Better Safer Transfusion Program

1
Better Safer Transfusion Program Form 2 Clinical
Audit of Red Blood Cell Use in Orthopaedic Surgery
During the study period please complete a form
for every patient who has undergone either
a total hip replacement or a knee replacement
whether or not they are transfused.
Alternatively, for hospitals that perform THR or
TKR very regularly, every third procedure may be
audited instead.
Patient Details
Hospital Code
Audit ID
Date of Birth
Sex
Male
Female
-------/--------/-----------
Chronic Lung Disease
Coronary artery disease
Haematological Disorder
Other
.

Co-morbidities
Surgery Details
Date of Surgery
-------/--------/-----------
Total Hip Replacement
Total knee Replacement
Revision
Primary
Blood Management
Autologous pre-donation YES NO
Number of autologous units collected ..
Intraoperative Salvage YES NO
Postoperative Salvage YES NO
Red Cell Transfusion
Haemoglobin Results
Form Vers 11May05
2
Office Use Only 1. Was the transfusion episode
aligned with the guidelines? -
intraoperatively or within 24 hours of
surgery Yes No - 24 hrs or more after
surgery Yes No 2. Was the patient over
transfused? - intraoperatively or within 24
hours of surgery Yes No - 24 hrs or more
after surgery Yes No 3. Was the patient under
transfused? - intraoperatively or within 24
hours of surgery Yes No - 24 hrs or more
after surgery Yes No 4. For this episode was
sufficient data provided to make an assessment of
alignment with Guidelines? -
intraoperatively or within 24 hours of
surgery Yes No - 24 hrs or more after
surgery Yes No