Jody Posted December 23, 2006 Share Posted December 23, 2006 Standard of practice issue. We have always offered full blood types and Rh only if requested. I have been doing some checking around since we are building a new computer system. Some of my contacts do not offer a RH only. Please let me know your facilities practice and if you have ever had any compliance issues if you only offer full blood types. Link to comment Share on other sites More sharing options...
Mabel Adams Posted December 23, 2006 Share Posted December 23, 2006 We don't offer Rh types alone. We have had no compliance issues. Link to comment Share on other sites More sharing options...
John C. Staley Posted December 26, 2006 Share Posted December 26, 2006 We do offer Rh only and the ER takes us up on it with alarming frequency. A young pregnant woman comes in for any number of reasons and all ER wants to know is if she is Rh neg or not for RhIG. If she is then we do the full work up if she is Rh pos then they go on their merry way. Link to comment Share on other sites More sharing options...
lef5501 Posted December 26, 2006 Share Posted December 26, 2006 We do the same as John, but I am not thrilled about the Rh only thing. Link to comment Share on other sites More sharing options...
John C. Staley Posted December 27, 2006 Share Posted December 27, 2006 I'm curious as to why doing only an Rh makes people so uncomfortable. That's all they need or want to properly care for the patient, why try to force more on them? Link to comment Share on other sites More sharing options...
bevydawn Posted December 27, 2006 Share Posted December 27, 2006 We don't offer an Rh only type, it's all or nothing. I can understand why they would only need the Rh type, but it's never been offered that way here and so far, there have not been any compliance issues. Link to comment Share on other sites More sharing options...
Lcsmrz Posted December 28, 2006 Share Posted December 28, 2006 I prefer to give them only what they need - Rh only for RhIg candidacy is fine with me! Link to comment Share on other sites More sharing options...
rcurrie Posted January 2, 2007 Share Posted January 2, 2007 We do the same as Wally ... er ... John- we give'em what they order. Rh only makes sense when the only concern is whether RHIG is needed. In law, the issue is always relevancy. If it isn't relevant, then it doesn't come in as admissible evidence. So, applying the same to medicine, why would we give information that is not needed? Why cloud the picture with unnecessary information? If you want to do an ABO just for your records, go ahead. But don't require the physicians to accept more info than they ask for.BC Link to comment Share on other sites More sharing options...
Mabel Adams Posted January 5, 2007 Share Posted January 5, 2007 My boss says we aren't supposed to do any tests that aren't ordered (although we don't offer the Rh alone) because it is fraud or something. It also has to do with being legally liable for having info about a patient that we need to provide to the doc. I am sure you could clarify some of this for us, Bob. Link to comment Share on other sites More sharing options...
rcurrie Posted January 5, 2007 Share Posted January 5, 2007 First, let me say that my reply is in no way intended to establish an attorney-client relationship, and just represents my opinion in reply to a hypothetical question based on my knowledge of the law in general. If you have a real issue, you should consult an attorney to get an opinion as it applies to your real case.You ask about liability. I ask, liability for what? An ABO determination in order to complete your routine records establishes no liability. In fact, it is good practice and actually helps establish patient safety if transfusion is needed at a later date or time. I don't think there is any issue of fraud here if you decide to have a policy of determining ABO/Rh on all specimens submitted for testing (or any other policy you may decide is prudent for operating a transfusion service). There is no need to provide the physician with the information that I can see. But let's say you performed a test such as an antibody screen because that was your policy, and it was positive. Well, Mabel, the issue, as always, is if you have a duty owed to the plaintiff, who would be the patient. In order to have a duty, you have to have a relationship with the patient, and that can just about always be established, even though it is an indirect relationship. You do have a direct relationship with the physician of the patient, though. Your duty would be to notify the physician of the abnormal results. That is what we call the duty to warn. Once you have done that, you have met your legal obligation to the plaintiff. I do not believe you have a duty to notify the patient directly. That's my take on having a policy to do an ABO when an Rh only is ordered. It is good practice, and I can't see where it is fraud or where it establishes any duties beyond the duty to notify the physician of any abnormal results.BC Link to comment Share on other sites More sharing options...
Mabel Adams Posted January 6, 2007 Share Posted January 6, 2007 Of course, the boss doesn't want us doing any work we don't get paid for. Charging for unordered work is fraud, I think. I appreciate your clarification. Thanks. Link to comment Share on other sites More sharing options...
John C. Staley Posted January 8, 2007 Share Posted January 8, 2007 Wow Bob, nice lawyer talk. Here I thought you were just funnin about being a lawyer. ;>) Another issue is the charge. If you are charging for testing not ordered that can be a rather "sticky wicket". I guess if you don't offer an Rh only possibility and the Doc has to order all or nothing this probably won't be an issue.Can I get just a glucose or do I have to order a complete chem profile? Quite a deep and dark hole once you start looking at it. Link to comment Share on other sites More sharing options...
rcurrie Posted January 8, 2007 Share Posted January 8, 2007 I actually have the credentials, John, but not the license. I completed law school in June 2005. I do not practice, although I do consultation work on occasion, and I write appellate briefs for a friend. As long as I work under another attorney's license, I don't have to pay that $3,000 a year malpractice insurance or the $2,000 in bar membership dues. Medical residents do the same thing, at least in my state.Back to doing unordered tests: there is nothing wrong with having a policy to perform an unordered test such as the ABO. You can even charge for it if it is your policy that you do not offer one test without the other, such that one cannot order an Rh without getting an ABO. This is okay as long as you publish your test list and make it plain that you will not do a separate Rh without the ABO. We don't do that. We will give the physicians what they order. But, we will also perform the ABO as part of our patient history, although we do not charge for it. There is no fraud unless you charge for something that was not ordered.BC Link to comment Share on other sites More sharing options...
Kathy3171 Posted January 16, 2007 Share Posted January 16, 2007 I thought the issue of fraud was that you can't charge a patient for a test the doctorhas not orderd, if theyorder only an RH, you should not charge them for a complete type. Our computer is such that it will only record a full type in patient history so if the doctor only order an Rh, we perform the full type (which goes into computer history) but only charge for the Rh. Link to comment Share on other sites More sharing options...
jhaig Posted March 19, 2007 Share Posted March 19, 2007 We also offer Rh only and have had no issues with the test as far as compliance. If the doctor wanted to know the ABO, it would have been ordered. I may run one for my own knowledge in case an RBC transfusion is needed later (this would give me a head start as far as preparing units for crossmatch), but that result is never reported to the physician unless there is an actual order. What the doctor doesn't order, the doctor doesn't get. :cool: Link to comment Share on other sites More sharing options...
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