14. After blood has Performed the Performed the Performed the Failed to
infused, flush the step with east. step with little step with some perform the
tubing with normal errors. errors. procedure.
saline.
15. Wash hand and Washed hands Washed hands Washed hands Washed hands
documentation and and some of but most of the but
documented the details of details of documentation
the information procedure were procedure were was not done.
about the not not
procedure documented. documented.
properly and
completely.

OVERALL SCORE:   __________

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

FACULTY SIGNATURE OVER PRINTED NAME