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Bm Forms Instructional Revised2005

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   1 BLOOD MONITORING FORMS INSTRUCTIONS MANUAL  –  revised 2005 For Quality Data Management in Blood Service Facilities of the National Voluntary Blood Services Program TECHNICAL COMMITTEE NATIONAL VOLUNTARY BLOOD SERVICES PROGRAM DEPARTMENT OF HEALTH December 2000   2 BLOOD MONITORING FORMS For Quality Data Management in Blood Service Facilities of the National Voluntary Blood Services Program These Blood Monitoring Forms have been designed to standardize the reporting and collation of data from all Blood Service Facilities under the National Voluntary Blood Services Program. The information obtained will be used in developing strategies for quality assurance and indicators to assess and further strengthen program implementation. The purpose and usefulness of each form are explained. Likewise, detailed instructions for completing the forms, definition of terms and formulas are provided. Please contact the Chairperson of NVBSP Technical Committee, Philippine Childrens Medical Center Pediatric Blood Bank at Tel. No. (02) 9260367 for further assistance in completing the forms. If you have comments and suggestions to make the forms more “user friendly”, please feel free to bring them to the attention of the Techn ical Committee. The Forms should be completed by each Blood Service Facility and approved by the Blood Bank Head. Submit a copy to the following at the end of each quarter: 1.   Director IV National Center for Health Facility Development, and Program Manager, National Voluntary Blood Services Program Department of Health, Sta. Cruz, Manila 2.   Regional Blood Coordinator Center for Health Development for (Region) TECHNICAL COMMITTEE NATIONAL VOLUNTARY BLOOD SERVICES PROGRAM DEPARTMENT OF HEALTH December 2000   3 FORM NO : BM-01 TITLE : DONOR RECRUITMENT REPORT PURPOSE : To collect information on the frequency and reasons for the deferral of blood donors. USEFULNESS: To identify weak areas in recruitment and advocacy campaign and therefore focus on other strategies for improvement. INSTRUCTIONS: 1.   Form BM-01 A - For Donors without Pre-donation Testing Form BM-01 B - For Donors with Pre-donation Testing for Transfusion Transmitted Infections 2.   The total no. of donors recruited is the sum of voluntary and replacement donors. 3.   Deferred by history and P.E. includes the number of donors who are temporary and permanently deferred because of any of the following: a.   conditions elicited from interview of medical history that disqualify prospective donors b.   high-risk activities for Sexually Transmitted Infections (STIs) c.   abnormal physical examination findings The percentage (%) is determined by dividing the total number of donors deferred by History and P.E. by the total no. recruited multiplied by 100. Example: No. of donors deferred by History and P.E. = 6 Total no. of donors recruited for the month = 105 % of donors deferred by History and P.E. = 6 x 100 = 5.7 % 105 4.   Deferred by laboratory testing includes the number of donors deferred because of a)   abnormal hemoglobin b)   reactive results in any one of the transfusion transmitted diseases/infections (TTD). The % is determined by dividing the no. of donors deferred by laboratory testing (i.e., Hemoglobin or TTD) by the total no. of donors recruited multiplied by 100. Example: No. of donors deferred by abnormal Hgb = 8 Total no. of donors recruited = 105 % of donors deferred by abnormal Hgb = 8 x 100 = 7.6 % 105 5.   Other reasons include the number of prospective donors who have no reasons for deferral but were unable to donate because of unsuccessful phlebotomy, refusal, did not come back, anxiety reaction, etc... List these reasons according to the frequency of occurrence in the space provided. The % is determined by dividing the no. of donors deferred due to other reasons by the total no. of donors recruited multiplied by 100. (Refer to above example) 6.   Accepted donors include the no. of donors who have no reasons for deferral by history, P.E. and laboratory testing and were bled successfully. Their blood unit is included in the blood inventory.  Autologous and directed donors are also included in this category. The % is determined by dividing the no. of accepted donors by the total no. recruited multiplied by 100. (Refer to above example) 7.   The percentages determined from nos. 3, 4, 5 and 6 should have a total of 100 %.   4 FORM NO. : BM-02 TITLE : CLASSIFICATION OF ACCEPTED DONORS PURPOSE : To collect information on the overall profile of the donors per month. USEFULNESS: To provide a general outlook of the overall implementation of the program in terms of donor retention (repeat donors) and the advocacy campaign of the Blood Service Facility. INSTRUCTIONS: 1.   Write the month of interest under the column month . 2.   The total number of accepted donors is the sum of the following categories: a.   new volunteer donors b.   repeat volunteer donors c.   new replacement donors d.   repeat replacement donors e.   new patient-directed donors f.   repeat patient-directed donors 3.   Write the total number of donors for each category for the month of interest. Definitions: New Volunteer Donor - First time donor without evidence of previous donation Repeat Volunteer Donor - Repeat donor with evidence of previous donation New Replacement Donor - First time replacement donor in any hospital Repeat Replacement Donor - Repeat replacement donor in the same hospital New patient-directed donors  –  First time patient-directed donor in any BSF Repeat patient-directed donors  –  Repeat patient-directed donor in the same BSF    VOLUNTARY NON-REMUNERATED BLOOD DONOR  –  A donor who gives blood freely and voluntarily without receiving money or any other form of payment. Voluntary non-remunerated blood donors give blood of their own free will and receive no money or other payment that could be considered a substitute for money. Their primary motivation is to help unknown recipients and not   to obtain any personal benefits. The principal reasons for promoting regular voluntary non-remunerated blood donation are as follows: 1.   Voluntary non-remunerated donors have a lower incidence and prevalence of transfusion-transmissible infections than family/replacement donors or paid donors. They have no financial incentive to conceal information (such as high-risk sexual behavior or a history of injecting drugs) that may have exposed them to an infection that can be transmitted by transfusion. 2.   Voluntary non-remunerated donors are more likely to be willing to donate blood regularly, which is important in maintaining safe and adequate supplies of blood. 3.   The lowest incidence and prevalence of transfusion-transmissible infections is generally found among regular voluntary non-remunerated donors rather than first-time or occasional donors. 4.   Regular donors are not financially motivated to donate too frequently and so are not placed at risk of anemia through the depletion of their iron stores. 5.   Regular donors are also more likely to respond to an appeal for blood donors during an emergency because they have already expressed a commitment to voluntary blood donation.
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