Release of uncrossmatched RBC units - update

A colleague reports that until recently her institution required that an ordering physician must authorize (in writing) uncrossmatched RBCs PRIOR to the product being released for transfusion. However, recently their SOP has been updated to permit the written authorization to be documented AFTER the product's release. The inquiring colleague wonders how other facilities manage requests for uncrossmatched RBCs.

Editors' Note: The previoius e-Network Forum discussion, Emergency release and who can sign for untested or uncrossmatched blood, is germane to the present question.

The following comments have been submitted in response.

ADDENDA Mar. 13, 2010

1. At a Level 1 trauma center in a sunbelt state, registered nurses are allowed to list the requesting physician and sign a waiver, prior to issue of the uncrossmatched RBCs, if the physician is unable. The physician then counter signs afterward.
   
   
2. A transfusion service located in an East Coast state strongly encourages written authorization to release uncrossmatched blood prior to or at the time of issue by trying to keep clinical staff aware of the massive transfusion protocol and availability of the emergency transfusion forms in patient care areas. However, in order to not cause harm to any patient in dire need of blood, their procedure explicitly states not to delay release of blood in the event that that the emergency transfusion form has not been received.

Submit comments to the e-Network Forum at enetworkforum@cbbsweb.org

Ira A. Shulman, MD
CBBS e-Network Forum Senior Editor & Moderator

W. Tait Stevens, MD
CBBS e-Network Forum Editor & Moderator

Elizabeth M. St. Lezin, MD
CBBS e-Network Forum Associate Editor & Moderator