Blood Request Form and Unit Traceability Log
From vein to vein: every unit traced from the donor number to the patient, with the check, the start and the outcome. The log the regulator will ask for
What it is
A blood request form with the minimum data set and the indication, and a traceability log per ward: unit number, component, group, patient, two-person check, start and end time, outcome, reaction, and the return of unused units — the record of 100 % traceability.
Where to use it
Request form to the laboratory; log kept on every transfusing ward and reconciled monthly with the laboratory issue register. Evidence for: Hospital Standard 4 — transfusion traceability; Governance — records. Evidence for: Hospital Standard 4 — transfusion traceability; Governance — records. Evidence for: Hospital Standard 4 — transfusion traceability; Governance — records.
Translate and adapt
English master edition. Georgian and other translations are added as they are clinically reviewed. Any facility may translate, add its logo and adapt wording to local practice — keeping the ASF block, the source attribution and the licence line on the sheet. Clinical thresholds and drug doses must be confirmed against national protocols before use.
The same code is printed on the tool itself. Scan it in any facility to reach this page.
Transfusion — Bedside Two-Person Check
Transfusion Reaction — Recognise and Act
Blood Refrigerator — Cold-Chain and Alarm Log
Print to share.
