I need to re-write the Emergency release (uncrossmatched) procedure in my blood bank.

What are minimum requirements for issuing Emergency Release?

Especially as regards to labeling and paperwork.

The system set in place many years ago is very cumbersome (I don't see any difference in amount of paperwork-we are not on computer- than for a regular crossmatch). Which is why I don't see people following the procedure and if they try the dr yells at them for being too slow.

Label on unit (required?): now currently requires the same as for a xm unit except a different box is set up.

Paperwork for unit (goes with unit, hand written): Same as for crossmatched unit... Just says uncrossmatched.

VERY time consuming to write all this stuff. No computer in site for now.

Would appreciate information and advice.

Kym

There are no "per se" requirements for emergency release. Some places have units ready to roll (just have to complete paperwork). When the excitement is over you need to be able to crossmatch the units released, know who got them, have the release form completed by requesting MD. We release uncrossmatched with no paperwork . . . it follows . . . they need the blood not the papers.

There are no "per se" requirements for emergency release. Some places have units ready to roll (just have to complete paperwork). When the excitement is over you need to be able to crossmatch the units released, know who got them, have the release form completed by requesting MD. We release uncrossmatched with no paperwork . . . it follows . . . they need the blood not the papers.

So there are no written standards for HOW to make sure which patient got the units? I have been reading the AABB standards and I do not see where any abreviated labeling is endorsed for emergency. Standards 5.18.5 say:

5.18.5.3 Container or Tie Tag shall say in conspicous fashion that testing is not completed at time of issue.

Is a UNCROSSMATCHED sticker enough?

5.18.8.5 Records shall contain a signed staement from requesting physician saying clinical situation was urgent......

Is this where you write (to track) the unit numbers you are releasing? What patient identifiers must be on this physician

statement?

So my basic question is how much info is required to meet 5.18.8.3? Name or identifier of patient? Or just that it is uncrossmatched? If name is not required how do we know this specific patient received this specific unit?

And regarding other paperwork how much info is required to meet 5.18.8.5?

I know what has been done here since before my time here is way to cumbersome. I want to streamline it but also want to meet standards.

Thanks again, Kym

Our Emergency Release Form may be used by nursing or lab to record a verbal order (MD may not be on site or otherwise occupied, like in the OR trying desperately to save the patient) with the understanding that the MD will actually sign it after the dust settles. Or the MD can sign it at the onset of the situation. We record the reason, patient identifiers and list the units given under the emergency release.

We have a "Pretransfusion Testing Incomplete" stamp that we use for the tie tag and unit/patient ID paperwork. (Usually it's not a I.S. crossmatch that's the holdup in an emergency, it's waiting for the antibody screen to cook, or the typing as well since the specimen hasn't arrived yet...The stamp covers all the bases.) Unit and patient ID are on the paperwork as with any issued unit. If you issue the blood with your usual paperwork, then the transfusionists can do the pretransfusion check per usual protocol. Whether you keep a paper hard copy in the chart or capture the info electronically, there should be documentation as to who got what.

We catch up on the testing in the computer as we finish it.

The closer you can stay to your routine traffic flow, the better. The process should enable the rapid issue of the blood components but minimize confusion and possible mixups.

Kym,

I have attached (I hope) the emergency release we use. In addition to this form we attach a label to each unit (also attached I hope). This process has been through several inspections over many years without issue. Once the situation is over the techs are great about getting a physician signature and the physicians are always willing to sign of on the form as well. We complete the testing and when filling out our tie tag indicate in the nursing signature space that the unit was issued without a completed cross match and refer to the chart copy of the attached form for the nursing signature.

[ATTACH]466[/ATTACH]

[ATTACH]467[/ATTACH]

Uncrossmatched Blood Label.pdf

BB-326A.pdf

Edited February 8, 201114 yr by Deny Morlino

Nice forms, Deny.

Thanks. Focus was on concise and complete.

Kym,

I have attached (I hope) the emergency release we use. In addition to this form we attach a label to each unit (also attached I hope).

Thank you. I have copied for review onto my computer. For your unit tag, do you have computer (preprinted label? Or do you write in all that pt id at time of emergency xm?) Kym

We have a similar process to Deny's. Our emergency release form allows up to 12 unit numbers to be recorded on it. We do put the same bag tag and sticker on the unit as for a routine crossmatch, but we have a stamp for uncorssmatched and emergency released so that doesn't have to be written (or printed). If we can get the nurses to bring patient ID stickers, we use those instead of writing patient information on the tag. Anything that shortens the time it takes to get everything together!

I would like to NOT put patient identifiction on the unit (UNXM, Type O) if at all possible. As this is what is slowing everyone down. Our labels require writing, sticker from floor does not work. Of course I can make a label JUST for this purpose, but in some cases, doctors want the blood waiting for an ambulance (no id, no MR number yet) to roll in.

Right now I am leaning on lables which have a place for pt sticker. But could this be optional. IE : No pt information, just UNCROSSMATCHED?

We do (to be revised based on info from this thread) have a form where we can list unit numbers where pt ID will go and DR signature.

Thanks, everyone. Kym

You can put a statement in your procedure that says "patient information may be handwritten on the label if time allows".

JB

We fill out the labels at the time of issue. The labels are a preprinted roll with fluorescent orange background (the color did not scan) sourced from Shamrock. Works well for us.

On blood waiting for the squad to arrive, could the patient be identified as a John Doe or Trauma Patient 1, etc. to allow for tracking of unit to patient? That would be a concern in a multiple victim situation. As we use a blood ID band process, this is fairly straightforward for us to ID the patient and track the units. Many different solutions for a problem. Let us know what route you choose.