Quality Audit Preparation
- Blood bank staff BMS or MLA
- Blood Transfusion Co-ordinator
- Pathology Quality Services Manager
- Does it have a title?
- Does it have a unique identifier?
- Does it have a revision number?
- Does it have a date of implementation?
- Does it have a review date and has the SOP been regularly reviewed?
- Is the author identified?
- Has it been authorised by an appropriate member of staff?
- Are the number of copies and their locations identified?
- Is the history page up to date?
- Is there evidence that staff have signed and dated they have read and understood the SOP?
- Are there COSHH and risk assessments if relevant?
Additional Evidence required:
- Are there training and competency assessments for the member of staff performing the data entry task?
- Has the member of staff signed that they have read the current version of the SOP?
- Observation of the member of staff answering the telephone in real time
- Is the manner in which the caller is dealt with satisfactory i.e polite
- Observe the member of staff completing the telephone log form / entering in LIMS with the information as required by the SOP e.g.
- Patient ID
- Hospital number
- Caller ID/Bleep No.
- Date and Time
- Take a selection of telephone logs and undertake a retrospective audit on the following:
- Complete Patient information data
- Caller ID
- Other information as appropriate to the task
- Storage and retention and disposal of tel logs
- Confidentiality of patient data