Ideas and interpretation on Emergency Release forms

[apfelblosm]

Currently we have a very manual process for our Emergency Release and MTP processes. We are a 1250 bed, level 1 trauma center. We currently tag each unit ahead of time with a Emergency release tag with the attestation that requires the MD signature. The MD, currently, has to sign each tag which is labeled with the unit number, PC, type and patient information. There is no electronic charting for this until after the event.

We are looking to have the MDs sign off in the computer on an order. The order wouldn't contain the product numbers or how many products were given until after the event was over. The point is to eliminate the tags on every unit and having the doctor sign each of these tags which can be 30 tags in a single case. (We still have a "Uncrossmatched Blood" sticker on all the units even if this tag is removed)

The question is, if we are not able to build this in the computer and we have to continue doing a manual process, do we have to present the MD signing with the product numbers when he signs? The director would like to present the MD after the fact with a list of all the units that were transfused and then get their signature.

IMO, the doctor knows that he transfused units and a ballpark figure of how many units. The actually WBNs will be recorded in the blood bank for lookback, but the MD doesn't know, nor does he care, what the unit numbers are. If he really wanted to know, we could produce that information.

My peer believes that the standard 5.25.5 says that the doctor needs to know what units he is signing for.

Ideas? What is your all's interpretation? What do you do?

Thanks,

Jen

[goodchild]

All I see is "The records shall contain 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 or infectious disease testing." I don't think a doctor would have any use for DIN's.

[mollyredone]

We have an emergency release form that has a place for the Dr. to sign. We place unit stickers on the form, which we make up in advance for 2 ON units. If the Dr. needed more units, we would attach more stickers on the form, but he just has to sign the form for that number of units once. We also have a yellow manual card on each unit, but that is for transfusion recording. I can send you a copy of our emergency release form, but I think I attached it during another discussion. Try searching for emergency release forms.

[R1R2]

All I see is "The records shall contain 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 or infectious disease testing." I don't think a doctor would have any use for DIN's.

I agree with goodchild. This documentation can be completed after the emergency. You can present a document to the doctor with all unit numbers issued emergency release for one signature. Make sure your units or paper work are clearly labeled as uncrossmatched.

[mollyredone]

I did have a case recently where the Dr. wanted emergency release units on a patient we knew had two antibodies. I sent the paper to the ER and made sure I got the signature back before releasing the units.

[Changezi]

HI ALL , we have a emergency form, which is there in emergency ,the porter came directly with form to take the blood and is called

Emergency blood release form

1 = O neg without screening Un-Xmatch blood

2 = O neg screen blood Un-Xmatched

3 = Group to Group with immidiat spin

no of blood required ______

signed DR xyz

(P.s in case of more blood required we go for O+, depend on the stock )

but if the number of patient is more we do all documentation later after the emergency finished , because the situvation is totally diffrent when the number of patient becomve more like 10 or 20 or more than this its depend , but for routien emergency this form is okay its simple just one tick and signe and got the blood

[Mabel Adams]

We used a form where I used to work that had patient ID and the request for unxm that the dr signed. It was unrelated to the unit numbers or really even the number of units (quantity).

We currently have a computer order in CPOE with the exact wording from the std posted above for unxm. We hope someday to use it in lieu of the paper that goes with the units and also doubles as a form for recording vitals and other transfusion info. We will accept either one but still usually get the paper.

Edited April 18, 2013 by Mabel Adams
add a thought

[David Saikin]

We usually complete the form/paperwork when the emergency is over . . . the doc signs one form with all the unxm units documented.

[Eagle Eye]

For MTP, we get a emregency release form signed by the doctor at the start and then we document all units in computer. All transcation related to MTP uncrossmatched units in our computer. We issue uncrossmatched units in our LIS which generates tranfusion tags. So we do not write those units on this form.

But we have a trauma ref. in ER equipped with O pos & O neg units with tag attached to it. For those units Dr./designee is require to write unit number on the emergency relase and then they send us form with tags. (But lots of time they complete papework after the emergency is over but we get completed paperwork).

[goodchild]

We used a form where I used to work that had patient ID and the request for unxm that the dr signed. It was unrelated to the unit numbers or really even the number of units (quantity).

We currently have a computer order in CPOE with the exact wording from the std posted above for unxm. We hope someday to use it in lieu of the paper that goes with the units and also doubles as a form for recording vitals and other transfusion info. We will accept either one but still usually get the paper.

I wanted to do something similar to this as well but so many of our CPOE orders are actually entered by unit secretaries and nurses.

[bbbirder]

We have a computer order for emergency issue.  If it is a verbal order, it goes to a queue (did I spell that right?) for the doc to sign later.  This order prints on the BB printer, plus the ER or OB will always call us.  We don't care about the number of units or even the type of product.  All we care about is the doctor order.  We used to have a form, one for each unit, but found that these sometimes got lost or not scanned into the chart.

[Mabel Adams]

Most EMRs have a way for entering verbal orders that the Dr. has to sign off on later.

[Likewine99]

I was a Blood Banker working on the Orders Team at one of my prior jobs and I drafted an electronic version of the Blood Bank's manual emerg release form.  When it was placed it printed in the BB so they would know to start the emergency issue process.  

 

Like the other have said, this can be entered by a unit secretary or RN and goes into the physicians Order Review queue for final sign off.  The BB could then access the EMR and if necessary print off a "signed" copy of the Emerg Rel order.

 

Worked great and gave the BB a better tracking mechanism since the paper forms were often "misplaced".

[BBCLS]

Most EMRs have a way for entering verbal orders that the Dr. has to sign off on later.

Yes, and we audit to make sure all orders are signed.

[DOGLOVER]

We have an emergency issue form that we send with the first units. It will have the unit#s on it. The physician signs (either then or later) and returns the form to us. We just add more unit numbers to it as needed.The doc doesn't care what the numbers are. That is really for us. The form also has a line on it that says ABC_______________for XYZ_______________MD.for use when the physician is unable to sign but has verbally told the nurse to get emergency blood. That is rarely used. We also attach transfusion tags to these units that can be scanned into the EMR later, because otherwise when there is a big emergency it probably won't get into the EMR properly. (In our system the unit numbers have to be manually entered because the EMR doesn't "talk" to Cerner Classic except for orders and resutls to cross.

[SMILLER]

We also have a single form sent down with the first cooler.  It has the patient ID and a statement that the undersigned doc says that the emergent situation warrents transfusion of uncrossed product.

 

Neither JCAHO or the FDA has ever had a problem with this.

 

Scott

[kirkaw]

We have an emergency release form that has a place for the Dr. to sign. We place unit stickers on the form, which we make up in advance for 2 ON units. If the Dr. needed more units, we would attach more stickers on the form, but he just has to sign the form for that number of units once. We also have a yellow manual card on each unit, but that is for transfusion recording. I can send you a copy of our emergency release form, but I think I attached it during another discussion. Try searching for emergency release forms.

We do almost exactly as mollyredone does. Our emergency release form that the requesting MD signs is a 2 part/carbon copy form so that one copy is retained in the blood bank and one goes on the patient's chart. 

[kirkaw]

We used a form where I used to work that had patient ID and the request for unxm that the dr signed. It was unrelated to the unit numbers or really even the number of units (quantity).

We currently have a computer order in CPOE with the exact wording from the std posted above for unxm. We hope someday to use it in lieu of the paper that goes with the units and also doubles as a form for recording vitals and other transfusion info. We will accept either one but still usually get the paper.

 

 Mabel, what is your CPOE system and does this order from the MD cross to your blood bank computer system automatically?