Emergency Issue / MTP

[DANDERS]

I am wanting to go paperless with Emergency Issue and MTP.  How do you meet the requirement for capturing the Dr's signature for taking responsibility for the uncrossmatched blood? 

[jhoannac]

Following this thread.

We are still having our providers physically sign an emergency release form.  This form gets scanned into the chart and then shredded afterwards.

[Ensis01]

While I understand the convenience of making MTPs and emergency release a paperless process. I regard the physical signature a good reminder that issuing uncrossmatched blood must not be taken lightly. 

[Mabel Adams]

We have a statement on the order in Epic that they click.  It's a slightly abridged version of the 
AABB regulation.  I don't think the signature ever made them think twice where I have worked.  They didn't usually sign it until after the fact anyway.  We still have the paper version if needed but seldom do.

[jayinsat]

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. 

[BankerGirl]

On 3/7/2023 at 5:41 PM, Ensis01 said:

While I understand the convenience of making MTPs and emergency release a paperless process. I regard the physical signature a good reminder that issuing uncrossmatched blood must not be taken lightly. 

We scan the form to the EMR and the physician signs it electronically.  We recently had a physician who refused to sign the uncrossmatched form when the patient first started hemorrhaging but then called an MTP.  Of course, the MTP was discontinued a few minutes later and he sent back everything except 4 RCs and a platelet.  No idea what he was thinking, but he did sign the form.    

[John C. Staley]

What I noticed over the years was that many times when faced with signing for uncrossmatched blood the physician would take a second to reevaluate the situation.  Often they would then respond with something like,  I want it crossmatched so hurry.   Not always but it was not uncommon or rare.  When they did sign the form it was most often when the crisis had resolved and the dust settled.

 

[Malcolm Needs ★]

4 hours ago, John C. Staley said:

When they did sign the form it was most often when the crisis had resolved and the dust settled.

 

I can fully understand what you are saying (and agree almost 100%), but I do have some sympathy for them signing the forms "after the event" as it were, because when they do have to use the uncrossmatched blood that quickly, then they are going to be pretty busy doing things like preventing the demise of the patient - if you see what I mean!!!!!!!!!

[John C. Staley]

Malcolm, I meant that statement not as a criticism of them but just a recognition of reality.  Frankly I was excited to get the forms back most of the time and fully understood the pressure they were under.  When I was in school I worked in the emergency room on night shift so I was very familiar with trauma situations and fully understood the, "do it now and worry about the paperwork later" mentality. 

Cheers  

[DPruden]

Most of our MDs order the MTP in Epic fairly real time, and if they don't the Blood Bankers enter the order with a required co-sign.

[Andrea Pointer]

Our facility uses Cerner Millennium. We have a lab orderable that we place on the chart as "verbal" order type that routes for signature. As for the emergency crossmatch tags we use, we designed them with a space for two people to mark that they ID'd the patient, then space for who transfused and data/time. If not signed/returned, I follow up with the director of whatever unit for follow up. I will either fill in the info myself or have the person back to fill out the paperwork. If the person who didn't fill out the paperwork only emails me the information, I will fill it out, then save the email with the rest of the paperwork for audit purposes. 

After two months of this, the nurses are at 7% compliance. the Lab is at 100% compliance with our part (does that surprise you??? LOL). So, not great. But, everyone I have talked with (and all of you) seem to have the same struggle. This may just be something we never fully hash out.

[JJSPLAYHOUSE]

@jayinsat, how is EMISS set up in Meditech? Do you have the dictionary parameters for the physician signature process? I would love to move our facilities to this.

[jayinsat]

On 4/10/2023 at 1:45 PM, JJSPLAYHOUSE said:

@jayinsat, how is EMISS set up in Meditech? Do you have the dictionary parameters for the physician signature process? I would love to move our facilities to this.

It is an orderable test. When it is ordered with the source "Emergent/Triage," it triggers the physician electronic signature requirement. With HCA, we have LIS coordinators that build these things. I do not know how to set up the parameters. Sorry.