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Audit Home  >  Data Entry-Red Blood Cell Audit in Orthopaedic Surgery

* = Mandatory

Form 2: Clinical Audit of Red Blood Cell Use in Orthopaedic Surgery

Patient Details

Hospital *:

Audit ID*:
Sex*: Male Female

Age: *

Co-morbidities
Coronary artery disease
Chronic lung disease
Haematological Disorder
Other

Surgery Details
Date of Surgery:* dd/mm/yyyy
Replacement of:* Total Hip Bilateral Replacement Type: * Primary
Revision
  Total Knee Bilateral   Primary
Revision

Blood Management
Autologous pre-donation* Yes No Number of autologous units collected:
Intraoperative Salvage Yes No Postoperative Salvage Yes No

Red Cell Transfusion
  Pre-Transfusion Hb g/dL Record of Pre-Transfusion Symptoms No. Units Transfused
Donor Blood
(Number of allogeneic)		 Pts own blood
(Number of autologous)
Intraoperatively or within 24 hrs of surgery Yes No
24 hrs or more AFTER surgery Yes No

Haemoglobin Results
 

Date of Test
dd/mm/yyyy

Result g/dl MCV Result (fl) Not available
Pre op Hb
Post op Hb (within 48 hrs of surgery)  
Pre Discharge Hb (day 3 or beyond ie. the last recorded Hb)  

Comments:


 
 

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

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