Verbal orders for emergency release of blood products

A colleague in the Northeastern USA wants to know if other institutions accept 'verbal orders' for uncrossmatched blood in emergencies? If so, do they wait until they receive the paperwork (written/signed order) before issuing the blood? The inquiring colleague has had lively discussions about this with some members of her staff on the floors/wards (Emergency Department, Trauma ICU and OR were not involved in this discussion since there is a policy for issuing uncrossmatched blood in emergences). The clinical areas think that the blood bank should issue blood immediately after receiving a verbal order and not wait for requesting paperwork.

Background: The reason for all these discussions at the inquiring colleague's institution was because of an incident on the 'floor', where a patient who was status post cardiac surgery was all 'dressed up to go home', started bleeding. The floor staff called (verbal) for uncrossmatched blood at 2:57PM, the blood bank received the paperwork at 3:00PM, and uncrossmatched blood was dispensed at 3:07PM. (all these transactions were via pneumatic tube & electronically recorded). However, the floor staff claimed that a Blood Bank Technologist (Blood Bank never delivers blood) delivered the product 30 minutes after their request & blamed the blood bank for the patient's death. A Root Cause Analysis meeting has been scheduled and the inquiring colleague has all the pneumatic tube electronic records to prove that the blood bank had sent the product via pneumatic tube in 7 minutes, received on the pneumatic tube station, but nobody picked it up from there.

Their local policy right now for emergency release of uncrossmatched blood products is as follows: As soon as they receive a verbal order, they start getting the uncrossmatched blood ready. They have a release form for uncrossmatched blood which the physician signs & sends to them, and as soon as the blood bank gets the form (either via pneumatic tube or hand-delivered), they issue the blood. If the request is for 2 units, they send them via pneumatic tube. If the request is for more than 2 units, a staff member from ER/OR/Trauma ICU (these departments have been very compliant with this policy) comes to pick the blood up. The blood bank is able to issue uncrossmatched blood within 5 - 10 minutes from the time they get the verbal order.

What is done at other institutions regarding managing verbal orders for emergency blood release?

The following comments have been received in response.

ADDENDA Dec. 16, 2010

The transfusion service supervisor at a community hospital in Southern California writes: "We get the blood ready and we fill out the emergency release form. Then when the person picking up the blood comes we have them complete the portion regarding the pick-up and then we give them the paperwork and units.

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