We began our PICC line program in December. When we first started we were using the general surgical consent, writting in PICC line insertion in the blank and then writing the name of the nurse who was inserting it. Risk management started working on a consent. I went to a meeting and we all thought is was good. Just need a few minor changes. Next thing I know the steering commitee along with risk management has decided that we do not need a consent. The consenus was that it is covered in the general consent for treatment for the hospital to treat just as blood draws, ABG's, regular IV starts and etc. So now we just explain the procedure to the patient or the family. We then just document in our notes that we explained the procedure to the pt and/or family and they agreed to have the line inserted. Â
Does anyone have any input on this subject?
Rhonda Wojtas, RN
Massachusetts
Ann Zonderman, BSN, JD, CRNI, LHRM
I wonder if the risk manager realizes the greater potential for adverse effects/ outcomes related to a PICC vs a PIV... while documenting the facts / risks - benefits and opportunity to meet JCAHO criteria for informed consent is one way to go....be sure you have a document (even a check sheet) that does fully inform the patient of all and that they have had the right to ask questions and also to accept or refuse placement.
Not doing a formal doucment may fly if you at least do document that you have done all the above = with out such documentation - the facility will be open to liability for failing to provide sufficient info to allow the patient to make a valid decision.
7million dollars - for the plaintiff McGary vs Memorial Hospital, Ormand Beach Florida.... bad PIC outcome also included lack of informed consent. See JAVA last spring by Nancy Moureau and myself...
CYA is always reasonable .... Maybe some other folks who dont use a consent can comment on how the decision was made and how it is working out. ..A
Ann Zonderman, BSN, JD, CRNI
Ann,
I wholeheartedly agree with you and I developed a PICC consent for my nurses to use years ago. Now I am having problems with physicians, particularly in ICU, telling the staff when we are having problems getting family to sign the consents, writing orders "have PICC nurse place PICC without consent". The ICU staff thinks we should do it and the PICC nurses are put in a bind. I tell them to stand strong with their convictions, it is not that doc that will go to court with them if something goes wrong. Any suggestions? He also writes orders such as PICC is emergent when our policy clearly states there is no such thing. I feel if he wants a central line so badly on that patient, he can put one in.
Thanks
Patty
There is a simple way to handle this situation. Does your hospital policy require an informed consent? If this is written as a policy statement, these are considered non-modifiable and non-negotiable. So there is no way that this order would be consider to be legal. Anything written as a policy statement can not be altered by anyone. It must be changed through the proper channels of all the various committees. This is one of the primary things that JCAHO looks for - following policies. It is also the main reason why every aspect should not and can not be written as a policy. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Ann Zonderman, BSN, JD, CRNI, LHRM
I would agree that your nurses should not proceed when a doc says place the line without consent - if consent is indeed your policy. Some places have a patient teaching tool describing all the PICC info - given to the patient, allowed to review, allow to ask questions and then you can document that process. This comports with an opportunity described as the process to obtain informed consent. If the patient / authorized alternative can't review this info then you are in the same place - not having valid consent..
Perhaps the higher powers, i.e., nursing director, RM, and medical director should be in the discussion. - Medical review board at you facility too?? Doctors should have some respect for the nursing process and standards / rules by which we are licensed to practice.
As the nurses and their licenses are on the hot seat if the event of an adverse outcome, a physician asking to breach policy and your standard is definitely compromising your practice.
Ann
Ann Zonderman, BSN, JD, CRNI
Ann,
Thank you for your feedback. I don't necessarily agree that we don't need consent but I don't have anything to say otherwise. I think I would acctually prefer to get a consent. I am not sure I can access the JAVA back that far as I just joined but I will try. I would very much appreciate a link to the article or copy if not too much trouble.
Thank you.
Rhonda Wojtas, RN
Rhonda Wojtas, RN,BSN, VA-BC
It is important to remember that the informed consent process is much more than getting a signature on a piece of paper. The person performing the procedure is responsible for explaining it and answering all questions as well as providing information about alternatives. If you have documented this process the signature on a piece of paper is the last thing that I would go to battle over. I agree with Ann that a checklist process is great for this purpose. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Lynn,
Thank you for your reply.We have electronic medical records. We have a specific form for cental line insertion. It is all a check off or fill in the boxes type of form. I have talked to the IS department about adding in a check box that the procedure was explained to pt and/or family and they verbalize understanding of the procedure and agree to procedure. It is quite a process to add it in to the system and it is on the bottom of the list of things to do. Right now I am adding it as a comment. It does all appear on the document.
Rhonda Wojtas, RN
Rhonda Wojtas, RN,BSN, VA-BC
As the nurse doing the procedure, you have more knowledge about it, the outcomes, alternatives, and risks. So you must be responsible for educating the patient and gaining their consent for the procedure. This is true for anything we do whether it is putting in a PICC, starting a peripheral IV or giving a medication. This is just part of our practice. The issue is about the signature on a piece of paper, which is a small component of the process. Some have decided that a separate piece of paper for PICC insertion is not necessary while other still use them. This is a risk management decision. But as the inserter, you will always be responsible for making sure that the patient totally understands what is happening. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861