![]() If an institution's procedure allows abbreviated testing in massive NOTE: Written policies and procedures must be available to expedite testing for transfusion inĪ life-threatening situation. Handling of life-threatening situations (such as the use of uncrossmatched blood orĪbbreviation of testing) that include the written authorization of a qualified physician. TRM.40770 Life-Threatening Situations Phase IIĪdequate policies and procedures have been established for the investigation and I don't know if it's overkill, but it works, and it's good for our patients. No inspection problems w/ Joint Commission, CAP or CLIA and we've been doing this way for years. Our problem is maintaining staff competency to make sure that everything goes quickly and smoothly This is where the quality improvement part of the equation comes in and we've made some major improvements there. For us the reviews are not a major problem because we don't have that many emergency releases. Quality improvement projects/processes are also part of regulatory compliance. We have an ongoing quality project to monitor documentation, how long it takes to provide product after request, and compliance with SOP. Our medical director is also looking for evidence that we followed the SOP for our emergency release process. If we 'emergency release' blood, it is released uncrossmatched, and plasma (platelets) is/are released w/o a patient blood type. What I regard as a deviation is: our policies require us to perform compatibility testing for RBCs or perform a blood type for plasma (platelets) prior to providing them for transfusion. My viewpoint is that the emergency release is a 'deviation from SOP' and that is what the blood bank medical director must review. Where is the requirement that the medical director review them? Is that CAP?īelow are the relevant CAP checklist items for emergency release of blood products. The question “This patient’s clinical situation is sufficiently urgent to require release of uncrossmatched blood.” – must select YES. I think this is what ended up being our final wording in Epic: I have seen harm from not transfusing a patient with a strong anti-D during an O neg shortage where they attempted to avoid giving Rh pos blood by just using blood salvage during his emergency aortic aneurysmectomy and he ended up needing dialysis. I've seen a few antigen positive units issued to patients with antibodies who still didn't show evidence of harm so maybe the lack of litigation is because I've never seen harm. ![]() I've never even heard of any litigation arising from a case where a patient was harmed from an emergency issued unit. I am inclined to agree that getting the order/signature doesn't really accomplish much. It seems like just asking if they need uncrossmatched blood will halt the ones who just think that calling the lab repeatedly will speed up the process but remind those who really need it that it is an option. ![]() We do request that either the computer order be placed or a paper be signed so we can have that in the record, but it can be done after the patient is cared for. Our process is partly for the above situation and also because they sometimes decide they need uncrossmatched units before the antibody screen is complete even though they have already ordered RBCs. Our uncrossmatched order in Epic does not send product orders to the Lab it is a communication order that gives us permission to create the supporting product orders in the BBIS. We will issue uncrossmatched on a simple verbal request or the order (it is built into our trauma order set). We don't require it to be completed before we will issue uncrossmatched blood so there should be no delay in care. We require a signature be in the record because it is a requirement of standards.
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