BeST - Better Safer Transfusion Program, Department of Human Services, Victoria, Australia


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BeST - Audit

Data Entry - Clinical Audit of Cryoprecipitate Use

During the study period please complete a form for every patient who receives cryoprecipitate. For hospitals who transfuse cryoprecipitate very regularly, every third cryoprecipitate transfusion may be audited.
Definition of transfusion episode: An episode will be defined as each time the participating blood bank issue one or more therapeutic doses of cryoprecipitate to a patient. The same patient can only be entered into the database twice.

* = Mandatory

Transfusion Date*

/	/
dd	mm	yyyy

Hospital Code:*

Sex:*

Male Female

Audit ID:*

Age:*

Patient Weight:*

kgs
or not recorded

Hospitals Contact Email
to receive confirmation report on data submitted electronically to Blood Matters.

Pathology
If a pathology result is not provided it will be assumed that the test was not done.

Pre Transfusion			(dd/mm/yyyy)*
Fibrinogen (g/l)			Date:
PT (secs)			Date:
INR			Date:
APTT (secs)			Date:

Post Transfusion			(dd/mm/yyyy)*
Fibrinogen (g/l) only if less than 6 hours post transfusion			Date:
PT (secs)			Date:
INR			Date:
APTT (secs)			Date:

Cryoprecipitate
Transfused *

Approx
30-40ml = 1 Unit

No of
Units:

Approx
60 ml = 2 Units
(apheresis bag)

No of
Units :

Active Bleeding up to 24 hours before transfusion *	Yes	No
If Yes, did the bleeding cease within 6 hours of transfusion? *	Yes	No	Unable to determine
Surgery/Invasive Procedure 24 hours before, during, or after transfusion*	Yes	No
Did the patient receive Recombinant factor Vlla ?	Yes	No
Patient location in hospital *	Theatre
	ICU
	Ward
	Other, please specify

Patient Diagnosis (also use for other relevant comments, e.g., reasons why weight not recorded):*

Is the indication for Transfusion recorded in the medical record?*

Yes

Recorded Indication:

Fibrinogen deficiency with active bleeding

Fibrinogen deficiency with invasive procedure

Fibrinogen deficiency with trauma

Fibrinogen deficiency with Disseminated Intravascular Coagulation (DIC)

Other (Please specify):

* "deficiency" means below the hospital's normal range

Email questions or comments: BestAudit@dhs.vic.gov.au

Contact:

Karen Botting (Program Manager) Tel: (61 3) 9096 9037 Address: Clinical Information & Knowledge Management Unit Statewide Quality Branch Level 17, 50 Lonsdale Street Melbourne Vic 3001	Lisa Stevenson (Transfusion Nurse) Tel: (61 3) 9096 0476 Mobile: 0417 519 023 Address: Clinical Information & Knowledge Management Unit Statewide Quality Branch Level 17, 50 Lonsdale Street Melbourne Vic 3001
Email questions or comments: BestAudit@dhs.vic.gov.au

Last updated: 8 April, 2008
This web site is managed and authorised by the Quality Improvement Unit, Quality & Safety Branch, Rural & Regional Health & Aged Care Services Division of the Victorian State Government, Department of Human Services, Australia