When physicians are required to sign for high-risk transfusion (ex. presence of warm auto and no compatible product), what frequency of signature do you require? 

1.  Signature with each transfusion order

2.  Signature once for length of specimen

3.  Signature once for length of admission

We will do it for every new order. Our form has a place to put unit stickers on them. So, essentially, the physician signs for however many units we put a sticker for. Any more after the initial units, we require a new form. This also kinda serves as a reminder to physicians that their patient has special blood bank circumstances.

I think these bureaucratic methods corrode the trust and collegiality felt by our bedside practice colleagues.  High risk patients require discussion between the medical staff of the transfusion service and the ordering provider, and a note in the medical record documenting the decision making. Signing forms is a another tip of the hat to bureaucracy and legalese that should have no role in the provision of medical care.  A joint responsibility for such decisions and documentation is far more humane and in the interests of good patient care.  Neither the FDA nor regulatory agencies require such divisive practices and we should abandon them for better patient care and documentation of shared decision making. I realize some of you do not have knowledgeable and enthusiastic physician support, but this responsibility needs to be taken by the transfusion service medical director, who is paid to do so, however reluctant and happy to dump this on medical technologists.  Just saying.

Signature each admission.  After discussion, this is usually done by a hematologist.  (It is really not that big of a deal "bureaucratically" for us.  Perhaps large medical centers have more turf issues with this type of thing.)

Scott

signature for the length of the specimen.  New workup= new form.  I am pretty sure they don't even read it  

To answer simply, option #3. However, normally we have documentation filled out to express the intentional deviation from procedure that denotes it was per MD approval. These sort of things end up becoming a larger discussion between the transfusion medicine doctors and the pt care team, and then the lab is notified one way or the other. If the MD selects specific products to use, those products and Unit Numbers are also documented.

We have an Exception Form that is used when we are going to make an exception to policy.  Sometimes it is signed and sometimes not.  It depends on the exception.  If signed, it may be signed by either a pathologist or the patient's attending.  This is dependent on what the exception is.  When I was supervisor of blood bank, it was used most often because of supply issues.  That may not be the case any longer since we now make no distinction between CMV negative and CMV safe products.  Well, except for stem cell transplant patients.`

Each transfusion order