Consent

[lef5501]

We've had some consent questions recently that I wanted some opinions on. First, when do you get consent for the transfsuions? Is it before a sample is drawn, right before the transfusion, etc. We recently had a physician order a type and cross on a patient that had an antibody. The workup was extensive and required our reference lab. We stuck this lady twice to get samples for the workup. Once the blood was ready, the RN calls back and says the patient is not consenting to the transfusion. I feel that the consent should have been gotten long before any units were ready. How ais your facility handling consent?

Second, do you draw samples on a person that refuses blood products, ie. Jehovah's witnesses? We have had several JW's come in through our OP lab and say they would refuse blood products. I have told our phlebotomists not to draw the sample. I feel no need to charge a patient for a workup if they are going to refuse blood. However, one of the OP nurses feels that the sample should be drawn anyway as a precaution. Any feelings on this?

:confused:

[ybunch]

If the patient has a Healthcare Power of Attorney indicating refusal of blood we do not cross. Not only is it not fair for patient to be charged, you are setting your institution up for problems. Hope this helps, yb

[durantee]

our current practice for inform consent form as soon as the physician order blood transfusion we must obtain a consent . .In the case of blood sample regardless of the patient refusesI think that patient still need blood sample in case of emergency. and besides patient might be convinced later on.

thanks

[Malcolm Needs ☆]

our current practice for inform consent form as soon as the physician order blood transfusion we must obtain a consent . .In the case of blood sample regardless of the patient refusesI think that patient still need blood sample in case of emergency. and besides patient might be convinced later on.

thanks

I would agree with this post.

In your first example lef5501, if the patient had decided to allow a blood transfusion at the last minute, and as a Reference Laboratory Manager, I would be none too impressed if we were put under pressure to identify the antibody urgently and provide blood urgently when there would have been ample opportunity to do this "at leisure".

:(:(

[David Saikin]

The doc is supposed to get the consent after explaining about the transfusion . . . it is not part of our lab policy that we obtain the consent. On our ordering form there is a check box for the doc to indicate that consent has been obtained. If it has not been obtained, that by itself does NOT prevent me from performing the workup.

[rebel]

We require consents to be signed before the orders are sent down if the patient is capable of doing so, and, it is not an emergency release. But, we do not require a copy of it until a product is requested.

Other than that, I stay out of the moral, religious debates and play ignorance to them. Personally, if I was staff out on the floor, i would not even order blood products if there was not an implied consent already signed.

Not sure how your facility handles this issue

[Eoin]

Consent is a very tricky area. It will depend very much on the laws of the country. Try to look up precedence cases for review. Here in Ireland consent must be informed and obtained by a physician. Nurses would hand out information leaflets to patients before physician attend to obtain consent, so they could ask any relevant questions of him/her.We too have checkboxes on our request for the requesting physician to complete, but would proceeed if not completed, but would bring attention of medical staff to lack of (or failure to indicate on request) consent. In the case of proceeding with drawing blood for a crossmatch (ref durantee), if the patient had refused to consent, the action of blood draw would constitute assult to the patient, punishable by law. We could get into implied consent (if a patient put out their arm for venepuncture for collection of a blood sample), but that is another can of worms too.We also have a "Refused consent " form for completion of those who do not wish to be transfused. Application to transfuse minors whose parents refuse consent would need to be taken before the courts. Most countries would have precedence for this if they have Jehovah Witness citizens. All I can say is the hospital you work for should have an unambigious policy, which should be strictly adhered to - or someone will be before the court.

Regards, Eoin