Refusal to allow crossmatch tube collection

[mlasson]

My night shift tech had a strange situation to handle.

 

A teenage girl was brought to the ER for hemoptysis.  The physician ordered 2 units of blood, and asked that we emergency-release O negatives.  While the tech starting preparing the units, a phlebotomist ran to the ER to draw a crossmatch sample, but her parents refused to allow her to be stuck (even though presumably they had agreed to the transfusion).

 

The tech called the physician to explain that we still had to crossmatch the units, even if they were emergency-released and already hanging before the crossmatch was complete.  By the time she was able to get it all explained, the physician had decided to fly the patient to a children's hospital 4 hours away, so he canceled the emergency released units.

 

I've never had a patient willing to take blood but unwilling to provide a sample for crossmatch.  I'm glad the nightshift tech stuck to her guns, but what if the doctor had insisted that the patient's life was in danger without immediate transfusion - what would be the right thing to do in those circumstances?

 

 

 

 

 

 

[R1R2]

I agree that it was odd. I would give the blood and ask questions later or better yet have your medical director or manager get involved. If you never get a sample and no more blood is required you should document appropriately and move on.

[Laurie Underwood]

Agree with R1R2. This has happened to us on more than one occassion. We just document on the emergency release form which the doctor signs that a specimen was unable to be obtained before patient was transferred to another hospital. In this case, patient refused specimen to be collected.

[David Saikin]

This also happens to us occasionally in the E.D. - unxm rbcs but pt expires before a specimen is obtained.  I document on the emergency release and have my Med Dir sign off on it.  If it becomes too frequent then she directly interacts with the MDs in emergency.   Not much you can do in these situations.

[tbostock]

Patients (or parents/guardians) have a right to refuse. Not much you can do. If she had stayed and kept bleeding, I would explain the situation to the doc and have him/her talk to the parents and make them understand that type specific/crossmatched blood is much safer for her.

[John C. Staley]

I can only echo what the others have stated above.  Just let the ED doc know the patient/parents are refusing and decision/responsibility is the doctors.  Probably not the best time to be holding a philosophical debate on what could happen and considering the age of the patient, most likely not happen.