StephanieM Posted October 13, 2012 Share Posted October 13, 2012 I realize this may have been answered in previous threads but the few I have looked at did not mention this aspect of the Emergency Release form.When an emergency release of blood and/or blood products are requested, how long do you all give the ordering physician to sign the release form?When I first started, we brought the cooler up to the requested area and had the physician to sign right then. Eventually it changed (probably due to the off hours when the doctors aren't on location) to where they had up to 24 hours to sign.This has worked well for us until recently. We had a doctor order Stat FFP on a patient who did not have a current specimen. The nurse taking care of the patient called the BB tech saying the Nurse Practitioner did not want to wait on the specimen to make it to the lab and for the testing to be done, she wanted the FFP emergency released. AB neg FFP was thawed and issued as an emergency release, the patient had an allergic reaction, the original doctor who ordered the FFP tore up the release form saying he wasn't signing it because he only wanted it STAT not Emergency. Come to find out the Nurse Practitioner knew he didn't want it as an emergency release but she ordered it anyway....leaving us with no one to sign the release form. Because of this we are not suppose to issue emergency release products until we have a physcian's signature.Have any of you had issues like this? What did you do? And again, how long do you give for a signature? Link to comment Share on other sites More sharing options...
SMILLER Posted October 13, 2012 Share Posted October 13, 2012 Sounds like the nurse practitioner is in trouble for that one case if I read it correctly. But such a mix up must occur only rarely.We give our docs 24 hrs, but make every effort to get the release signed ASAP after the patient is stablized.Scott Link to comment Share on other sites More sharing options...
Eagle Eye Posted October 13, 2012 Share Posted October 13, 2012 They should look at NP's job description and take necessary action to prevent this. This is more like some one not following policy/order. I would not change the practice based on at least this incident. Link to comment Share on other sites More sharing options...
BBCLS Posted October 14, 2012 Share Posted October 14, 2012 I realize this may have been answered in previous threads but the few I have looked at did not mention this aspect of the Emergency Release form.When an emergency release of blood and/or blood products are requested, how long do you all give the ordering physician to sign the release form?When I first started, we brought the cooler up to the requested area and had the physician to sign right then. Eventually it changed (probably due to the off hours when the doctors aren't on location) to where they had up to 24 hours to sign.This has worked well for us until recently. We had a doctor order Stat FFP on a patient who did not have a current specimen. The nurse taking care of the patient called the BB tech saying the Nurse Practitioner did not want to wait on the specimen to make it to the lab and for the testing to be done, she wanted the FFP emergency released. AB neg FFP was thawed and issued as an emergency release, the patient had an allergic reaction, the original doctor who ordered the FFP tore up the release form saying he wasn't signing it because he only wanted it STAT not Emergency. Come to find out the Nurse Practitioner knew he didn't want it as an emergency release but she ordered it anyway....leaving us with no one to sign the release form. Because of this we are not suppose to issue emergency release products until we have a physcian's signature.Have any of you had issues like this? What did you do? And again, how long do you give for a signature?We ask our doctors to sign the emergency release orders in the computer. So far the last audit was 100 %. Link to comment Share on other sites More sharing options...
StephanieM Posted October 14, 2012 Author Share Posted October 14, 2012 I know, I hate changing the policy because of one person. We had talked about the mid levels not being able to authorize emergency release but it seems like there are more NPs or PAs treating and ordering everything on patients so how can we really say yes you can do everything but make the call for an emergency release??? And yes, the NP should definetly be held accountable for this. I know the doctor was upset about it and I'm sure my pathologist is planning on speaking to her. I had placed a Midas report on her and I was told nursing was doing one as well...I did find documentation in the nursing notes that the NP ordered an emergency release but as to being able to sign emergency release orders in the computer??? As of now our system isn't capable of this. The Lab and the rest of the hospital have different computer systems. I can get on and look at the other side but most other people in the lab can not so if they did add it to where the doctor could electronically sign, it would have to be set up to cross to HLAB too. I'm sure it should be something that can be done but how is the compliance with this? We have just started CPOE and it has been a challange for some of the doctors.... Link to comment Share on other sites More sharing options...
BBCLS Posted October 15, 2012 Share Posted October 15, 2012 I know, I hate changing the policy because of one person. We had talked about the mid levels not being able to authorize emergency release but it seems like there are more NPs or PAs treating and ordering everything on patients so how can we really say yes you can do everything but make the call for an emergency release??? And yes, the NP should definetly be held accountable for this. I know the doctor was upset about it and I'm sure my pathologist is planning on speaking to her. I had placed a Midas report on her and I was told nursing was doing one as well...I did find documentation in the nursing notes that the NP ordered an emergency release but as to being able to sign emergency release orders in the computer??? As of now our system isn't capable of this. The Lab and the rest of the hospital have different computer systems. I can get on and look at the other side but most other people in the lab can not so if they did add it to where the doctor could electronically sign, it would have to be set up to cross to HLAB too. I'm sure it should be something that can be done but how is the compliance with this? We have just started CPOE and it has been a challange for some of the doctors....LIS takes care of the computer link, BB Quality Assurance takes care of compliance, Pathologist takes care of ordering doctors. I believe we have a system. Link to comment Share on other sites More sharing options...
tbostock Posted October 15, 2012 Share Posted October 15, 2012 We make them sign in person. If the situation is critical enough to ask for uncrossmatched blood, the doc needs to sign. Sometimes by the time they are done arguing about who will sign, that the half hour is up, and the blood is now crossmatched. Link to comment Share on other sites More sharing options...
DOGLOVER Posted October 15, 2012 Share Posted October 15, 2012 I just tell the nurse that this uncrossmatched and if i her I wouldn't be hanging it without the physicians signature as then she would be repsonsible. This tactic works very well. Link to comment Share on other sites More sharing options...
Deny Morlino Posted October 16, 2012 Share Posted October 16, 2012 Nursing signs at the time of unit issue. If the doc is available we get that signature as well. Most times the physician is a bit "preoccupied" with the patient's care. After things calm down a bit we approach the physician for signature. This works well for our situations. Link to comment Share on other sites More sharing options...
kate murphy Posted October 16, 2012 Share Posted October 16, 2012 Just an FYI - we are am extremely busy level 1 trauma center - at least 5 emergency release patients per day. We were cited by FDA and AABB 2 years for having a "designee" (RN) sign the form. Both FDA and AABB stated that the ORDERING licensed provider (MD, PA, NP) MUST sign the form. A time frame was not stated - both agencies agreed that before or shortly after is okay, but the ORDERING person must sign. Link to comment Share on other sites More sharing options...
Eagle Eye Posted October 16, 2012 Share Posted October 16, 2012 Also check the licensed provider definition in your state as some state doesn't allow PA to order blood products same as NP. In some states PA need to consult &/or need co-sign of physician. Link to comment Share on other sites More sharing options...
sgoertzen Posted October 16, 2012 Share Posted October 16, 2012 AABB Standard 5.25.5 requires a signed statement from the requesting physician. CAP requirement TRM.40770 also states that you must have records of emergency release (documented) authorization by a qualified physician. Neither make an allowance for a PA or NP or RN. It must be the physician, but there are no specified time frames for getting the signature. Link to comment Share on other sites More sharing options...
Deny Morlino Posted October 17, 2012 Share Posted October 17, 2012 I just reread my reply and guess I should clarify. The RN signs the release for having been issued the units. The physician signs as to the necessity of emergency release, the number of units, etc. Sorry for the confusion. Link to comment Share on other sites More sharing options...
tms8313 Posted October 18, 2012 Share Posted October 18, 2012 We are also a busy Level 1 trauma center and were cited by CAP and AABB for allowing nurses to sign the emergency release forms. We had to change our policy to only allow physicians to sign the form. We try to get the signature at the time of delivery but patient needs supersede our form so we sometimes have to follow up later. The doc may physically sign the form or more commonly will electronically sign the form which we can print from the patient's chart. We don't specify a specific time limit, but they rarely need a reminder phone call from us, it's usually pretty quick. Link to comment Share on other sites More sharing options...
Likewine99 Posted October 19, 2012 Share Posted October 19, 2012 I (the Blood Banker) worked on the EHR team in a very large trauma center and we were moving towards having an electronic signed "order" be part of the physician order set in the ED. The idea being that this electronic order was mirrored after the AABB and CAP standards for emergency release. The Bld Bk would receive a printed copy of the order in the BB and write the SOP to state that upon receipt of the order it was the documentation that an order had been signed.We tried it several times, never could get it to print or the order never was placed in the first place. Compliance was dismal at best and the poor BB sup ran all over the place to try and get the proper paper documentation. The saga continues. Link to comment Share on other sites More sharing options...
apfelblosm Posted October 20, 2012 Share Posted October 20, 2012 I also work in a very busy Level 1 trauma center. We allow 48 hours for them to sign and return, but I have to admit they are not very good about it. We are also a teaching hospital so that adds to the headaches in this area. If they don't sign, then we create an addenduem with the patient information and the units and have the ordering physician sign that at a later time, but we log a "problem" in our area so that these are tracked for trending purposes. Link to comment Share on other sites More sharing options...
mollyredone Posted October 22, 2012 Share Posted October 22, 2012 We send down a release form with the emergency units, usually someone from the ER picks up the units. We make a photocopy of the form when we set up the units as emergency release, and will follow up with that if the other one gets lost in the ER. We don't have a time limit but try to get it within 24 hours. Link to comment Share on other sites More sharing options...
aafrin Posted October 23, 2012 Share Posted October 23, 2012 Can anyone please post their Emergency Release Form as attachment here. At our hospital we have a Blood Waiver Form for physician to sign, but now the doctors are saying that it should have a minimum 2 doctor's signatures - one the primary physician/surgeon and other the A & E Dept. physician or intensivist, plus the patient's nominee's signature stating I agree or accept, which I find puzzling. Do your forms have these many signatures? Link to comment Share on other sites More sharing options...
mollyredone Posted October 23, 2012 Share Posted October 23, 2012 Hopefully I am attaching a copy of our emergency release form...[ATTACH=CONFIG]652[/ATTACH]Mari Link to comment Share on other sites More sharing options...
tbostock Posted October 23, 2012 Share Posted October 23, 2012 We bring the Emergency Release to the bedside with the units and the ordering physician MUST sign or the blood is not released to them. No second physician's signature is required (nor is that a regulatory requirement). We also do not require the patient or proxy to sign anything other than the normal blood transfusion consent. If they need Emergency Release, the patient should not be in any condition to sign anything anyway. And their proxy/designee would probably check off anything in the heat of the moment out of fear. Not sure of the value of what they are asking you to do. Seems a little overkill to me. Link to comment Share on other sites More sharing options...
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