by Susan Bator, MD, and Mary Bassalin, RN, Patient Blood Management Program
Informed consent for blood transfusion is required by The Joint Commission and other regulatory bodies. The essential components are the risks, expected benefits, and available alternatives to transfusion, including non-treatment. Ideally this discussion occurs prior to admission (although not possible in many instances), and is the responsibility of the provider ordering the transfusion. If the ordering provider is not available, another provider responsible for the patient’s care should lead this discussion.
The emphasis in informed consent should be on delivering an essential core content of information in a consistent and standardized fashion, tailored to the patient’s ability to understand. And while obtaining the patient’s signature is often the focus of informed consent, it is not informed consent in and of itself. It merely is a way of documenting that the informed consent process has occurred.
For patients refusing transfusion for religious, cultural or personal reasons, an advance directive that documents their refusal is indicated. This directive must make clear which transfusion alternatives are acceptable to the patient and the implications of adverse outcomes (i.e. possible organ injury or death) related to the refusal of blood as a life-saving intervention. However, we must keep in mind the directive may be revoked personally by the patient at any time.
In emergency situations where an immediate blood transfusion is necessary in preventing a patient’s death or permanent harm, and the patient is physically or mentally unable to give or refuse informed consent, blood or blood products may be administered at the discretion of the treating physician. Denial of permission to administer any blood products by competent adult patients should be honored; however, in cases of incompetent adult patients, the consent to administer blood or blood products should be addressed with decision-makers as for any other medical procedure. In the event a provider has medical/legal concerns, the hospital administrator on call should be contacted.
For patients with a recurring need for blood or blood products during a hospital admission, there is no need to have more than one consent form signed, unless the provider or patient indicates there has been a change in the information upon which the consent was based.
For outpatients having transfusions on a recurring basis, a new consent form should be signed at least every six months. Additionally, it is important to document the reason for the transfusion in Epic at the time the blood product is ordered. Here is a link to the Lancaster General policy regarding Consent for Blood Transfusion.