Emergency Release

[lgabbert]

I am being pressured to do emergency release units without a label. I have contacted CAP, and they said I need two identifiers. What policies are out there? Do any of you give O neg units without two patient identifiers?

[adiescast]

Two IDs are required for everything. This can be your trauma number and medical record number or a medical record number and an independent bracelet number if the patient is unidentified. It also has to prominantly state that the unit is uncrossmatched, which can be done with a preprinted sticker. We put the minimum required information on a transfusion tag and a sticker for the unit.

[Dansket]

I am being pressured to do emergency release units without a label. I have contacted CAP, and they said I need two identifiers. What policies are out there? Do any of you give O neg units without two patient identifiers?

Is your facility a trauma center? Was there a specific incident that triggered this request? How quickly can your staff issued uncrossmatched blood? Do you use a blood bank computer system? We will issue group ONEG rbcs from our Meditech system with only the patient name, usually John Doe using a customized NPR report. But we are not CAP accredited.

[lgabbert]

We are not a trauma center. We use Meditech, and issue with emergency release. We had someone sent from the floor to get "Universal Blood", but that person had no information about patient, not even a name even though patient was in house, so they were sent to get info. Now nursing wants to change policy because it took too long. I think education would be better here than changing policy.

Thanks for input.

[ANORRIS]

I am being pressured to do emergency release units without a label. I have contacted CAP, and they said I need two identifiers. What policies are out there? Do any of you give O neg units without two patient identifiers?

Reviewing the CAP checklist 9-25-2012...TRM.40770....It does not state that any identifiers must be on an emergency released unit of blood, just a label stating Uncrossed. If the patient is a trauma John Doe that has not had time to be registered, how can any identifier be placed on the unit? There would be no MR number yet.

[R1R2]

Reviewing the CAP checklist 9-25-2012...TRM.40770....It does not state that any identifiers must be on an emergency released unit of blood, just a label stating Uncrossed. If the patient is a trauma John Doe that has not had time to be registered, how can any identifier be placed on the unit? There would be no MR number yet.

I agree with you Anorris. CAP may be a little off base with their answer to original poster's question.

[PAWHITTECAR]

Even a trauma just walking in the door can be identified in some way even if it is white male with stab wound. I really have a hard time with the thought of handing them blood with no idea where it is going. Slap a generic typenex band on him them his name can be RJZ 2414 white male.

[cthherbal ☆]

I agree with others that 2 identifiers [we use name and DOB (or Med Rec#)] should be there.

Name could be John or Jane Doe, and a fake DOB or assigned MR# (if not known). Even though not official, these things identify that blood to that patient even if the patient is eventually ID'd and the two accounts gets merged into one.

[SMILLER]

We are not CAP certified, (JCAHO and FDA), but i would be surprised if CAP had nothing about being able to connect a particular unit, uncrossed or otherwise, to a particular patient.

Its not that big a deal to have a list of "John/Jane Doe" numbers in your ER for use when an unidentified patient comes in. We occasionally have drop-offs left at our ER and they still have time to supply an interim Doe ID and med rec number.

In most cases, EMS is doing triage as they come in from the field and we have lots of heads-up time to get armbands and whatnot ready to go. In many cases of orders for uncrossed blood for ER, we have the cooler down there with properly ID'd products before the patient arrives. This is pretty common practice if I am not mistaken.

Scott

[lalamb]

Our ER has ready made "Trauma" Id packs....hospital labels w/fake names (Sunset, Obee One Kenobee) and fake MRN's.

Our trigger to get uncrossmatch O neg units ready is a phone call (we need blood) and a name (fake one or a know one)

We have Cerner and freetext the name in so there is a name that prints on the tag...no MRN at this time is on the Emergency tag.

Red "uncrossmatch blood" labels are put on the unit and all 3 copies of the tages.

Once pt is ID'ed, the info is merged.

Edited February 6, 2013 by lalamb

[carolyn swickard]

We are not a trauma center. We use Meditech, and issue with emergency release. We had someone sent from the floor to get "Universal Blood", but that person had no information about patient, not even a name even though patient was in house, so they were sent to get info. Now nursing wants to change policy because it took too long. I think education would be better here than changing policy.

Thanks for input.

I absolutely agree with you. With any in-patient, you should have had at least the name of the pt and then you could have used the Meditech Emergency release screens and had a very nice tag for the unit and a complete computer trail of who, what , when and where. No real excuse on nursing's part to not have supplied that data.

We do also have a manual Emergency release form that can be taken to the bedside and filled in there and signed by the requesting physician then, that would have also allowed tracking of the incident and the units. I used that the one time (in 20 years) that we had to do Emergency release units to a floor, in-patient (pre-computer, I think). You give them a policy and it will be so long before it gets used again that no one will remember it. Tell them you will utilize your Emergency Room protocols in-house if ever needed again and make sure what you do for your ER is adequate - that way you will have only 1 SOP for Emergency Release blood.

[lgabbert]

Thanks to all for the responses!

[kate murphy]

It's not a CAP requirement, but a Joint Commission requirement. I would imagine that somebody on staff is knowledgable about JC requirements. You need to be able to track the unit to a particular patient. So you need some identifier. The FDA requires that all blood be tracked to a "final disposition" - transfusion into a patient is a final disposition. We're a large trauma center, so we use trauma packs described here by others.

[griffsh]

After releasing uncrossmatched O POS or O NEG blood should the transfusionist verify the donor number, ABORH and expiration against the bag tag? Can exceptions be made in emergency situations? When the patient is very critical is it acceptable to only verify that the blood is O POS or O NEG (depending on patient sex/age) and tagged as uncrossmatched?

[Mabel Adams]

The most important part of the bedside check on uncrossmatched blood is to make sure that the units being hung are truly uncrossmatched universal donor units and not from the cooler full of A pos crossmatched blood for a patient that just left the ED and they haven't had time to return to the blood to BB yet, but someone assumed must be the uncrossmatched blood they asked for. Never make assumptions is my motto. To keep patients safe they need to know the blood isn't expired. That transfusion slip is probably just a chart record. It could theoretically be a blank form in the patient's chart that the nurse adds a unit number sticker to. If it is printed in the BB by the same computer that printed the bag tag, the only purpose of comparing them for uncrossmatched blood is to make sure you have not swapped paperwork between units. One more argument for an electronic transfusion record--one less piece of paper to compare.

[griffsh]

Thank you for your response! My feeling is that 3 things should be verified- that the unit is O POS or O NEG (age/sex dependent), the expiration, and that the blood has a big orange uncrossmatched tag attached to it. The transfusion record accompanies the unit (not attached) and is put aside if they give the unit. In a trauma situation they just do not take the time to check the transfusion record against the unit. The doctor signs it later and then sends it back to the BB. I was trying to find some sort of regulation regarding the verifications required for uncrossmatched blood use other than a physician signature and haven't found anything.

[jalomahe]

For anyone out there with electronic charting -- how are you handling documentation of uncrossmatched blood? We still issue our uncrossmatched units with a hard copy form for the MD to sign. The form is supposed to be scanned into the patients electronic chart and the hard copy returned to us. Unfortunately the scanning rarely occurs so then there is no documentation in the chart and the return of the hard copy is not 100% which then takes time to track it down.

Our LIS receives orders and sends results to the HIS but other than that we have no access to the HIS for entering or scanning information.

[Mabel Adams]

We still use a paper copy but we have built an uncrossmatched blood order in the computer that has a statement with it that pretty much quotes the AABB standard about what the MD is signing for. My hope is to someday get them to use the order instead of the paper. Problem is, some computers will not let orders be written for patients not currently in their unit so if the patient moves from ED to OR to ICU and then the ED doc gets around to ordering the uncrossmatched blood in the computer, we would need to make sure that he (or the nurse he gives a verbal to) has access still. We do not have the order cause units to be ordered in the BB computer system because there are too many variables. If we need units ordered, we will enter the order (with the uncrossmatched order serving as the doctor's legal order). This also makes it workable if we get a frantic verbal request that we need to fulfill before the doc has time to enter the order.

[Mabel Adams]

Another caveat about emergency patient ID: we once had a trauma come in and a request for uncrossmatched blood which we issued. Within a few more minutes a specimen arrived from the ED. The tech scrambled to get the Type and Screen done and was about ready to crossmatch the uncrossmatched units when we found out that the specimen was for another patient in the ED and we hadn't even received the specimen for the trauma yet. Again, even if you are giving untagged, uncrossmatched, universal donor blood you need to establish positive patient ID fairly quickly. What if she had set up type-specific uncrossmatched units on him and sent them down? If ED nurses didn't check ID thoroughly then, A blood could have been given to an O patient. (This, of course, comes back to my belief that type-specific uncrossmatched blood should not be used until full patient ID checking can be done at every stage of the process and no one will be in too much of a hurry to do it.) Or just the confusion about which patient is the trauma could set us up for another mistake with all of the name changes and the like that happen in those cases.