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seraph44

Who signs the emergency release documentation?

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I have an interesting case where the E.R. physician ordered 2 units of Emergency Release red cells. They got them and transfused one. The patient was transferred to the O.R. for an emergent procedure and received the second unit there. Does the physician requesting the emergency blood sign it? or does the physician responsible for the patient during the transfusion sign in (in this case the O.R. doc)?

Thanks,

 

Edited by seraph44
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It's all electronic orders here, so the ER physician would be initially responsible; but the OR surgeon or anesthesiologist are responsible for any transfusions there, including uncrossmatched units.

Scott

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The provider who requests the Emergency release of the 2 units is who is asked to sign/take responsibility for the uncrossmatched blood, not the provider (usually surgeon or anesthesia) who gives the Transfuse order. However, we would make sure that the surgeon (or anesthesia) was aware that the unit being transfused was uncrossmatched - he/she could then determine whether or not they wanted to continue with the transfusion or wait for the crossmatch to be completed. We are a level III trauma center and this has not been an issue with TJC, CAP or the trauma surveyors from the state up to this point. You should probably check for regulations in your state, as a start.

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The easy answer on a practical note is as long as the Emergency Release order has been signed by the physician who placed the order all is well in the BB.

My understanding, from when I worked at a level I trauma center, is that once the patient is in the OR; the anesthesiologist is in charge and is not required to finish the transfusion orders of the ER physician. If the anesthesiologist wants to transfuse the remaining uncrossmatched unit they cancel the ER order (if electronic) and place their own when things calm down. This has to do with billing, transfusion criteria and removes ambiguity.

As long as your policy ensures that any physician ordering/transfusing  Emergency Release products is documented in case they need to justify their decision.

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