I just got out of a meeting where our lab leadership says that it is no longer possible for a Doctor to call the laboratory and request a MTP panel (PT, PTT, Fibrinogen, HH, and PLT).  They say it is a CAP requirement that you have to have an order electronically or manually.  But can you not take verbal orders in emergent situations?  Our Blood Bank takes verbal orders for MTP products.  This seems to be a contradiction and a misinterpretation of CAP guidelines.  How can a surgeon be asked to put in orders during this time.  Can anyone provide clarity on this matter?  If you can refer me to some CAP guidelines for a rebuttal that would be great.  

 

Thanks.

There is no requirement that I know of that requires a physician to enter all orders at all times.  But the amount of orders entered by a particular physician does affect compensation for the hospital (in the US anyway).  So insisting that a doc enter all orders for an emergent situation like a MTP is a dangerous bit of overkill.

To make it easier for our docs, we have an order set that includes a "heads up" order to the BB for things like an MTP.  We follow our established protocol in BB when that happens, and keep on it  until the MTP is called off.  These orders are entered typically before the patienet arrives at the hospital in the case of ER.

Scott

We have order sets available to providers, but will go into action with a phone call for MTP and emergency release. The order does need to be placed for that to happen. The patient comes first. CAP specifically says that blood products the patient needs should not be delayed so as to  endanger that patient by sticking to paperwork rules. The orders do need to be placed as soon as it is feasible, but sometimes some of those orders are placed by lab. Our procedures spell that out.

TRM.40770 Life-Threatening Situations Phase II
Adequate policies and procedures have been established for the investigation and
handling of life-threatening situations (such as the use of uncrossmatched blood or
abbreviation of testing) that include the written authorization of a qualified physician.
NOTE: Written policies and procedures must be available to expedite testing for transfusion in
a life-threatening situation. If an institution's procedure allows abbreviated testing in massive
transfusion situations, records should indicate that the procedure was followed. Records must
include the authorization by a qualified physician. (If approved by the institution and recorded
in the laboratory's procedures, the physician responsible for the transfusion service laboratory
may accept this responsibility.) If an incompatibility is discovered on completion of an incomplete
crossmatch, the responsible physician must be notified in a timely manner and this notification
recorded.
29 of 85
Transfusion Medicine Checklist 08.21.2017
Red blood cells released before testing has been completed must be conspicuously labeled
as uncrossmatched on the tag or label. Records of completion of compatibility testing for units
released uncrossmatched must be maintained.
Evidence of Compliance:
✓ Records of emergency release authorization by a qualified physician
REFERENCES
1) Food and Drug Administration. Current good manufacturing practice for blood and blood components. Laboratory controls.
Compatibility testing. Washington, DC: US Government Printing Office, 1999(Apr 1):[21CFR606.151]
2) ibid. Records and reports. Records. Washington, DC: US Government Printing Office, 1999(Apr 1):[21CFR606.160]

Edited April 10, 20187 yr by AMcCord

AMcCord-  

Thank you so much for your response.  That helps a lot!  

Our policy is written to allow the blood bank to order products in emergent situations to avoid potentially life threatening delays for the patient. We do not order lab tests for the patients though.