United States Health Information Knowledgebase

 

Blood or Blood Product


Form ID: F4
Form Name: Blood or Blood Product
Version: 1.1
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 form. Narrative detail can be captured on the Healthcare Event Reporting Form (HERF).
Comments: None defined at this time
Description Of Change: Not applicable for this release
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 1.1 03/31/2010 - -
DE120 ISBT code 2 1.1 03/31/2010 - -
DE117 Description of the blood or blood product event 3 1.1 03/31/2010 - -
DE123 Incorrect action in blood or blood product administration 4 1.1 03/31/2010 - -
DE126 Two-person, three-way check documentation 5 1.1 03/31/2010 - -
DE129 Incorrect volume of blood or blood product 6 1.1 03/31/2010 - -
DE132 Incorrect blood or blood product administration rate 7 1.1 03/31/2010 - -
DE135 Process when blood or blood product event discovered 8 1.1 03/31/2010 - -
DE138 Process when blood or blood product event originated 9 1.1 03/31/2010 - -
Effective Date: 03/31/2010
Until Date: - -
Update Date: - -
Submitting Organization: Agency for Healthcare Research and Quality (AHRQ)
Date of Submission: 03/31/2010
Responsible Organization: Agency for Healthcare Research and Quality (AHRQ)
Creator: John C. Moquin
Data Steward: Agency for Healthcare Research and Quality
References: No specific reference at this time
Administrative Status: Final
Administrative Status Date: 03/31/2010
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