ARRA and Meaningful Use

[Dansket]

Currently, we use a paper form (stocked in each Nursing station) that is completed by RN/MD and physically delivered to Blood Bank to obtain release of uncrossmatched blood.  It is very fast and is not dependent on patient being admitted to HIS, specifically ER patients.

 

Does your facility/IT department require that an order for Uncrossmatched Blood must be placed in HIS, i.e., to be consistent with some requirement that all orders must be electronically generated?

 

Would anyone construe this requiremen to mean that a paper form may not be used to order uncrossmatched blood?

 

Has anyone been told by their IT department, that the order for Uncrossmatched Blood must be placed in the HIS before blood can be released for transfusion?

Edited December 9, 2013 by Dansket

[tbostock]

Since going live with our EMR, we do require a 2 unit red cell order to be entered in the computer when we bring uncrossmatched blood. It can (and usually is) after the fact; save the life first, then get your blanks filled in. Sometimes we really have to nag to get it ordered.

Don't see any reason why it couldn't be paper, though, as long as the physician signs.

The only thing not allowed (at least from our state DOH) is a verbal order.

[Mabel Adams]

We scan in the release with the MD signature so it ends up in the chart "electronically".  We have an uncrossmatched blood order built in CPOE but we don't require it--especially not in advance of issuing.  I hope someday to set policy so that the electronic order, as long as it was placed the same day, can fulfill the need for the MD release for unxmed blood.  Our UNXM order in CPOE has a long description that quotes the AABB standard requiring MD signature for emergency release blood. Then, if I can't get the signed paper, maybe I can just get them to enter the order once the dust settles.

 

Don't let IT dictate the practice of medicine unless they have MD after their names.

[OxyApos]

We use Sunquest in the Lab.  Nothing happens in Epic for these patients.  In Sunquest, we have a test called EON ( Emergency O neg).  We have a fake trauma patient in SQ.  We order this test on the fake patient and are able to document what's going on while we wait on a valid name, specimen, tysc, xm.  We have a paper form the doctor signs.  Once the work is completed, we transfer the unxm units to the "real" patient and document real times and unxm status there.  But the EON gives us labels and a paper trail to keep things organized in the mean time.

[R1R2]

We use Sunquest in the Lab.  Nothing happens in Epic for these patients.  In Sunquest, we have a test called EON ( Emergency O neg).  We have a fake trauma patient in SQ.  We order this test on the fake patient and are able to document what's going on while we wait on a valid name, specimen, tysc, xm.  We have a paper form the doctor signs.  Once the work is completed, we transfer the unxm units to the "real" patient and document real times and unxm status there.  But the EON gives us labels and a paper trail to keep things organized in the mean time.

How do you transfer the units to the real patient?

[kate murphy]

We do the same thing with Sunquest and our EMR (soon to be Epic).  A fake patient in Sunquest, a paper form.

We merge the fake patient with the real patient after the fact in Sunquest, so that the history is accurate.

We are currently setting up Epic to go live in May 2014 and replace our current EMR.  There will be an emergency release order in there.  But all MDs agree that they want to continue to use the paper form and do the computer after the fact.

In our experience, the FDA likes to see the signed paper forms.  Not sure how we could show an inspector that if the only order for un-Xm was in Epic.

[EDibble]

We use a paper form. No problems here. With the flurry of activity that often accompanies an emergency release of blood, it would be unreasonable to expect the physician to HAVE to order the blood electronically. Patient care is the primary concern.