Consent Forms for Transfusions

[Alongoria74]

To all,

I would like to know what others thinks in regards to having Drs sign consent form for transfusions. This question came about at a nursing directors meeting. My opinion is that the physicians should not be required to sign the consent form for transfusion being that they are placing the original order to transfuse. This initial order serves as consent from the physician. What's your opinion or practice on this topic? Thanks

[Likewine99]

My understanding that the Consent for Transfusion is signed by the patient or the patient's representative. It is the documentation in the chart that outlines the risks/benefits of a transfusion.

You might want to get your Risk Mgt people involved in any future discussions you have on this topic.

[John C. Staley]

It's probably a matter of semantics but physicians order or prescribe transfusions they do not consent to them. Patients, on the other had do consent to transfusions.

:whisper:

[snilon]

Our consent form has the physician sign that they have explained the risks/benefits of transfusion to the patient (Paul Gann Act).

[L106]

I agree with all three of the preceding three responses to the original question.

(P.S. Didn't know it was called the Paul Gann Act. Why? Was he by any chance a patient who was transfused against his wishes?)

Donna

[adiescast]

Our process is the same as snilon's. The physician signs that they have explained the risks/benefits of transfusion to the patient. The patient (or patient representative) signs that they consent or do not consent.

[snilon]

Paul Gann was a CA based political activist (co-author of Prop 13) who contracted HIV from a blood transfusion and died in 1989. The Paul Gann Act (California Health and Safety Code 1645b) took effect in 1990 mandating physicians discuss risks of blood transfusion with their patients and is recorded in their medical record.

[L106]

Thanks, snilon. (I "googled" it and read up about it.) So, is it a law only in California, or do other states have similar codes?)

[tbostock]

Yes, hospitals should require that physicians obtain informed transfusion consent. It respects the patient's wishes, ensures that they understand all of the risks involved, and it also protects the hospital from litigation should there be an adverse reaction/event related to the transfusion. The Joint Commission also recommends this, and they are including it in their new Blood Management Performance Measures.

[L106]

Oh, I realize it is recommended (and why.) I was wondering if many states actually had a law that dictated that it must be done.

Donna

[tbostock]

Oops, sorry, Donna, I was answering the original post by Alongoria74, not responding to your post above mine...sorry for the confusion.

[L106]

No problem!

Donna

[carolyn swickard]

Yes - but how many hospitals can actually get their Dr's to do the counselling and sign the forms????? In our hospital, the whole explanation and counselling is falling on the RNs.

[clmergen]

This was a HUGE problem during my last AABB assessment. We had all the patient signatures but few of the doctors signatures. Sent this problem up through the Vice President of Medical Affairs. And then I promptly moved to the other coast of the USA so I have no idea if it has been resolved.

[ybunch]

To all,

I would like to know what others thinks in regards to having Drs sign consent form for transfusions. This question came about at a nursing directors meeting. My opinion is that the physicians should not be required to sign the consent form for transfusion being that they are placing the original order to transfuse. This initial order serves as consent from the physician. What's your opinion or practice on this topic? Thanks

Our physicians are required to sign the consent form as well as a witness. In fact, in our state statute they are the only ones that can do the informed blood consent, nurse practioners can not even sign this form. It is noteworthy though that just the form does not constitute informed blood consent. Informed blood consent is really the conversation the physician has with the patient as to risks, benefits and alternatives available. We also give the patient the risks listed by the aabb.

[Eoin]

Hi Folks,

Firstly we have a "Blood Transfusion Information Leaflet" spelling out risks, benefits and encouraging patients to ask questions when the physician (ideally, consultant - often Junior Doctors) come to consent them. By law, consent is required before transfusion can take place ( signed off on the Prescription and Transfusion Document and checked & countersigned by Nurse managing the transfusion).

In addition to the consent form, we also have a "Declaration against Transfusion" form for use with Jehovah Witness and others who specifically do not want to have a trasfusion.

Surgical consent also has a place for indication that transfusion may be required, and consultant will tick this if necessary. The big thing through it all is"INFORMED" consent.

Obviously I agree with all before me in saying that it is the patient who gives consent, after infformation by leaflet and conversation with the consultant of the pros and cons.

Cheers

Eoin

PS Obviously, this works well for planned planned transfusion of the patient with full faculties - different in the emergency situation.

Edited February 2, 2011 by Eoin
missed info

[John C. Staley]

I'm a little slow in my old age and re-read the original posting on this thread. :surrender

I think I understand the question now. I would think that whom ever counsels the patient on the transfusion would be required to co-sign the consent form with the patient. That may be the physician, the nurse, or whom ever is designated by the facility to perform this counseling.

[Dr. Pepper]

There is activity afoot in my hospital asking if nurses can obtain consent for transfusion. Does anyone know of any agency or regs that say it has to be a physician?

 

Thanks - Phil

Edited September 30, 2014 by Dr. Pepper

[tbostock]

The Joint Commission requires a physician, and our state (NY) Dept of Health recommends it.  Also it falls under the legal requirements for physicians for informed consent (medical staff practice).

 

There is no reg that the patient actually has to sign a piece of paper though.  Only that the physician has to discuss the risks, benefits, alternatives with the patient and the physician needs to attest in the medical record that this has taken place, he has allowed the patient time for questions, explained what could happen if they refuse, etc.

 

I doubt that all of that acually ever happens, but we do have physicians attest in the EMR that they have obtained informed consent.

[Dr. Pepper]

Terri, do you have the joint commission reference? Thanks!

 

Phil

[mollyredone]

Terri,

I'm interested in that as well. Our "consent is just two lines on the general consent form that patients fill out at admitting. I don't think that cuts it!

[Eagle Eye]

ANyone knows about the NJ regs? Is there a similar law in NJ?

[aafrin]

Our consent form is similar to others above and does require patient/patient's close relative's consent with the consultant's/housemen/registrar signature. It also has provision for patients to decline transfusion and for that reason(s) has to be mentioned. It also has provision for emergencies when a physician cannot obtain consent but deems transfusion life saving and so transfuses without consent. Here again reason(s) has to be mentioned.

[tbostock]

Very interesting: the JC reg is a little vague.  Here are a couple comments in an ASCP publication about consent and the JC.

 

To the Editor

In their interesting report, Friedman et al1 state that

“informed consent for blood transfusion is a requirement of

the Joint Commission.” This is not correct. The reference

they cite in support of this statment2 includes the comment

that “the final measures were recommended by the TAP

(Technical Advisory Panel) in November 2010 and submitted

to the National Quality Forum (NQF) for consideration of

endorsement in December 2010. Although not endorsed for

use at the national level, these measures are an excellent tool

for healthcare organizations that are interested in evaluating

processes around blood transfusions.” In other words,

although these measures may be useful, they are not Joint

Commission requirements. This is an important distinction

because hospital staff should understand that accreditation by

The Joint Commission is not jeopardized if the measures are

not implemented.

The Joint Commission does have an accreditation

standard (RI.01.03.01) that “the hospital honors the patient’s

right to give or withhold informed consent.” The hospital

is required to have a policy for informed consent, but this

standard does not specify that it applies to blood transfusion,

although this is certainly best practice. If a hospital has a

policy of obtaining informed consent for transfusion, or if

informed consent for blood is required by state law, The Joint

Commission would insist that the policy be followed.

Paul D. Mintz, MD

Division of Hematology

Office of Blood Research and Review

US Food and Drug Administration (FDA)

Rockville, MD

 

The Authors’ Reply

In his letter, Dr Mintz points out that informed consent

for transfusion is not a requirement for The Joint Commission

accreditation, a fact misstated in our article.1 We thank Dr

Mintz for this important clarification and further recognize

that implementation of the Patient Blood Management

Performance Measures2 is indeed not a requirement of

The Joint Commission but that hospitals may opt to use

the measures as a tool to evaluate processes around blood

transfusions, including transfusion consent. Nevertheless,

we maintain that The Joint Commission clearly encourages

and is supportive of transfusion consent even if it is not a

strict requirement. As noted by Dr Mintz, for hospitals that

do have a policy for obtaining transfusion consent, The Joint

Commission would insist that the policy be followed; we

believe that the majority of hospitals do have a policy in place

governing transfusion consent and as such are required to

follow the policy.

Mark T. Friedman, DO

Blood Bank and Transfusion Services

Continuum Health Partners

Beth Israel Medical Center

St Luke’s-Roosevelt Hospital Center

New York, NY

Norge Vergara, MD

Department of Pathology

Hospital of the University of Pennsylvania

Philadelphia, PA

[goodchild]

What kind of policy / documentation do your hospitals use for Jehovah's Witness patients?