LAS

We are version 6.15 in Meditech and currently use TAR for almost all transfusion documentation.  I find review fairly easy, but we have a real bull dog of an RN in our IS dept who did a great job building it, and assumes total ownership of it.  Documentation outside of TAR (in nurses' notes, in "vitals" section, etc.) is not considered compliant for non-emergent transfusions.  (Vitals entered in TAR do flow to the "Vitals" section of the EMR however). Nurses are prompted at the correct times and each timed entry includes a section asking if s/s of transfusion reaction are observed. She has included a 30 min post transfusion vitals check within the TAR record.  I review a sampling throughout each month and forward minor exceptions to dept nursing leadership; I submit Report of Events for significant exceptions.  Aside from checking for transfusion orders and labs, most everything else I need is included in the TAR documentation.  How TAR is built in OM determines how much info is available in it. Don't get me wrong, I spend a considerable amount of time in the EMR sleuthing out why we transfused someone who didn't appear on the surface to meet criteria, but that is not the fault of the TAR documentation.

I have a form which covers the 6 CLIA requirements that we use through out the whole lab. Each area has put on their own requirements. I will try to attach it.
I have a separate one for evenings and nights since they don't do all the same testing as days.
BB competency day.docx
BB competency evenings night.docx

The WRP Check from Sysmex extends beyond the stated "linearity" for most parameters.  I recommend that you stop doing periodic reportable range checks--it's not required by CAP anymore unless the analyzer is moved or you are reporting beyond the manufacturer's stated ranges.

Let me know when you find a solution or an answer . . . 'cuz I don't have one. Neither does my insitution.

First, I would point out that Nursing accepts verbal orders from Physicians all the time.  I too  have worked places where we accepted Verbal Orders "for emergencies only;" but we had a Manual Form where we wrote down everything the caller was saying to us (including their name and the name of the ordering Physician).  We kept those documents.  At 1 Trauma Center I worked at, we just had an alarm go off in the dept. as an indication that the ER wanted us to bring over a Trauma Cooler (6 units of uncrossmatched RBCs).  That is even less than a verbal order....so sometimes, you just have to "do what you have to do" in an urgent situation.  Also worked at a place where a post-partum woman hemorrhaged to death on the Night Shift.  Labor and Delivery was sending erroneous orders in their urgency (i.e. Fresh Frozen Platelets....).  Perhaps talking with them on the phone and getting immediate clarificaiton, might have resulted in a different outcome; don't know.......  You have to follow regulations and you have to be safe....but you also have to be realistic and do everything possible to ensure a patient does not bleed to death, just because you do not have a writen order in hand.
 
Just my thoughts/experience....  
 
Brenda Hutson