Download CC 75-010 Patient ID For Refusal Of Blood Components

INTERDISCIPLINARY CLINICAL MANUAL
Policy & Procedure
TITLE:
Section:
Source:
Distribution:
Patient Identification for Refusal
of Blood/Blood
Components/Products
Blood/Blood Products
All
NUMBER:
CC 75-010
Date Issued:
July 2007
Date To Be Reviewed:
Issuing Authority:
July 2010
Heather Francis
Health Services
Director
POLICY
1. Capital Health respects a person’s autonomy in making important decisions about his or her own
health care and treatment. This includes active respect for the right of adult patients who have
capacity to refuse transfusion of blood components/products when these are clinically indicated.
2. The attending physician (Surgery, Medicine, and Anesthesia) is to document the patient's refusal
to blood components/products in the appropriate medical record and obtain the signature on the
Refusal of Blood Transfusion - Risk Management (CD0738MR).
3. Patients refusing blood components/products are to wear a “No Blood” armband and the health
record is to be labeled indicating blood refusal.
4. A patient’s “No blood” status is to be reviewed on each care encounter (inpatient and outpatient)
as required and the patient’s wishes are to be documented in the health record and/or the
electronic medical record once a healthcare provider identifies the patient.
5. If a healthcare provider removes the “No Blood” armband for the purposes of facilitating
treatment or therapy, or notes that the band is absent or incorrect, that healthcare provider is to
ensure that a new “No Blood” armband is placed on the patient as soon as is possible.
6. ABO Type and Antibody screen and/or Group and Cross match will not be drawn on patients
who are identified as refusing all blood components/products. If patient agrees to accept blood
components, a Type and screen will be drawn.
7. Blood components/products will not be administered to a patient who:
7.1. is wearing a “No Blood” armband
7.2. has given informed consent to refusal of blood components/products, except as is consistent
with the patient’s expressed wishes
Patient Identification for
Refusal of Blood/Blood
Components/Products
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7.3. has indicated on a legally valid advance directive that blood components/products is not to
be given
7.4. signed the Refusal of Blood Transfusion form.
GUIDING PRINCIPLES
1. The wearing of “No Blood” armbands is strongly encouraged but not required. If the patient’s
health condition precludes application of the armband to one of the patient’s upper extremities,
the armband can be attached to another visible part of the patient’s body using tape appropriate
to the patient’s condition/allergies. See Patient Identification and Same Name Alert CH 70-040.
DEFINITIONS
Blood Component:
A therapeutic component of blood intended for transfusion (e.g., red cells,
granulocytes, platelets, plasma, cryoprecipitate, cyrosupernatant plasma) that
can be prepared using the equipment and techniques available in a blood
centre.2
Blood Product:
Any therapeutic product derived from human blood or plasma, and produced
by a manufacturing process that pools multiple units (usually more than 12)
e.g. human serum albumin, immunoglobulin preparations, and coagulation
products(factors VIII and IX, fibrinogen, anti-thrombin III, etc.).2
Advance Directive:
A document in which a capable person sets out what, how or by whom health
care decisions are to be made in the event that he or she is not capable of
making health care decision on his /her own. Two types of advance
directives are instruction directives and proxy directives:
• Instruction directives- a directive in which the maker specifies what
type of health care and treatment he or she wishes to receive or not
receive.
• Proxy directive- a document (sometimes referred to as an “enduring”
or “durable” power of attorney for health care decisions) in which a
capable person of 19 years or older names a proxy to make health care
decisions for him/her in the event that he or she is not capable of
making those decisions on his/her own. Proxy directives must be in
writing, must be dated and signed by the maker; and must be
witnessed by someone other than the proxy or the proxy’s spouse.
Substitute Decision
Maker:
A person who has legal authority and willingness to make health care
decisions for the patient when the patient does not have the capacity to
make his/her own decisions in the following order of priority:
• A person named as a proxy in an advance directive or in a medical
power of attorney;
• the patient's court-appointed guardian;
Patient Identification for
Refusal of Blood/Blood
Components/Products
CC 75-010
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Interdisciplinary Clinical Manual
•
the spouse or common law partner who is cohabitating with the patient
in a conjugal relationship; for a common law partner, this relationship
must have been of at least two years duration;
• an adult child of the patient;
• a parent or a person who stands in loco parentis;
• an adult brother or sister of the patient;
• another adult next-of-kin; and
• the Public Trustee
Other than a proxy, medical power of attorney, guardian and the Public
Trustee, the substitute decision maker must have been in personal contact
with the patient over the preceding twelve months.
Capacity:
A capable patient must be able to understand: the condition for which the
treatment is proposed; the nature and purpose of the treatment; the risks
involved in undergoing the treatment; and the risks involved in not
undergoing the treatment. Any assessment of capacity includes a
determination as to whether or not the patient’s ability to consent or dissent
is affected by his/her medical condition(s). A person is presumed to be
capable unless assessed as being incapable by an attending physician, in
consultation with a psychiatrist as necessary, or deemed to be incapable by
the court under the provisions of the Guardianship Act or the Incompetent
Persons Act. Where a patient’s capacity is difficult to assess, or is not agreed
upon by those providing health care to the patient or the family of the patient,
or there is dispute as to who has the right to make substituted health care
decisions for the patient, a psychiatrist’s assessment as to the patient’s
capacity is required.
Healthcare
Provider:
A healthcare provider is a medical or allied health professional who offers
services for the prevention, treatment, and management of illness and the
preservation of mental and physical well-being.4
Invasive
Procedure:
An invasive procedure is defined as any procedure excluding venipuncture
and IV therapy which involves puncture or incision of the skin or insertion of
an instrument or foreign material into the body, including, but not limited to,
percutaneous aspirations and biopsies, cardiac and vascular catheterizations,
internal laser procedures, endoscopies, angioplasties, and implantations. 4
Treatment:
The application of medical care to cure diseases, heals injuries, or ease
symptoms.4
Extracorporeal
Circulation:
Diversion of blood flow through a circuit located outside the body but
continuous with the bodily circulation.5
Patient Identification for
Refusal of Blood/Blood
Components/Products
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EQUIPMENT
1.
2.
3.
4.
5.
6.
7.
“No Blood” Armbands (S6058954)
“No Blood” stickers for spine (S1020991)
“No Blood” stickers for front of patient’s health record (S1020993)
Refusal of Blood Transfusion - Risk Management (CD0738MR).
PeriOperative Assessment/Observations (CD0128MR)
Notification of Refusal of Blood Components/Products form (CD1298MR)
Preoperative Checklist Record (CD0608MR)
PROCEDURE
General
1. Capable patient or substitute decision maker indicates refusal to receive blood
components/products.
2. At the time of admission, the healthcare provider documents the patient’s refusal to blood
components/products in the progress notes of the patient’s health record, including where the
healthcare provider has confirmed through an informed consent process that the patient’s wishes
about blood transfusion have not changed.
3. The attending physician or resident provides information to ensure the patient has made an
informed choice about the refusal of blood components/products.
3.1. The physician documents the patient's refusal to accept blood components/products in the
health record and obtains the patient’s or substitute decision-maker’s (SDM) signature on
the Refusal of Blood Transfusion - Risk Management (CD0738MR). The physician
contacts the proxy decision maker if one has been identified.
4. The health care provider:
4.1. Places a copy of an advance directive – if the patient has one - on the patient’s health record.
4.2. At the time of admission to hospital, places the “No Blood” armband on any patient who has
been identified as refusing blood components/products.
Exception: In situations where the healthcare provider deems it inappropriate from a clinical
perspective to identify the patient through the use of an armband, place the armband on the
patient’s health record.
4.3. Places a “No Blood” sticker on both the front and spine of patient's health record upon
admission for any patient who has been identified as refusing blood components/products.
4.4. Notifies the Perioperative Blood Management program (PBMP) when a patient is identified
as refusing blood components/products. Fax the Notification of Refusal of Blood
Components/Products form (CD1298MR) {includes patient’s name, medical record
number (MRN), attending physician, today’s date, nurse signature, and patient unit}to 4735804 (PBMP).
Patient Identification for
Refusal of Blood/Blood
Components/Products
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5. The Registered Nurse documents refusal of blood components/products on the Preoperative
Checklist Record (CD0608MR).
6. Any healthcare provider with questions as to whether human products are in certain drugs
prescribed, may call pharmacy or BTS for clarification e.g. IV products that are immune
globulins, vaccines or produced by recombinant DNA technology.
Revocation of Refusal to Accept Blood Components/Products
1. Where a patient (or their SDM) indicates to a healthcare provider a wish to change a “No Blood”
designation, the healthcare provider advises the patient’s attending physician of the patient’s
desired change.
1.1. The treating physician ensures that the patient is giving informed consent to receive blood
components/products.
1.2.The treating physician or healthcare provider notes the withdrawal of the refusal on the
patient’s Refusal of Blood Transfusion - Risk Management (CD0738MR) and has the
patient sign the withdrawal.
1.3. The treating physician or healthcare provider ensures that the change is noted in the patient’s
health record, that the “No Blood” stickers are removed and the “No Blood” armband is
removed.
2. Notify the PBMP at 473-3117 if a patient consents to change their “No Blood” designation or if
further information is required.
Perioperative Services
1. Follow the General procedures as applicable.
1.1. The Registered Nurse documents refusal of blood components/products on the PeriOperative
Assessment/Observations (CD0128MR) form.
1.2. If the “No Blood” identification band is removed, the healthcare provider places it in a clear
plastic bag with the patient label on the front of the patient’s health record.
1.3. The Registered Nurse or delegate replaces the “No Blood” armband on admission to Post
Anesthesia Care Unit (PACU) and Intensive Care Unit (ICU),
RELATED CAPITAL HEALTH DOCUMENTS
Policies
Blood/Blood Product Transfusions CC 75-005
Patient Identification and Same Name Alert CH 70-040
Advance Directives CC 90-005
Forms
Refusal of Blood Transfusion - Risk Management (CD0738MR).
Preoperative Checklist Record (CD0608MR)
Patient Identification for
Refusal of Blood/Blood
Components/Products
CC 75-010
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Interdisciplinary Clinical Manual
PeriOperative Assessment/Observations (CD0128MR)
Notification of Refusal of Blood Components/Products form (CD1298MR)
REFERENCES
Shander, A., Rijhwani, T.S., Bloodless medicine and surgery: one arm of blood management.
Current reviews in clinical anesthesia. Lesson 19, vol. 25 April 21, 2005.
Canadian Standards Association (2004). CSA Standard Z902-04 Blood and blood components.
Mississauga: ON.
Web References:
1. http://cdhaintra/departmentservices/riskmanagement/Advance%20Directives.doc last
accessed April 5, 2006
2. http://www.dictionary.com last accessed April 5, 2006
3. http://medical-dictionary.com/dictionaryresults.php last accessed April 5, 2006
HISTORICAL DATES
New – July 2007
Armband
Identification
Blood
Patient Identification for
Refusal of Blood/Blood
Components/Products
CC 75-010
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