Jump to content

Who signs the emergency release documentation?


seraph44

Recommended Posts

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
Typos
Link to comment
Share on other sites

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.

Link to comment
Share on other sites

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.

Link to comment
Share on other sites

  • 3 weeks later...

As for the signed Emergency Release form, we have always sent the original to the chart and kept a copy in the blood bank. CAP says that "records" of the emergency release must include the authorization of the physician; AABB says the "records" must contain a signed statement from the requesting physician, etc....... .  Does this form actually need to be placed in the patient's chart or is our blood bank file a sufficient "record?" We are exploring the possibility of obtaining an electronic authorization and signature for emergency release.

Thanks

 

Link to comment
Share on other sites

  • 3 weeks later...

We require that it be signed in the ER "while we are still there with the cooler."  This usually  means the Physician that requested it is rather "busy" at that moment and cannot stop and sign.  So we allow another Physician in the room to sign when necessary.

Brenda Hutson

Link to comment
Share on other sites

We also keep the original signed document and scan a copy into the patient's EMR.  Once we go live with our new blood bank system, we'll also scan a copy directly into the patient's blood bank record. We don't hold the product hostage for the signature. If the provider is available to sign the form, we ask them to do so. If they are too busy that moment, we track them down after things calm down a little. If the ER provider goes off duty, I rely on our trauma coordinator to assist in getting the signature (ED providers are all hospital employees). If it's a surgeon or OB, I send the form and ask them to complete as soon as possible so that I can complete required documentation. Our medical director can give them a little nudge if necessary. Usually not a major issue.

My biggest problem is with nursing staff getting their hands on the signed form before I do and sending it to Health Information with other chart material. . . even though there are bold red letters on the form that says 'Return to Blood Bank'.   :threaten: 

Link to comment
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now
  • Recently Browsing   0 members

    • No registered users viewing this page.
  • Advertisement

×
×
  • Create New...

Important Information

We have placed cookies on your device to help make this website better. You can adjust your cookie settings, otherwise we'll assume you're okay to continue.