Just wondering, for those of you who give out Emergency Uncrossmatched blood requiring a Physician's signature (accepting responsibility, etc. etc.)....

Do you require 1 Form for each pick-up (i.e. maybe they come for 2 units initially); so if they come for more uncrossmatched before Type/Screen/Crossmatch complete, would need to sign another Form....or

Do you do a "1 Form fits All?" So in a given episode (i.e. of bleeding), if the MD signs a Form, they can just keep coming for more uncrossmatched RBCs without having to sign another Form?

I personally feel the need to document the unit numbers on the Form being sent with the blood for Physician signature; thus requiring 1 Form each time they request Uncrossmatched RBCs.....but would like to know what others do.

Thanks,

Brenda Hutson, CLS(ASCP)SBB

One form for multiple units.

Ditto Terry

One form for multiple units listed on the form.

JB

I believe regulations require one form (or computer order for uncrossmatched blood) per bleeding episode although we have a signature line on each form that goes out with usually 2 unxmed units that we usually get signed. (The forms pre-date my tenure here.)

One form, one physician signature. Each unit is a line item and is accompanied by a nursing signature when blood is issued. Works well here.

One form - usually signed by MD after the excitement - we put all the unxm'd units on it (with date/time of release). Once they request unxm, I keep giving it that way until I can get it worked up (at least T&S).

We do it like David, but I like the idea of using the form for signing those units out like Deny.

I had a form for many units. But recently changed it to one form per unit.

We have a signature line on our transfusion tags, so one signature per unit. We have a "trauma patient" that we use to pre-print tags and keep them labeled for emergency release. We highlight the signature line on those pre-tagged units and most of the time the MD will sign and if not, we badger them until they sign the form.

One form, one signature for up to 10 units. Usually the physicians automatically come by the blood bank to sign the form because they know that they will eventually have to sign it. I have even visited them in their offices to get the form signed.

Just wondering, for those of you who give out Emergency Uncrossmatched blood requiring a Physician's signature (accepting responsibility, etc. etc.)....

Do you require 1 Form for each pick-up (i.e. maybe they come for 2 units initially); so if they come for more uncrossmatched before Type/Screen/Crossmatch complete, would need to sign another Form....or

Do you do a "1 Form fits All?" So in a given episode (i.e. of bleeding), if the MD signs a Form, they can just keep coming for more uncrossmatched RBCs without having to sign another Form?

I personally feel the need to document the unit numbers on the Form being sent with the blood for Physician signature; thus requiring 1 Form each time they request Uncrossmatched RBCs.....but would like to know what others do.

Thanks,

Brenda Hutson, CLS(ASCP)SBB

We do one from for a batch (for example, if they request 2) and we write the unit # on the form.

Two questions Re:Emergency Release

1. How are transfusions vitals performed and recoreded during transfusion with uxm'd blood? Is this not a TJC reg?

2. At what point, do you convert to type specific blood in a massive bleed?

OK. Three questions.

We have one form per event. The form has all the units listed and is signed by the provider after event.

Our form (for 2 unxm units) has the same grid on the bottom for recording vitals that our regular form has. Of course, uncrossmatched units are usually given so fast there isn't much time for vital signs.

I would only convert to type specific unxm blood when I am convinced that patient ID is firm enough that no one will kill anyone by hanging it on the wrong patient. Five patients from the same car wreck in the ED with the same last name is when I would NOT want to issue anything but O. One of my nightmares is someone grabbing what they think is universal donor blood and hanging it without any ID checks because it is universal donor blood--except it is actually A pos type-specific unxm blood for another patient.

So trying to clarify all of these "1 Form for Multiple Units" responses....

So, for example; if you initially send the Form out and there are 2 units listed on the Form; the MD signs it and returns it. But then they need 4 more uncrossmatched untis....most seem to be saying ALL units are documented on that 1 Form?? So do you just ADD the unit numbers (stickers from back of units; hand-written; whatever) to the already-signed Form? I guess my "problem" with that is it almost seems like fraud (maybe not exact word I am looking for) to add information to a Form that has already been signed by someone???

Brenda Hutson

So is this the same Form that you normally have attached to units, or does it "look" different? And it sounds like you are saying that is a Form that comes back to you?

Thanks,

Brenda Hutson

We have a signature line on our transfusion tags, so one signature per unit. We have a "trauma patient" that we use to pre-print tags and keep them labeled for emergency release. We highlight the signature line on those pre-tagged units and most of the time the MD will sign and if not, we badger them until they sign the form.

A Form still needs to go out with the units (have always used the same Form as for crossmatched; just may not have ALL of the information when uncrossmatched goes out). So however your Institution provides vitals (on the Form; in the patient's records; etc.) should be the same.

When trying to decide when to switch the patient to their own type, you might want to take into consideration what type of anticoagulant the transfused uncrossmatched units are suspended in. For example, are you giving Adsol Units such that you do not have to be concerned about a lot of incompatible plasma now circulating, or CPDA-1 which depending on how many units you give, could leave a lot of Anti-A,B in the patient's circulation? (i.e. patient group A; multiple group O uncrossmatched units given)?

Brenda Hutson

QUOTE=mia9941;44201]Two questions Re:Emergency Release

1. How are transfusions vitals performed and recoreded during transfusion with uxm'd blood? Is this not a TJC reg?

2. At what point, do you convert to type specific blood in a massive bleed?

OK. Three questions.

Brenda,

Yes we keep adding to the signed form. A nurse signs the form for each unit as we issue the products. The physicians here do not seem to have any problem with the process. The signature on our form is an acknowledgement of the statement that they feel the situation is a life threatening one requiring blood without delay prior to completion of cross match testing and/or antibody screening / identification.

Ok, thanks. I like the idea that at least someone signs the form for each unit (i.e. RN). Having seen so many Physicians over the years that suddenly "don't need uncrossmatched blood" once they realize they will have to sign for it and take responsibility, it makes me wonder what would happen if a patient had a reaction to a unit that was later "added" to a Form the Physician had initially signed.....just my paranoia getting the best of me I guess.

Brenda

Brenda,

Yes we keep adding to the signed form. A nurse signs the form for each unit as we issue the products. The physicians here do not seem to have any problem with the process. The signature on our form is an acknowledgement of the statement that they feel the situation is a life threatening one requiring blood without delay prior to completion of cross match testing and/or antibody screening / identification.

We also have a signature line on our emergency release uncrossmatched tags. The Dr. signs at a bottom portion of the tag

which has a perforated line locatd above so that this bottom portion tears off and is returned to the blood bank.

I think the physician is signing for the fact that the patient needs uncrossmatched blood in the current situation. The way I read the AABB regulations, I don't think it has to tie to specific units. I hope eventually to have an electronic order for unxm blood that the MD enters or signs off on later that is the entire requirement for unxm blood approval. In my past, we had the signature a part of a paper order slip that had nothing to do with the unit numbers given. Of course, in the blood bank we have a record of which units are given unxmed.

I think the physician is signing for the fact that the patient needs uncrossmatched blood in the current situation. The way I read the AABB regulations, I don't think it has to tie to specific units. QUOTE]

I agree.

1 form for the event. We document all the units on the form and at the end of the month all of our emergency release forms are sent to Health Informatics where they are scanned into the patient's EMR. This is where they are flagged for the requesting physician's signature as part of keeping their EMR charting current.

Our form allows for multiple units however we only put one donation on per form and attach to each unit individually. We in a sense force the doctor to sign for each unit. We find this is easier for us since it always seems one unit is given at the facility and the other may or may not be given in the ambulance during patient transfer.