WICHITA STATE UNIVERSITY
DEPARTMENT OF MEDICAL LABORATORY SCIENCES
BLOOD BANK LAB CHECKLIST
Student _________________________________ Medical Facility______________________________
Start Date of the Rotation__________________ Number of Days Missed in the Rotation___________
INSTRUCTIONS FOR CLINICAL ROTATION EVALUATION
Each scale on the Clinical Rotation Evaluation form is to be completed by assessing the individual
student's level of achievement in completing the stated objective:
4 = Exceeds standards. Performs above entry-level expectations. Demonstrates initiative and
independent functioning.
3 = Meets standards. Performs at entry-level expectations. Needs some supervision.
2 = Marginal performance. Performs marginally below entry level standards. Needs supervision.
1 = Below standards. Performs significantly below entry-level expectations; needs constant supervision.
OBS = observed
NA = Not Applicable. Not performed at the facility.
Clinical instructors: Please evaluate the student based on these technical points plus oral questioning
and/or unknowns as appropriate to the clinical setting. Initial items which you have evaluated and sign
the form on the last page.
Site Education Coordinator: Please inform the school ([email protected]) by email concerning immediate
issues or problems regarding this student. Please review the rotation evaluation with the student at the
completion of the rotation. This form can be completed from the link provided and saved to computer
with student name and then email to [email protected] or complete and print and mail to WSU Medical
Laboratory Sciences, 1845 Fairmount, Box 43, Wichita, KS 67260-0043.
Place the number (or NA) of your assessment to the objective and your initial in the left-hand box.
GENERAL OBJECTIVE: Demonstrate the ability to correctly perform and interpret the following procedures:
Assessment
Objective
(4,3,2,1,NA)
Blood Grouping
Set up the procedure according to manufacturer's directions given in the procedure manual
concurrently with crossmatch
Grade the strength of reaction from 4+ to negative for each reaction as defined in the procedure
manual
Transcribe the reactions correctly on laboratory form and/or in the computer
Interpret correctly the ABO group from the forward and reverse with 100% accuracy
Name the types of Rh typing sera and the use of each
Interpret correctly the Rh type with 100% accuracy
Resolve discrepancies encountered in Blood Grouping
Antibody Screening
Explain uses for antibody screening
Discuss limitations for procedure
Identify atypical antibodies
Confirm patient is lacking antigen for atypical antibody identification
Compatibility Study
Review record of past transfusions and select appropriate product based on history, ABO/Rh and
product outdate
Explain the anamnestic response and effect on transfusions
Label the test tube with adequate identifying information
Set up the test concurrently with Blood Grouping and Antibody Screening
Accurately read and promptly record results onto workcard or into computer
Confirm the significance of the crossmatch, its importance and limitations
List causes for incompatibility at different stages
Resolve any serological incompatibilities encountered
Investigate transfusion reactions
Select ABO compatible non-group specific plasma or red cells
Donor Processing
Recall required testing procedures for donor blood by a collecting facility as opposed to a
receiving facility
Relate the need for donor records
Recommend possible uses of donor blood with atypical antibodies
List all available products
Differentiate the medical indication for each product
Summarize the storage life and temperature for each product
Discuss crossmatching and donor processing for each component
Correctly transcribe the product into transfusion service records
Place products into correct storage environment
Place platelets on rotator upon receipt and until given or disposed
Prepare and transfer products to other facilities without difficulty
Utilize appropriate reagents and procedures for ABO/Rh confirmation
Prepare products for transfusion. Pool platelets, thaw fresh frozen plasma and cryoprecipitate,
prepare syringes,change modified product outdates
Direct Antiglobulin Test
Investigate the positive direct antiglobulin test using the proper procedure
Interpret antiglobulin test results
Explain the theory of the antiglobulin reagent and control
Prepare an eluate when the direct antiglobulin is positive with the IgG fraction of the anti-human
globulin reagent
Recommend use of the direct antiglobulin for invivo antigen-antibody reactions as in hemolytic
disease of the newborn, hemolytic transfusion reactions, acquired hemolytic anemia, and drug
sensitized red cells
Name at least 2 causes for false positive and false negative antiglobulin tests
Use mono-specific antisera if the polyspecific antisera is reactive
Obtain and analyze any available patient history for reactive direct antiglobulin tests
Work Flow
Observe established protocol for releasing blood products
Handle phone calls with technologist assistance
Function as a team member. Notice work to be done and promptly begin working on procedures
where competency has been validated
Efficiently process transfusion requests and diagnostic tests. Prioritize, organize and concurrently
perform multiple tasks
Use data entry skills to check transfusion history and enter results in the computer. Comfortably
locate and use appropriate computer menus
Correctly dispense blood products for transfusion
Rh Immune Globulin
Perform appropriate test on the mother and baby including - blood type, antibody screening,
newborn group and types, and fetal screen
Investigates test results to determine mother's eligibility
Calculate the amount of Rh immune globulin that should be given
Perform testing on post-delivery maternal specimen
Accurately read and interpret fetal screen
Perform weak D test on all Rh Immunoglobulin workups
Cell Washing
Operate machine correctly according to directions given in procedure manual
Record appropriate product washing in computer/logbook
Correctly label washed cell product
Quality Control
Perform department quality control
Observe the blood products for hemolysis, turbidity or any abnormalities
Describe procedure to test a blood bank alarm system
Describe recordkeeping needed in the blood bank
Perform tachometer & timer check on centrifuges
Miscellaneous tests (Please list and evaluate other tests that were performed by this student in this department)
PROFESSIONALISM
4=Always, 3=Usually, 2=With Coaching, 1=Infrequently, 0=Never, NA=Unable to observe
Safety:
Follows all clinical affiliate and OSHA safety requirements for working in a clinical laboratory
Keeps working area and equipment clean and orderly without being reminded
HIPAA: Protects patient’s confidentiality at all times.
Communication:
Completes written, oral and electronic laboratory reports accurately, using the format of the
clinical affiliate
Is polite and considerate and shows self-confidence in a generally pleasant and firm diplomatic
manner, when dealing with patients and healthcare personnel.
Reliability:
Upon arrival in the laboratory, immediately assesses work to be done and gets started
Respects the policies of the facility in regard to start and ending time of each rotation day, and
lunch and break time assignments.
Respects the work flow of the facility by giving advanced notice of absences from the lab.
Accountability:
Listens to criticism and constructively acts upon suggestions to improve performance
Completes assignments.
Performs logically and systematically, handling interruptions skillfully in stressful situations
Comments (Both positive and negative. Please provide information about low-scoring items and issues not
addressed on the checklist):
Evaluator Signatures and Dates of Evaluation
Student Signature and Dates of Review
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