Electronic authorization for uncrossmatched blood

[jalomahe]

Has anyone set up a system where the physician documentation authorizing use of uncrossmatched blood is done via the electronic medical record instead of on paper? If yes: is done as part of the blood order, or as a specific physician patient care note or do you have another process?

 

We currently send a form with the uncrossmatched units and the physician needs to sign and return at some point in time (does not need to be done prior to transfusion). When ordering uncrossmatched blood, sometimes an order is placed in the hospital system for units with special order, uncrossmatched. Sometimes it's placed in the hospital system with no special order but blood bank receives a "verbal" to send the blood uncrossmatced. Sometimes it is picked up as part of a trauma activation prior to the patient even being physically in the hospital or identified/registered.

 

We currently use Epic as our hospital information system but have Sunquest as our lab/blood bank information system so feedback pertaining to these systems would be especially helpful but information from any system would be welcome.

 

Thanks in advance for any input you can give.

[tbostock]

We also looked at Epic for this as well, but were concerned that nurses and PAs would be able to order it, We only allow physicians to order emergency uncrossmatched blood here.  I would think there would be a way to limit it to just MDs, but my people couldn't figure out a way to make it work.  So we're still on paper.

[Mabel Adams]

We have an order in CPOE for uncrossmatched blood.  There is wording attached to it straight out of standards about uncrossmatched blood being necessary.  We have never done the education piece for physicians so still do the paper version, but would depend on the order in the computer if we had it and didn't get the paper signed. Someday we will make the switch. All of our orders in CPOE that are entered by a nurse (as verbal or phone orders), have to be signed off by the physician later.  This process is automatic in the software. PA's would probably be able to order it without any additional sign-off, but PA's here can order blood transfusions so it would probably be legal.  I don't think they ever have ordered uncrossmatched blood.

[jayinsat]

We use Meditech 5.6.6. and have switched to a paperless process.  When the physician calls requesting uncrossmatched blood, an emergent CPOE order is generated by the Blood Bank staff which, according to our Lab IS staff, must be acknowledged by the ordering physician or privileges are revoked.  When they come to pick up the units, the Blood Product Request form we use must have the physicians signature. 

[jalomahe]

jayinsat "When they come to pick up the units, the Blood Product Request form we use must have the physicians signature."

 

It seems like you have a two-step process, one electonic and one paper. I like the electronic part where the order gets entered and must be acknowledged. How long do they have to acknowledge the order? Is it easy to find when an inspector wants to see your process? 

 

If they are having to sign the request form before they come to pick up the units then doesn't this duplicate the electronic order?

What happens to the signed Blood Product Request form? Do you save it?

 

Our physician and nursing staff want to get away from having to sign any hard copy/papers at all. They think it should be done as part of the electronic medical record (EMR). The problem is getting something that they (physician) can do quickly at the time or more likely something that can done retroactively once the crisis is past. What I want is something that is consistent so that it shows up in one place in the EMR so that when an inspector wants to see the authorization we don't have to look to see where the physician put their "signature".

 

 

[jayinsat]

jayinsat "When they come to pick up the units, the Blood Product Request form we use must have the physicians signature."

 

It seems like you have a two-step process, one electonic and one paper. I like the electronic part where the order gets entered and must be acknowledged. How long do they have to acknowledge the order? Is it easy to find when an inspector wants to see your process? 

 

If they are having to sign the request form before they come to pick up the units then doesn't this duplicate the electronic order?

What happens to the signed Blood Product Request form? Do you save it?

 

Our physician and nursing staff want to get away from having to sign any hard copy/papers at all. They think it should be done as part of the electronic medical record (EMR). The problem is getting something that they (physician) can do quickly at the time or more likely something that can done retroactively once the crisis is past. What I want is something that is consistent so that it shows up in one place in the EMR so that when an inspector wants to see the authorization we don't have to look to see where the physician put their "signature".

The pick up slip is a "soft" requirement.  We do not save that  slip past 30 days.

 

The electronic order is easily reviewed under the review orders routine.  When  acknowledged by the physician, an "A" will appear in the acknowedged column.  That happens pretty quick as they are always having to acknowledge telephone orders for all sorts of things.