Signed emergency release statement

[Mabel Adams]

Does anyone use their computer system to capture "a signed statement from the requesting physician indicating that the clinical situation was sufficiently urgent to require release of blood before completion of compatibility testing..."? I was thinking if it was defined sufficiently in the computer, having an order entered in the HIS by the physician (or signed off by him later) for uncrossmatched blood could meet this AABB requirement and we wouldn't have to mess with chasing a piece of paper. Has anyone tried this and did it work?

[Mabel Adams]

I'll take that as a no.

Can anyone think of any reason why it would not be permissible to capture this signed statement electronically if we have an electronic medical record system that captures MDs "signatures" via orders they enter? Or why it would be a bad idea?

[eeagan]

We are in the process of switching to physician ordering through UCare computer system. Part of this process will include an electronic signature by the physician for emergency release blood. Because we have not gone live with it, I cannot comment on how well it is working. But I look forward to having this option as it will be easier than getting a piece of paper. If an electronic signature is valid for medical records and on line review fo procedure,s I see no reason why it isn't valid for emergency release.

[L106]

I have a question.....How will it be possible for the physician in Emergency Dept or Surgery (who is obviously treating the critical patient) to stop and sign into the computer system to generate the request (and electronic signature) for emergency release of blood?

[eeagan]

That's a very good question and I don't have an answer for it. It still may work out that the order is placed after the actual emergency release has been done. But I do know that there is an option in the computer for the physician to request emergency release blood.

[L106]

Thanks, eeagen. I would be concerned that if the doc could sign for emergency release of blood after the fact (either electronically or actual signature), we'd have a hassle ever getting his/her signature probably half the time. (And it would be Blood Bank's problem the next time the FDA inspector shows up at our door.)

[Mabel Adams]

We usually have to get signatures after the fact even on paper so that problem wouldn't change for us. Yes, it is sometimes difficult. The regs just say you have to have a statement on file, not that it must be in advance of transfusion. The way our HIS system that uses EMRs works is that a nurse or secy can enter the order as a verbal, but the dr. has to sign off on all verbal orders later. Since it is just the click of a mouse it might be easier to get done than paper.

[bbbirder]

We haven't done this for emergency issue, but I think it is an excellent idea! We do have physician signature on file for our trauma protocol, when we automatically take 2 O negs to our Emergency Department, and this seems to cover for these first 2 units.

Linda Frederick