NVBSP FORM15

OCTOBER 2011 REVISED NVBSP BLOOD MONITOPRING AND HOSPITAL BLOOD TRANSFUSION REPORT

REPUBLIC OF THE PHILIPPINES DEPARTMENT OF HEALTH H EALTH CENTER FOR HEALTH DEVELOPMENT for NORTHERN LUZON REGION I BLOOD SERVICES NETWORK NATIONAL VOLUNTARY BLOOD SERVICE PROGRAM

NVBSP BLOOD MONITORING REPORT LA UNION MEDICAL DIAGNOSTIC CENTER & HOSPITAL Name of Hospital Hospital Anch!" S!# c$!% of S"n Frn"no' L" Un$on Address 607-83-39 / 607-83-40 Contact No.

Period Covered . !"!A# N". "$ %"N"& !otal !otal n'm(er of donor s intervie)ed/e*ami intervie)ed/e*amined+ ned+ ,,,,,,,,,,,,,,,,, !emporar %eferment #o) "ter 1edical H Conditions

!ravel and oter &easons

Permanent %eferment+ Hi2 &is eavior oters

!otal

.A. !"!A# !"!A# #""% C"##C!"N 5N'm(er of %onors led+ ,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,, ,,,,, 1o(ile %eposit led for #""% ol'nteer/ $amil/ *can2e lood for mer2enc P&"%C! al-in &eplacement transf'sion %onation lective Case N

&

N

&

N

&

N

&

N

&

N

&

A'tolo2o's !ransf'sion N

&

!otal

Paid %onors N

$res ole lood N – New Donors; R - Repeat donors .. APH&:: #""% P&"%C!

ol'ntar N

&

$amil/ &eplacement N

&

Paid %onors N

"ters (Specify)

&

Platelet

. %:!&!"N "$ #""% %"N"&: ; A AN% N%& ender A2e 1ale $emale <6-<7 <8-=4 =>-44 4>-64 6> and a(ove . . :&"#"CA# !:!N $"& $"& !&AN:$:"N-!&AN:1::# N$C!"N: 5!!s R()*! of Conf$r+"!or% T(! NO OF BLOOD UNITS TESTED ,RITM&AC! N"N N"! &:#!: !:! &AC! NA! NA!  P":! P":! :C&N% &:#!: :trip A HsA2 HC %&#/&P& 1alaria H !"!A# R"(on.( for no! (crn$n/ !h 0*oo )n$!.(

Non-availa(ilit Non-availa(ilit of &ea2ents/?its &ea2ents/?its

@ :it'ation :it'ation

:taff :orta2e :orta2e

B'ipment $ail're/Po)e $ail're/Po)err #oss

"ters

&

!otal


. N". "$ #""% A: %:CA&%%/ N"! :% lood Prod'ct

*pired

Positive !!s

Contaminated

Processin2 Pro(lem 5'ns'ccessf'l (leedin2

:tora2e Pro(lem 5HemolDed

!ransport Pro(lem

"ters

Paced &ed Cell $res $roDen Plasma Cros'pernate Croprecipitate Platelet !"!A#

. C"1P"NN! $&AC!"N CAPA#!; a. Ho) man H"# #""% donations )ere separated into componentsE ,,,,,,,,,,,,,,,. (. No. of (lood components prepared for ole lood donationsE ,,,,,,,,,,,,,,,,,,,,, lood Prod'cts

&efri2erated Centrif'2e

Aperesis

$res ole lood/ole lood Paced &ed Cell/ased &C $res $roDen Plasma/Plasma Cros'pernate Croprecipitate Platelet "ters . NN!"&; "$ #""% P&"%C!: &C% #""% N!: $&"1 lood Prod'cts

%"H 5Government Hospital)

#ocal overnment nit 5# Hospital

Pilippine &ed Cross

Private Hospital

$res ole lood /ole lood Paced &ed Cell $res $roDen Plasma Platelet Croprecipitate / Cros'pernate ased &C "ters !"!A# . C#A::$CA!"N "$ #""% :&C $AC#!; a

")nersip overnment Private

(

nstit'tional Caracter Hospital-(ased Non-ospital-(ased

c :ervice Capa(ilit lood Center 5C lood :tation 5: lood Collectin2 nit 5C C/: Hospital lood an "ters ,,,,,,,,,,,,,,,,,,,,,,,,,

F. %o o' ave standard operatin2 proced'res 5:"P or local )ritten instr'ction and records of te follo)in2E

Commercial lood an


;es

No

<. lood donor recr'itment =. Pre-donation co'nselin2 and donor selection 3. lood collection and donor care 4. Post donation co'nselin2 >. #a(orator screenin2 and (lood donations for !ransf'sion !ransmissi(le nfections 5!!s 6. lood ro'p :erolo2 !estin2 of (lood donations 7. Preparation of (lood components 8. Compati(ilit testin2 9. !ransf'sion of (lood to patients F. %o o' participate in an e*ternal B'alit assessment sceme/e*ternal eval'ation on performance for+ ;es

No

<. !ransf'sion-transmissi(le infections =. lood serolo2 3. Compati(ilit !estin2

F. NN!"&; "$ #""% P&"%C! %:PN:% !" "!H& #""% :&C $AC#!; NA1 "$ H":P!A#

$/

P&C/&C

P#A!#!

$$P/C&;":P/C&;"PP!

!"!A# F. 1"# #""% %"NA!"N #ocation

N'm(er of 1o(ile lood %onation

!otal No. of %onors led

Prepared (+

Noted (+

Approved (+

1edical !ecnolo2ist

:eldon :teven C. AB'inoG 1%G %PP Head of #a(orator

,,,,,,,,,,,,,,,,,,,,,, Hospital Administrator


HOSPITAL BLOOD TRANSFUSION COMMITTEE REPORT

.

#""% C"1P"NN! !&AN:$:"N BLOOD Pro)c!(

SURGERY

OB1GYNE

MEDICINE

PEDIA

ORTHO

ENT

OTHERS

TOTAL

$res ole lood ole lood Paced red Cell $res $roDen Plasma Cros'pernate Croprecipitate Platelet ased &C "ters To!"*

.

PA!N!: !&AN:$:% ACC"&%N !" A AN% N%& ender

A2e

1ale

$emale

> >-<4 <>-44 4>->9 60 and a(ove .

#""% P&"%C!:

C&"::1A!CH%/!&AN:$:% &A!" :&&; "-;N 1%CN P%A I of I of I of I of I of I of I of I of 'nits 'nits 'nits 'nits 'nits 'nits 'nits 'nits

"&!H" I of I of 'nits 'nits

N! I of 'nits

*matc ed

*matc ed

*matc ed

!rans $'se d

*matc ed

!rans f'sed

*matc ed

!rans f'sed

*matc ed

!rans f'sed

!rans f'sed

$ ole lood Paced &C !otal C+! . A. . C. %. .

No. of patients )om (lood )as reB'ested ,,,,,,,,,,,,,,,,,,,,,, No. of patients )o received (lood ,,,,,,,,,,,,,,,,, No. of s'r2ical cancellations d'e to 'navaila(ilit of (lood ,,,,,,,,,,, No. of cases delaed d'e to 'navaila(ilit of (lood ,,,,,,,,,,,,,,,,, No. of deat d'e to 'navaila(ilit of (lood ,,,,,,,,,,,,,,,,,,,,,,,,

I of 'nits !rans f'sed

"!H&: I of I of 'nits 'nits

!"!A# I of I of 'nits 'nits

*matc ed

*matc ed

!rans f'sed

!rans f'sed


. A. No. of errors dealin2 )it la(orator processes a. #a(elin2 ,,,,,,,,, c. !estin2 ,,,,,,,, (. Preparation ,,,,,,, d. ss'ance ,,,,,,,,,, . ncomplete Collection ,,,,,,,,,, C. No. of 'nits prepared and eld for patients ('t not 'sed 5te difference (et)een I of 'nits *-matced and transf'sed :'r2er ,,,,,,, "-ne ,,,,,, 1edicine ,,,,,, .

"rtopedics ,,,,,,,,, Pediatrics ,,,,,,,,,,, N! ,,,,,,,,,,,,,,,

rolo2 ,,,,,,,,, Hemodialsis ,,,,, "ters ,,,,,,,,,,

&J:! $"& #""% AN% C"1PA!#!; !:!N

A. &o'tine ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, . mer2enc a. Crossmatced tree pases ,,,,,,,,,,,,,,,,,,,,, (. Crossmatced saline and al('min onl ,,,,,,,,, c. Crossmatced saline pase onl ,,,,,,,,,,,,,, d. A" !pe specific 'ncrossmatced ,,,,,,,,,, e. ro'p @" ncrossmatced (lood ,,,,,,,,,,,,

.

#""% !&AN:$:"N &AC!"N 5Please 'se e*tra seet if necessar

D"! Tr"n(f)(

B*oo Pro)c!

P"!$n!2( Wor3$n/ D$"/no($(#

S$/n( "n S%+4!o+( of Tr"n(f)($on R"c!$on

S)++"r%.I+4r(($on Tr"n(f)($on R"c!$on In5(!$/"!$on


.

Hospital lood !ransf'sion Cases Per %epartment 5%ia2nosis 5Please 'se e*tra seet if necessar

D4"r!+n!

Prepared (+

1edical !ecnolo2ist

D$"/no($(

Noted (+

:eldon :teven C. AB'inoG 1%G %PP Head of #a(orator

6 of C"((

Approved (+

,,,,,,,,,,,,,,,,,,,,,, Hospital Administrator

NVBSP FORM15

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