jayinsat

Agree! Save the life first.
Our medical director would likely order at least one DAT the next day, possibly for additional days, to monitor. Anti-E is generally relative benign (though I have seen one patient who had an acute hemolytic reaction), We might also monitor plasma Hgb or haptoglobin, depending on the antibody involved.

You did everything that was required in this situation. The patient was a trauma and needed emergency transfusion. The risk of death outweighed the risk of a hemolytic transfusion reaction in that scenario, according to the treating physician. I once had a trauma surgeon tell me "I can treat a transfusion reaction but I can't treat death!" That put things in perspective for me. That is why thy sign the consent.
Next step would be to report this to your risk management department so that follow-up can be made, including monitoring the patient for the s/s of DTR. 

You did everything that was required in this situation. The patient was a trauma and needed emergency transfusion. The risk of death outweighed the risk of a hemolytic transfusion reaction in that scenario, according to the treating physician. I once had a trauma surgeon tell me "I can treat a transfusion reaction but I can't treat death!" That put things in perspective for me. That is why thy sign the consent.
Next step would be to report this to your risk management department so that follow-up can be made, including monitoring the patient for the s/s of DTR. 

We use MEDITECH. We have an order built called EMISS (EMERGENCY ISSUE). We enter the electronic order anytime we have to give uncrossmatched products. The order requires the requesting physician to electronically sign off on the order. If they do not, their privileges are revoked and they are locked out. This is the same process used for any telephone orders from physicians. We have had 100% compliance with this for more than 15 years using this process. Our hospital compliance department follows up for signatures that are outstanding. The process works and is compliant. 

I agree with Neil above. I would challenge that deficiency and not change my process. 

Small rural critical access hospitals operate under very tough conditions. If they close their doors the next closest facility, which may also be a critical access hospital, might be an hour or more away. It's a world I am thankful I am not working in, though my facility is one that receives transfers from critical access hospitals after they stabilize and ship.

Agree with AMcCord. We use Cardinal CH5214-18. 
Question: why are you looking for glass pipettes? We were forced to stop using glass pipettes years ago by our infection control team (glass breakage/employee injury risk). We were able to keep the glass tubes because of the potential effect on antibody detection. I do not believe using plastic pipettes pose any risk though.

CAP does not recognize a "30 minute" rule. Each facility has to have a validated policy and procedure that defines when a unit may be returned to inventory post-issue. That usually involves have some sort of thermometer to measure temperature upon return, especially if issued outside a validated cooler.
The time of start of transfusion is really a separate issue that was tied to the old "30 minute rule" that we all went by. The main point for nursing was that they did not pick up a unit before transfusion could be started. Pre-issue vitals, consent, orders, or any other requirement should be complete before the call for the blood. The blood should then be started immediately so that they have the maximum 4 hours to infuse it. Every minute that passes is a minute faster they have to infuse the unit. That may be a problem for someone who cannot tolerate a rapid infusion. We do not want nurses letting the unit sit on a counter somewhere for an hour while they do other things.

CAP does not recognize a "30 minute" rule. Each facility has to have a validated policy and procedure that defines when a unit may be returned to inventory post-issue. That usually involves have some sort of thermometer to measure temperature upon return, especially if issued outside a validated cooler.
The time of start of transfusion is really a separate issue that was tied to the old "30 minute rule" that we all went by. The main point for nursing was that they did not pick up a unit before transfusion could be started. Pre-issue vitals, consent, orders, or any other requirement should be complete before the call for the blood. The blood should then be started immediately so that they have the maximum 4 hours to infuse it. Every minute that passes is a minute faster they have to infuse the unit. That may be a problem for someone who cannot tolerate a rapid infusion. We do not want nurses letting the unit sit on a counter somewhere for an hour while they do other things.

CAP does not recognize a "30 minute" rule. Each facility has to have a validated policy and procedure that defines when a unit may be returned to inventory post-issue. That usually involves have some sort of thermometer to measure temperature upon return, especially if issued outside a validated cooler.
The time of start of transfusion is really a separate issue that was tied to the old "30 minute rule" that we all went by. The main point for nursing was that they did not pick up a unit before transfusion could be started. Pre-issue vitals, consent, orders, or any other requirement should be complete before the call for the blood. The blood should then be started immediately so that they have the maximum 4 hours to infuse it. Every minute that passes is a minute faster they have to infuse the unit. That may be a problem for someone who cannot tolerate a rapid infusion. We do not want nurses letting the unit sit on a counter somewhere for an hour while they do other things.

Same as @AMcCord. We use MEDITECH and cold antibodies are listed as clinically insignificant in our rules table for determining if EXM will be allowed. For those who are panicking, note:
EXM will be rejected if the CURRENT antibody screen is positive EXM will be allowed only if the CURRENT antibody screen is negative and THE ONLY antibody listed in the patient's history is a cold antibody. EXM will be rejected if any other clinically significant antibody is present, regardless of the current antibody sreen. That's how we handle it.

Same as @AMcCord. We use MEDITECH and cold antibodies are listed as clinically insignificant in our rules table for determining if EXM will be allowed. For those who are panicking, note:
EXM will be rejected if the CURRENT antibody screen is positive EXM will be allowed only if the CURRENT antibody screen is negative and THE ONLY antibody listed in the patient's history is a cold antibody. EXM will be rejected if any other clinically significant antibody is present, regardless of the current antibody sreen. That's how we handle it.

CAP does not recognize a "30 minute" rule. Each facility has to have a validated policy and procedure that defines when a unit may be returned to inventory post-issue. That usually involves have some sort of thermometer to measure temperature upon return, especially if issued outside a validated cooler.
The time of start of transfusion is really a separate issue that was tied to the old "30 minute rule" that we all went by. The main point for nursing was that they did not pick up a unit before transfusion could be started. Pre-issue vitals, consent, orders, or any other requirement should be complete before the call for the blood. The blood should then be started immediately so that they have the maximum 4 hours to infuse it. Every minute that passes is a minute faster they have to infuse the unit. That may be a problem for someone who cannot tolerate a rapid infusion. We do not want nurses letting the unit sit on a counter somewhere for an hour while they do other things.

Same as @AMcCord. We use MEDITECH and cold antibodies are listed as clinically insignificant in our rules table for determining if EXM will be allowed. For those who are panicking, note:
EXM will be rejected if the CURRENT antibody screen is positive EXM will be allowed only if the CURRENT antibody screen is negative and THE ONLY antibody listed in the patient's history is a cold antibody. EXM will be rejected if any other clinically significant antibody is present, regardless of the current antibody sreen. That's how we handle it.

It is possible to designate a cold reactive antibody as not clinically significant in our BB LIS system. We report them as we would any other antibody. We can add a 'special needs' requirement for an AGT crossmatch to the patient profile, if appropriate/necessary for the antibody in question, when a 'clinically insignificant' antibody is reported. Our system is also set up to flag all red cell units issued for patients with antibodies, including clinically insignificant, if antigen screening was not performed. That flag is included in the daily system review report. We don't remove a cold antibody ID from the LIS, but can inactivate the AGT crossmatch requirement if the antibody is no longer detectable. I have no references for that.

We order and perform ABORH confirmations as needed. 
In your situation, I would probably discuss with the preop team that any ABORH confirmation drawn that is not required will be cancelled by our blood bank team to avoid wasting reagents and time. If they insist that they want it done on all patients, perhaps a discussion with the person driving that decision is necessary. It could be that the person had an experience at another facility where a mistype happened and is now being overly cautious. That may not be a bad thing.

We have cubicles and workbenches made by some company that is a guy's name, Howard something?  That's useful information, right?

I was wondering how other facilities are meeting the requirements for CAP TRM.41300 and AABB BBTS 5.28.3 regarding the bedside verification performed by nursing staff before transfusion.  We were recently cited for no documentation that nursing staff was reviewing the interpretation of crossmatch testing and if special transfusion requirements are met (CMV, Irradiated, etc).  We have that information included on the transfusion report that goes with the product to the nursing unit.  We use the Bridge administration system and it records all of the other required information by scanning the patient armband and the blood product.  Also the nurses have to answer questions in Bridge before they start the transfusion, such as  1. consent form signed? 2. physician order reviewed?  along with some other information.  
I am wondering how other facilities document what information the nurses are checking.  I can add an additional question in Bridge to document that the nurse has checked for special transfusion requirements ordered by the physician but I am not sure how to proceed with the crossmatch interpretation.  Nearly all of our crosssmatches are compatible and the RN could document that in Bridge, however what do you all do if you have to give least incompatible units as in the cases of warm autos?  It is marked that way on our transfusion reports but I am imagining some of the nurses not understanding the situation and not wanting to take responsibility for giving the unit.
Any suggestions, advice or how you handle these situations is greatly appreciated!

Have you asked the vendor who is providing the automation line for a Six Sigma or Lean evaluation of your lab? They may be able to provide recommendations for furniture and storage.

Have you asked the vendor who is providing the automation line for a Six Sigma or Lean evaluation of your lab? They may be able to provide recommendations for furniture and storage.

We order and perform ABORH confirmations as needed. 
In your situation, I would probably discuss with the preop team that any ABORH confirmation drawn that is not required will be cancelled by our blood bank team to avoid wasting reagents and time. If they insist that they want it done on all patients, perhaps a discussion with the person driving that decision is necessary. It could be that the person had an experience at another facility where a mistype happened and is now being overly cautious. That may not be a bad thing.

We use MEDITECH. We have an order built called EMISS (EMERGENCY ISSUE). We enter the electronic order anytime we have to give uncrossmatched products. The order requires the requesting physician to electronically sign off on the order. If they do not, their privileges are revoked and they are locked out. This is the same process used for any telephone orders from physicians. We have had 100% compliance with this for more than 15 years using this process. Our hospital compliance department follows up for signatures that are outstanding. The process works and is compliant. 

We use MEDITECH. We have an order built called EMISS (EMERGENCY ISSUE). We enter the electronic order anytime we have to give uncrossmatched products. The order requires the requesting physician to electronically sign off on the order. If they do not, their privileges are revoked and they are locked out. This is the same process used for any telephone orders from physicians. We have had 100% compliance with this for more than 15 years using this process. Our hospital compliance department follows up for signatures that are outstanding. The process works and is compliant. 

We use MEDITECH. We have an order built called EMISS (EMERGENCY ISSUE). We enter the electronic order anytime we have to give uncrossmatched products. The order requires the requesting physician to electronically sign off on the order. If they do not, their privileges are revoked and they are locked out. This is the same process used for any telephone orders from physicians. We have had 100% compliance with this for more than 15 years using this process. Our hospital compliance department follows up for signatures that are outstanding. The process works and is compliant. 

Correct. That is why we typically use 5.5 as the upper set point instead of 6.0. If it alarms at 5.6, you are still covered and have time to move product before it reaches the upper limit. I think that is why I am confused by the OP's citation. I wonder if they have it set to 6.0