Transcript Document
Implementation of Informed Consent for Transfusion and Written Patient Notification Eckert K, Berta D, Leigh K, Barr RM, Komar W. London Health Sciences Centre (LHSC) and St Joseph’s Health Care (SJHC), London ONTARIO CSTM Standards for Transfusion Medicine (H2.02) CSTM Standards for Transfusion Medicine (H2.02) 6th 6th Edition (1999) • A mechanism shall be in place to ensure that patients are appropriately informed before receiving blood products. CSA Standards on Blood and Blood Components (11.2.1) Draft CSTM Best Practice Guidelines for Hospital Transfusion Services (L1.4) • A mechanism shall be in place to notify patients that they have received blood products CSA Standards on Blood and Blood Components (11.2.2) Draft Z902N4e (Mar 2002) Draft Z902N4e (Mar 2002) • There shall be a written policy concerning the process of obtaining informed consent of the recipient prior to receipt of whole blood and blood components. Information to the recipient shall include: a. a description of the whole blood or blood component b. the associated risks and benefits, including life-threatening risks c. alternatives, if appropriate to clinical circumstances, including benefits and risks. LHSC Consent to Treatment Policy • No treatment shall be administered by any health care provider unless an informed consent has been given by the patient (if the patient is capable with respect to the treatment) or the patient’s Substitute Decision Maker (SDM) (if the patient is incapable with respect to the treatment). • It is the responsibility of the Health Practitioner proposing and/or performing the treatment to obtain and document informed consent for that treatment. • The Health Practitioner obtaining consent must have the knowledge, skill, and judgment to determine the patient’s capacity to give informed consent and to provide information to enable the patient/SDM to give informed consent. • This information must include: – the nature of the treatment, – expected benefits, risks and side effects, – alternative courses of action and likely consequences of not having the treatment. • The Health Practitioner must also be able to answer questions that the patient/SDM may have. • A policy shall be established to ensure that patients are appropriately informed before receiving blood including information on: a. the blood product b. transfusion risks and benefits c. clinically appropriate alternatives to transfusion, including benefits and risks • The policy shall describe the process of obtaining recipient informed consent including the opportunity for recipients to ask questions and receive satisfactory answers LHSC Consent for Transfusion of Blood and/or Blood Products Policy • As per Appendix D of the LHSC Consent to Treatment Policy, written informed consent is required for patients receiving, or likely to receive blood and/or products. This includes but is not limited to ALL patients requiring Group and Reserve/Crossmatch • Blood and blood products include but are not limited to red blood cells, plasma, platelets, albumin, factor concentrates, immune globulins • Health Practitioner proposing the transfusion or proposing the treatment that may result in the need for blood transfusion must hold a discussion with the patient/SDM including time to answer any questions • Discussion must explain: – The nature and expected benefits of the transfusion – The risks and side effects of transfusion – Any alternatives available to the patient and their potential benefits, risks and side effects – Consequences of NOT receiving a transfusion • Documentation entails completing the appropriate forms (Consent or Refusal/Consent with Restrictions) and should also include notation on the patient’s health record Edition (1999) • There shall be written notification of transfusion for all recipients receiving whole blood and blood components. Draft CSTM Best Practice Guidelines for Hospital Transfusion Services (L1.5) • Special Acknowledgements: Linda Petkovic: Web design Linda Thomson: Poster design CSA Standards on Blood and Blood Components (11.2.3) Draft Z902N4e (Mar 2002) • There shall be a mechanism in place to ensure that current information concerning risks associated with transfusion is communicated to the physicians and nurses in the facility. Draft CSTM Best Practice Guidelines for Hospital Transfusion Services (L1.6) • Information shall be communicated to healthcare professionals who participate in any component the transfusion process within the healthcare facility related to current risks of transfusion and prescribing and administration practice(s). • All recipients of blood components shall be notified in writing of the transfusion. LHSC/SJHC Patient Notification of Transfusion Policy • Patients who have received blood and/or blood products will receive written notification at the end of each calendar month. Deceased patients do not receive notification • The Blood Transfusion Laboratory computer database is cross-referenced with the Medical Records database. • Letters are mailed to the patient’s home address (NO letter sent) • Bloody Easy: A Guide to Transfusion Medicine” distributed to physicians, nursing educators and clinical areas • Inservices were available to all staff on consent implementation including transfusion benefits, risks and alternatives • Hematologists, Transfusion Safety Officer and Nurse Coordinator available as resources to Medical, Nursing and Laboratory staff • Printed patient information brochures available to be distributed • Letter informs the patient of: –Date of transfusion –Type of product received –Unit or lot number of product Exception LHSC/SJHC Communication Strategies • Internet web site with links to patient and physician information at www.lhsc.on.ca/lab/bldbank/index.htm Reason for Exception Patients receiving ONLY Rh Immune Globulin (RhIg) • Unique consent process • Patient receives a copy of the consent form • Respects the confidentiality of patients receiving RhIg following abortion Patients receiving ONLY Intravenous Immune Globulin (IVIG) • Receive monthly infusions of IVIG • Patients are well informed of their infusion of IVIG Patients receiving ONLY Factor VIII and Factor IX • Well informed patient population • Most FVIII and FIX are recombinant products with little or no blood component