Emergency Release Physician Signature in EPIC

[evee53 ★]

Hello everyone

this topic was explored last year and I am hoping that those with insight/experience will weigh in.  

We have EPIC and SunQuest (older version right now) in our lab.  Our emergency releases are called to the Blood Bank and then a form for signature is sent.  Our physicians have requested that we implement a mechanism in EPIC for signature.  We have not found a way to do that as of yet.   It is typically nursing or a resident MD entering the orders and not the attending physician, as the attending physician (usually Trauma) is busy taking care of the patient.  I would appreciate any information as to how anyone was able to institute signature/acknowledgement statement in EPIC of the emergency release by the attending physician responsible.  If you could share your process, that would be great. 

Many thanks in advance. 

[Cliff]

This sounds like a great option, if it exists.

Hopefully someone has attempted it and can offer suggestions.

[David Saikin]

I am working on a system in which the MD documents the need for uncrossmatched product in the medical record.  It still takes a phone call but i'm trying to get rid of the paper chase which follows.

[Johnv]

In Cerner after UNXM units are issued, the Blood Bank tech orders the a UNXM test with the release statement attached. It goes right to the physician's inbox for their electronic signature.  It's not perfect because although the physician is suppose to approve immediately after the trauma, in some case you still have to hunt them down to sign.  It has the advantage of allowing the ordering physician to complete the approval signature where ever they are or where you find them, ie. on the beach in an exotic south seas island.          

[sgoertzen]

When blood bank is called to release uncrossmatched blood, we specifically ask who the ordering physician is. The blood banker then places an order in EPIC called "Release of Uncrossmatched Blood" which is the statement (taken from AABB Standards) about the situation being critical enough to warrant the release of blood before compatibility testing is completed.  This order must be electronically co-signed in EPIC by the physician that we name as the ordering physician.   We have EPIC and WellSky (Mediware HCLL), but it shouldn't matter what blood bank computer system you have since this is all done (ordered/cosigned) in EPIC.  I'm attaching our uncrossmatched worksheet that includes the instructions that we follow to place this order in EPIC and assign it to the ordering physician for co-sign.  I check each day to make sure it gets co-signed. Once signed, I print the order with the co-sign tracking information, attach it to our worksheet, and file the paperwork for easy retrieval during future inspections/assessments.   

TO-381F01 Release of Uncrossmatched Blood.docx

[evee53 ★]

Thank you very much for the responses and form.  I will bring them to our committee meeting and see if we can enact them.    

[slsmith]

We have EPIC and the electronically signature of physician ordering is included in the "emergency uncrossmatched red cell " order that is placed by the RN. I imagine it works the same way as sgoertzen says but it is the RN or Resident putting in the order, not the lab

[RKB1988]

This is interesting.  We had the Emergency release order placed/signed by the physician in Epic.  FDA inspected sited that the physician signing and order wasn't enough because we had to also include the clinical reason the blood was requested and the AABB statement.  I added order questions in epic with answers like "acute blood loss" but in the end we opted to just keep the paper form to avoid any more scrutiny from FDA.

[applejw]

Our facility has built the attestation statement as part of the Emergency Released order set. We implemented this after our last FDA inspection in 2019 so don't have any feedback from them yet.  We also use a triplicate form that documents the diagnosis, date and units that were issued during the process.

[Sonya Martinez]

On 8/26/2021 at 7:26 AM, applejw said:

Our facility has built the attestation statement as part of the Emergency Released order set. We implemented this after our last FDA inspection in 2019 so don't have any feedback from them yet.  We also use a triplicate form that documents the diagnosis, date and units that were issued during the process.

Applejw, what tests/products are in your Emergency Released order set?  If possible can you share your SOP?  Thanks