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Yay, the Christmas lights are back! Smash 'em while you can!!

Yes, informed consent is part of physician credentialing. It cannot be done by the nurse. You could have your nurses offer an info sheet to patients, but the conversation about risks, benefits, alternatives, and consequences of refusal MUST be a conversation between patient and physician/provider (can be PA or NP but not an RN).

Informed consent should be done by the physician, as it is for other treatments/procedures. Risk/benefit explanations should be done by the individual ordering the transfusion as he/she is the person who is 'supposed' to be most familiar with the patient's condition. For some reason, consent for transfusions isn't taken as seriously as it should be. Shoving the responsibility onto nursing staff isn't fixing the problem. That's a tough one but it's something that I think is going to be a TJC issue - once a problem fits in that category, you have more teeth to address it.

I use the Genesis tube sealer. Love it.

In Massachusetts, it's the physicians. We audit a small percentage of transfusions every month, and consent in one of the things we look for. We've stopped "letters from the committee" as they are ignored. We report No Consent directly to Patient Safety/Risk Management. The hospital lawyers then contact individual MD and their chiefs. This is also reviewed at Medical Executive meetings. Very rarely now do we miss a consent. The higher up the food chain you report, the better the results.

I know that it is the law in Washington and Oregon to have the physician obtain informed consent. I don't know about other states. I also know that it is rarely done here by physicians, even though all other treatments or procedures are explained by the physician. I don't know why transfusion is being treated differently, but we have a new QI person and TJC will be inspecting soon, so hopefully they will decide to follow the law! Plus, it is very rarely fully completed here and I have beaten my head against the wall many times trying to get compliance. I just might make a comment when TJC comes in to talk to blood bank, even though the lab is inspected by CAP.

If there isn't, there should be. As I have said many times on this site, I have a huge respect for nurses, but they cannot be expected to keep up to date with all of the latest reasons why a transfusion is, or is not the best or safest treatment for a particular patient, with a particular condition. It is equally difficult for a doctor to keep up-to-date, but it is easier to keep the Consultant Physician/Surgeon abreast of such things, via the Haematologist, and for him/her to cascade this "news" to their staff, and these more junior doctors would also have the knowledge (or should have the knowledge) to answer any of the patient's questions on the subject honestly.