United States Health Information Knowledgebase

 

Blood or Blood Product


Form ID: F4
Form Name: Blood or Blood Product
Version: 1.2
Form Short Name: Blood
Synonym: Blood
Definition: A blood or blood product event or unsafe condition involves the processing and/or administration of blood or a blood product.
Setting: Hospitals, including outpatient pharmacies and outpatient departments located within the hospital
Language: U.S. English
Guide For Use: Use this form to report any patient safety event or unsafe condition involving the processing and/or administration of blood or a blood product. This form is not intended for reporting blood or blood product collection and other processes prior to receipt of the product by the blood bank. If the event involves a device, please also complete the Device or Medical/Surgical Supply, including Health Information Technology (HIT) form. Narrative detail can be captured on the Healthcare Event Reporting Form (HERF).
Comments: None defined at this time
Description Of Change: Not Applicable
Data Element ID Sort Data Element Name Sort Question Number Sort Version Sort Effective Date Sort Until Date Sort
DE114 Type of blood product 1 Hospital Version 1.1, Hospital Version 1.2 03/31/2010 - -
DE120 ISBT code 2 Hospital Version 1.1, Hospital Version 1.2 03/31/2010 - -
DE117 Description of the blood or blood product event 3 Hospital Version 1.1, Hospital Version 1.2 03/31/2010 - -
DE123 Incorrect action in blood or blood product administration 4 Hospital Version 1.1, Hospital Version 1.2 03/31/2010 - -
DE126 Two-person, three-way check documentation 5 Hospital Version 1.1, Hospital Version 1.2 03/31/2010 - -
DE129 Incorrect volume of blood or blood product 6 Hospital Version 1.1, Hospital Version 1.2 03/31/2010 - -
DE132 Incorrect blood or blood product administration rate 7 Hospital Version 1.1, Hospital Version 1.2 03/31/2010 - -
DE135 Process when blood or blood product event discovered 8 Hospital Version 1.1, Hospital Version 1.2 03/31/2010 - -
DE138 Process when blood or blood product event originated 9 Hospital Version 1.1, Hospital Version 1.2 03/31/2010 - -
Effective Date: 04/01/2012
Until Date: - -
Update Date: 04/24/2013
Submitting Organization: Agency for Healthcare Research and Quality (AHRQ)
Date of Submission: - -
Responsible Organization: Agency for Healthcare Research and Quality (AHRQ)
Creator: Amy Helwig, MD, MS
Data Steward: Agency for Healthcare Research and Quality
References: Not Applicable
Administrative Status: Final
Administrative Status Date: 01/24/2014
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